RMSCVA is the regional referral center for endometriosis surgery and especially when a woman intends to get pregnant. We have specialized training and extensive experience with endometriosis.
Endometriosis describes the presence of endometrial tissue (the uterine lining) outside of the uterus. Usually this tissue stays in the pelvis but in some cases it can be found outside the pelvic cavity. The actual incidence of endometriosis is uncertain, but it is estimated at two to five percent of the general female population. There is a familial predisposition and women who have a mother or sister with endometriosis have as much as tenfold increased risk of getting it themselves.
The most common symptoms of endometriosis are significant pain around menstrual flow, painful intercourse, and difficulty getting pregnant. There are a number of theories about why endometriosis occurs but the most commonly accepted explanation is called “retrograde menstruation.” In this theory, menstrual flow not only comes down through the cervix and out the vagina during the menstrual period as it is supposed to do but also goes the opposite direction, up through the fallopian tubes and out into the pelvis. Some of the fragments of endometrial lining implant on the surface of pelvic organs such as the ovaries, bladder, or external surface of the fallopian tubes and continue to grow, resulting in endometriosis. As one of my patients said, “It’s when the lining of the uterus grows in the wrong place.”
These abnormally placed endometrial fragments respond to the hormones produced by the ovaries just like the normal endometrium inside the uterus. Because of this, endometriosis and normal endometrium undergo similar growth and bleeding phases during the cycle. The body’s defenses recognize the presence of endometriosis as abnormal and attack the tissue, resulting in local inflammation and scarring. Because the endometriosis is usually on or close to the ovaries and Fallopian tubes, it is thought that the inflammation can interfere with the ability of the sperm to fertilize the egg and the inflammation damages eggs and sperm but more research is necessary. In more severe cases, the inflammation and scarring can damage reproductive organs, or the scar tissue can envelop the ovaries or tubes, effectively forming a barrier between the sperm and egg.