According to the Mayo Clinic, Endometriosis “is an often painful disorder in which tissue that normally lines the insides of your uterus—the endometrium—grows outside your uterus.” In a 2009 in-depth report on infertility in women, the New York Times reports that “endometriosis may account for as many as 30 percent of infertility cases.” Infertility, as a result of endometriosis, can be caused by endometrial lining growth in the fallopian tubes, blocking an egg’s path; growth in the ovaries, which can cause complications in the release of an egg.
Columbia University’s Medical Center in New York City works closely with Cornell University in Ithaca, New York, as the NewYork-Presbyterian University Hospital, where they have found that there are “several theories as to the cause of endometriosis, but none has been established with certainty.” New York University Langone’s Medical Center has an Endometriosis Center, where they specialize in the research and treatment of endometriosis. NYU Langone estimates that “six percent to 10 percent of women of childbearing age have endometriosis.” The endometrium in a woman’s uterus swells and thickens during a menstrual cycle in preparation for the possibility of pregnancy. However, if no pregnancy occurs, the endometrium exits the body during menstruation. Due to endometriosis, endometrial cells coagulate outside of the uterus and “attach to other organs in the body, where they grow into nodules called ‘implants,’” according to NYU Langone’s diagnosis information on endometriosis. Most often, endometriosis implants take form on the ovaries, fallopian tubes, cul-de-sac, and outer lining of the uterus. Less commonly, implants can form on the lower regions of the large intestine, bladder, and rectum. NYU Langone identifies possible, though still uncertain risk factors as: first menstruation at age 11 or younger and hereditary factors. They also mention that “not having been pregnant is also linked with a higher risk.” However, once a woman reaches menopause, ending menstruation, endometriosis will improve.
Endometriosis can be diagnosed in a variety of ways. Ultrasounds are the easiest and most comprehensive way for a medical professional to detect any structural abnormalities in a woman’s pelvic region, using a series of high-frequency sound waves that ricochet off of surfaces within the body, creating live images. More likely, however, a doctor will first perform a pelvic exam, where a doctor palpates “areas in your pelvis for abnormalities, such as cysts on your reproductive organs or scars behind your uterus,” according to the Mayo Clinic. Pelvic exams are not as reliable in the detection of endometriosis, unless the disease has advanced and formed cysts within the pelvis region. Another method is laparoscopy, which is similar to the laparoscopic surgeries that are used to treat endometriosis. Laparoscopy involves a small incision, usually at the navel, and the insertion of a long, thin tube with a telescopic lens that allows a doctor to visualize the interior of a woman’s pelvis.
Symptoms of endometriosis are expressed primarily during menstruation, or leading up to menstruation. They are shown as pelvic pain “before or during menstruation, with urination or bowel movements” and during sexual intercourse, according to NYU Langone. The severity of endometriosis will not impact the severity of the symptoms. Treatments for endometriosis, as recommended by Langone, begin with birth control pills. A Langone doctor may recommend either oral contraceptives or an injection, such as the synthetic progesterone medication, Depo-Provera®. The synthetic hormone is medroxyprogesterone, meant to treat the pain associated with endometriosis by thinning the uterine lining and shrinking implants. Another medication at Langone is Lupron Depot®, which must be prescribed by and administered at a medical facility every six months. This medication “suppresses hormonal signals from the pituitary gland in the brain to the ovaries, thereby curbing estrogen production and putting the body into temporary menopause,” according to the NYC based medical facility. Lupron Depot® treatments may put endometriosis symptoms in remission for an elongated period of time.
The New York Endometriosis Center (NY EC), based out of New York City and Greenwich, Connecticut, is a leader in the surgical treatments of endometriosis. Among their staff is Dr. Kanayama, a highly awarded specialist in endometriosis treatment and surgery, having been awarded placement on America’s Top Obstetricians and Gynecologists list in 2004, 2005, and 2007 after training and residency at the Mayo Clinic. Another acclaimed NY endometriosis specialist is Dr. Tamer Seckin, who specializes in gynecology and laparoscopic surgery. Dr. Seckin focuses his work on minimally invasive advance laparoscopy. He was granted the Ellis Island Medal of Honor in 2012, having founded the Endometriosis Foundation of America in 2009.
While laparoscopic surgery is a highly advanced method of endometriosis treatment, another avenue of surgical treatment is endometriosis excision surgery. This surgery aims to remove endometriosis implants with the goal of alleviating pain, increasing fertility, and removing the physical cause of inflammation and endometriosis, the implants. Rather than burning the accessible portions of an implant, as with laser surgery, excision surgery digs into the roots of the inflammatory tissue and allowing the surgeon to see the mass in order to effectively remove it and alleviate pressure on organs that the implants have attached themselves to. This also increases the functionality of those organs. Excision surgery has also been used in cancerous cases. However, if endometriosis is advanced enough, “where pelvic architecture is deformed, and organs are fused with various degrees of adhesions, the difficult of the excision surgery can be more complicated than most cancer surgeries,” according to Dr. Seckin’s explanation of excision surgery. In cases such as these, a surgeon must suture any injured organs and reconstruct them where necessary, after removing the lesions.
Laparoscopy is different from excision in that the pelvic cavity is seen through a telescopic lens (the laparoscope), a 5 mm long tube that is inserted after carbon dioxide is “injected into the abdomen. This colorless, odorless gas swells the cavity, lifting and separating the organs to allow the laparoscope to be safely inserted,” according to Seckel’s explanation of laparoscopy. This direct line of sight to the state of the pelvic region allows a surgeon to understand the extent of an endometriosis case, while remaining minimally invasive.
Here are some helpful links on endometriosis: