Endometriosis is a condition in which tissue similar to the cells of the lining of the uterus
(endometrium) grows in other areas of the body_ This abnormal growth can cause pelvic
pain, irregular bleeding, and infertility. The most commonly affected areas are the
ovaries, bowel, or the lining of the pelvis.
Just like normal cells of the lining of the uterus, endometriosis implants are stimulated
by estrogen (the principal female sex hormone). This stimulation produces thickening
and a small amount of bleeding inside the pelvis. Chronic inflammation produced by
these changes can cause pain and scar tissue in the internal pelvic organs. Typically,
pain related with endometriosis is worse during the period. Pain can also be present
with intercourse, bowel movements, or urination.
To diagnose endometriosis your doctor will ask you to describe the symptoms, including
the location of the pain and when it occurs. This will be followed by a pelvic exam on
which the doctor will palpate the pelvic organs and will identify the areas that are tender. In most cases, the lesions of endometriosis are small and therefore cannot be palpated. A vaginal ultrasound is another way in which your doctor can evaluate the reproductive organs. It will not definitively diagnose endometriosis, but it can identify cysts associated with endometriosis (endometriomas).
The diagnosis of endometriosis can only be certain after a laparoscopy. During this
surgery the surgeon insufflates the abdomen with carbon dioxide and then introduces a
camera (laparoscope) through a small incision in the navel. By moving the laparoscope
your doctor can visualize the uterus, ovaries, fallopian tubes, bowel, and lining of the
pelvis and look for signs of endometrial tissue outside the uterus.
o Non-steroidal anti-inflammatory drugs: Medications like Advil, Aleve, and
Ibuprofen may be recommended. This group of medications is more effective
when taken at the first sign of the period or pain.
o Hormonal contraception (birth control pills): Normal fluctuations in the
hormone levels during the menstrual cycle causes endometrial implants to
thicken, break down and bleed. Birth control pills work by limiting the growth of
the endometrial cells by eliminating the rise and fall of hormones during the
o Depo Provera: This injectable medication can stop menstruation and decrease
the growth of endometriosis.
o Gonadotropin-releasing hormone agonist and antagonist: These drugs block
the production of ovarian stimulating hormones that are produced in the pituitary.
By stopping the stimulation to the ovaries the production of estrogen is greatly
reduced. Lower estrogen levels can cause endometrial implants to shrink. These
hormones mimic menopause and therefore common side effects include hot flashes,
mood-swings insomnia, and vaginal dryness.
o Regular exercise produces chemicals that may block the pain. For some patients
a regular exercise regimen, especially around their menstrual period may
decrease the symptoms.
o Heat: a warm bath or a heating pad on the abdominal/pelvic area.
o Relaxation, yoga, acupuncture: These techniques can help some patients cope
with the pain.
When treatment with medications is not effective, the next step in management is
surgery. The definitive surgical management is a total hysterectomy during which the
uterus and ovaries are removed. Such surgery will cause menopause and therefore
eliminate the production of estrogen by the ovaries. The absence of estrogen will
eliminate the stimulation of the endometriosis implants and permanently treat
endometriosis. This type of surgery is the last resort and is not an option in younger
patients who want to become pregnant.
Another option is conservative surgery during which the endometrial tissue that is
growing outside the uterus can be removed or destroyed. This tissue may return after
surgery, but removing it may reduce pain for a significant period of time.
An endometrial biopsy is a procedure performed in our office to obtain a sample of the
lining of your uterus (endometrium). Your practitioner may suggest an endometrial
biopsy to assess the following:
o Abnormal uterine bleeding
o Bleeding after menopause
o Results of Pap smears
Preparing for an endometrial biopsy
Anesthesia is not needed for this procedure. It is suggested that you take Ibuprofen
600-800 mg as recommended by your provider prior to your appointment to relieve
cramping associated with the procedure, as long as you are not allergic to it or to
During the procedure
The entire procedure takes only a few minutes. You will lie on the exam table with your
feet in the stirrups. Your practitioner will place a speculum in your vagina and will apply
an antiseptic solution to your cervix, He or she will insert a tiny straw-like tube through
the cervical opening into the uterine cavity. Using the tube, the doctor will take a sample of cells from the inner layer of the uterine wall. During the procedure you may
experience menstrual-like cramping.
After the procedure
After the procedure it is normal to experience some cramping and bleeding from the
biopsy. Expect spotting for one to two days after the biopsy. If necessary, you can take
an over-the-counter pain reliever like Ibuprofen 600-800 mg or Aleve 200 mg to control
discomfort, as long as you are not allergic to these products or to aspirin. The biopsy
sample wilt be sent to a lab for further analysis. We will discuss your results with you at
a follow-up appointment or during a follow-up phone can. Avoid sexual relations and
tampon use for twenty four hours after the biopsy.
Risks associated with this procedure
As with all procedures) there are some risks involved, With an endometrial biopsy,
serious complications are extremely rare. Risks can include:
o Severe bleeding from the biopsy site
o uterine injury/perforation
o Inability to complete the procedure