Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
In this Article
- Endometriosis facts
- What is endometriosis?
- Who is affected by endometriosis?
- What causes endometriosis?
- Endometriosis and cancer risk
- Does diet affect endometriosis?
- How is endometriosis diagnosed?
- How is endometriosis treated?
- Medical treatment of endometriosis
- Surgical treatment of endometriosis
- Treatment of infertility associated with endometriosis
- Endometriosis FAQs
- Find a local Obstetrician-Gynecologist in your town
What are the
Most women who have endometriosis, in fact, do not have symptoms. Of those who do, the most common include:
- Pain (usually pelvic) that usually occurs just before menstruation and lessens after menstruation
- Painful sexual intercourse
- Cramping during intercourse
- Cramping or pain during bowel movements or urination
- Pain with pelvic examintions
The intensity of the pain can vary from month to month, and can vary greatly among affected individuals. Some women experience progressive worsening of symptoms, while others can have resolution of pain without treatment.
Pelvic pain in women with endometriosis depends partly on where endometrial implants of endometriosis are located.
- Deeper implants and implants in areas of high nerve density are more apt to produce pain.
- The implants may also release substances into the bloodstream which are capable of eliciting pain.
- Pain can result when endometriotic implants incite scarring of surrounding tissues. There appears to be no relationship between severity of pain and the amount of anatomical disease which is present.
Endometriosis can be one of the reasons for infertility for otherwise healthy couples. When laparoscopic examinations are performed during evaluations for infertility, implants are often found in individuals who are totally asymptomatic. The reasons diminished fertility in many patients with endometriosis are not understood. are not completely understood. Endometriosis may incite scar tissue formation within the pelvis. If the ovaries and Fallopian tubes are involved, the mechanical processes involved in the transfer of fertilized eggs into the tubes may be altered. Alternatively, the endometriotic lesions may produce inflammatory substances which adversely affect ovulation, fertilization, and implantation.
Other symptoms that can be related to endometriosis include:
- lower abdominal pain,
- diarrhea and/or constipation,
- low back pain,
- chronic fatigue
- irregular or heavy menstruation,
- painful urination, or
- bloody urine (particularly during menstruation).
Endometriosis and cancer risk
Some studies have postulated that women with endometriosis have an increased risk for development of certain types of ovarian cancer, known as epithelial ovarian cancer (EOC), according to some research studies. This risk is highest in women with both endometriosis and primary infertility (those who have never conceived a pregnancy). The use of combination oral contraceptive pills (OCPs), which are sometimes used in the treatment of endometriosis, appears to significantly reduce this risk.
The reasons for the association between endometriosis and ovarian epithelial cancer are not clearly understood. One theory is that the endometriosis implants themselves undergo malignant transformation to cancer. Another possibility is that the presence of endometriosis may be related to other genetic or environmental factors that serve to increase a women's risk of developing ovarian cancer.
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