Endometriosis FAQ

By: Robert Hunt, MD

Dr. Hunt is a Clinical Professor at Harvard Medical School, who practices at New England Baptist Hospital in Boston. Dr Hunt is Editor-in-Chief of The Journal of the American Association of Gynecologic Laparoscopists and past president of the same organization.

Q: What is endometriosis?
A: Endometriosis is normal tissue (similar to endometrium that lines the uterus) in the wrong place. Common sites of involvement are: ovaries; space behind the uterus (cul-de-cac, rectum, uterosacral ligaments); and urinary bladder. Endometriosis is usually confined to the pelvis.

Q: What causes endometriosis?
A: Research has shown that many women with endometriosis appear to have a defect in their immune system. Other causative factors may be spillage of menstrual blood into the pelvis through open fallopian tubes; movement of endometrial cells throughout the pelvis (and even outside of the pelvis) through blood and lymphatic systems; and the ability of certain cells to change into endometrial cells, hence endometriosis.

Q:Does endometriosis cause infertility?
A: Endometriosis has been identified as a major cause of infertility. However, endometriosis does not mean that a woman will have trouble conceiving especially if the disease is mild. Some women with endometriosis conceive without removal of the disease. Moderate to severe disease associated with scar tissue and ovarian cysts (endometriomas) are more likely to result in infertility and therefore may require treatment.

Q:Will depot Lupron and other hormonal treatments destroy endometriosis?
A: No. Hormonal treatment can be useful in some situations, such as temporary controlling pain or preparing a woman for surgery, but it does not remove the disease. In my opinion, endometriosis in general is managed most effectively with properly performed surgery. However, hormonal treatments (oral contraceptives or Lupron) together with anti-inflammatory medications are often tried first to determine response to medical treatment especially when treating pain.

Q:"I have been diagnosed as having endometriosis. Do I have a greater chance of developing ovarian cancer?"
A: No. Endometriosis is not thought to be associated with increased risk of ovarian cancer.

Q: "I have been diagnosed as having advanced endometriosis. Will I need a hysterectomy?
A: Usually not. In cases of infertility, it would definitely not be recommended. For treatment of pelvic pain, a maximal surgical effort in conjunction with medical and other treatments will often prevent the need for hysterectomy. Whereas the disease may not be "curable", it is usually controllable.

Q: "I am 32 years of age and have been trying to conceive 2 years. I have been diagnosed as having advanced endometriosis. I have never been pregnant, and my partner's sperm count is excellent. Should I be optimistic that I will conceive?"
A: Absolutely! Studies have shown that properly performed surgery will yield a pregnancy rate of about 60% in young women who have tried to conceive for less than 3 years and whose partner's have satisfactory sperm counts. If surgery is not successful in achieving pregnancy, controlled ovarian hyperstimulation with or without intrauterine insemination may be indicated. If the above treatments fail, IVF may be indicated.

Q:Should ovarian endometriomas be removed before IVF cycles?
A:Ovarian cysts less than 3 cm in diameter are generally not removed unless associated with pain. Ovarian cysts greater than 3 cm may have a negative effect on the IVF cycle and are recommended for removal prior to the IVF cycle in many centers.

Q:"I have advanced pelvic endometriosis and severe pelvic pain. I am 28 years of age. What chances do I have of pain relief after resection of endometriosis?"
A: My experience has been that approximately 50% of patients experience major pain relief, 30% have adequate improvement, and the final 20% are not improved. Often this latter group have additional problems, such as spastic bowel.

Q: "What is a maximal surgical effort?"
A: I believe that endometriosis should be removed with its roots. So-called ablation by laser, electrocautery, or other techniques often results in just treating the top of the endometrial implant, leaving the roots in place. Symptoms are sure to return within months after surgery in these cases. If the implants are excised, a symptom free interval of a few years is likely.

Q:What about holistic treatments?
A: Diet, massage therapy, acupuncture, and a variety of other holistic approaches have been used in endometriosis patients with varying degrees of success. I believe that alternative approaches are very useful in dealing with pelvic pain associated with endometriosis. There is no compelling evidence to suggest that such alternative treatments improve infertility associated with endometriosis. The Endometriosis Association has been very helpful in this area of management. (414-355-2200)