Endo is a pain

There are few entities in reproductive medicine as puzzling and frustrating as endometriosis. It can grow silently for many years and then present as an emergency visit to the hospital when the chocolate looking fluid begins to leak out of an endometrioma. I have seen minimal endometriosis in patients with terrible pelvic pain and severe endometriosis in patients in whom I expected a laparoscopy to be completely normal.

So let's start with some basics about endometriosis and its diagnosis. Here is the "Question of the Day" from 100 Questions and Answers about Infertility...the book that will sell itself as long as Dr DiMattina and I get invited on Oprah!


36. What is endometriosis and how is it diagnosed?


Endometriosis is the presence of endometrial-like tissue located outside of the uterine cavity. Most commonly, it is located on the ovaries, but it can also be found on any of the organs inside the pelvic–abdominal cavities. Although its etiology is unknown, endometriosis may arise when menstruation is obstructed, resulting in retrograde menstrual flow into the tubes and pelvic cavity. Just as the endometrium bleeds every month during menstruation, so, too, does the ectopically located endometriosis. This phenomenon leads to inflammation of the pelvic reproductive organs, causing pelvic pain, painful periods (dysmenorrhea), and infertility. Pelvic adhesions or scar tissue may also develop. Endometriosis may be suspected when patients complain of increasingly severe dysmenorrhea, pelvic pain, or infertility, but it can be definitively diagnosed only via surgery. Most often, a diagnostic laparoscopy—a simple outpatient surgical procedure—is used to diagnose endometriosis. Other nonsurgical techniques such as ultrasonography, CT scan, or MRI can occasionally be helpful in their abilities to detect endometriosis.