Endometriosis
The uterus (Latin for womb) has an interior lining, or endometrium , consisting of special cells that will support and nurture a fertilized egg that attaches there in the first stages of pregnancy. The endometrial cells shed every month during menstruation. Endometriosis is a condition in which these endometrial cells are found outside the womb and in the pelvis and other organs outside the pelvis.
"In endometriosis, some of these cells have migrated and can be found externally and they can metastasize to other organs," said Dr. Obianwu. "They can be found on the uterus exterior, the ovary, the bowel, and Fallopian tubes, just everywhere."
The real problem is that these cells still are programmed to shed each month as they do in menstruation, and so when they cause bleeding they do so internally wherever they are growing, which can create substantial scar tissue, pain, infertility and interference with other organs.
Several theories have been proposed why endometrial cells are found outside their place of origin. "One theory is that these cells are multi-potential cells, de nova cells almost like stem cells, that decide to become endometrial cells and form wherever they are located," said the surgeon.
"The other theory is that endometriosis is caused by retrograde menstruation, so instead of draining through the vagina the cells go up through the Fallopian tubes. Then they escape where the tube aligns with the ovaries and they spread out where they do not belong, causing bleeding, scarring and even infertility in some cases."
Scientists theorize that these cells cause infertility by blocking the Fallopian tubes, secreting fluid preventing fertilization of the egg, or they may have an effect on either the egg or sperm, preventing conception.
Nevertheless, the cause of endometriosis is unknown at this time, but there have been advances in the treatment of the condition to remove or shrink endometrial growths and relieve painful symptoms and improve fertility. In some cases, the physician will want to visualize the endometrial growths using a laparoscope inserted in a small incision in the abdomen and then treat the condition by laser, ablation or excision.
Other options include medication or use of an injection that significantly reduces estrogen levels in the body. This can stop menstruation and allow the body to attack and rid the endometriotic growth. Side effects may include menopause-like symptoms such as hot flashes and bone loss."
There are surgical options to combat the condition, said Dr. Obianwu.
They include ablative procedures using electricity, heat or laser. Electro cauterization is the process of destroying tissue using electricity to generate heat conduction from a metal probe (much like a soldering iron). Electro surgery involves the use of a device that passes an electric current through the tissue, which generates enough heat to destroy it. Ablation can also be accomplished with a light amplification laser that generates heat to vaporize the cells, which can be performed laparoscopically, with minimal invasive techniques.
"There are times the endometriosis is attached to an organ or ligament and it is too big to be burned off," said the surgeon. "In that case we extirpate, meaning we surgically excise the area."
Each case requires customized treatment, Dr. Obianwu explained. "Sometimes we use medicines to shrink the tissue and then do surgery, sometimes the steps are reversed. Endometriosis can be mild, moderate or severe and not all options work in all cases. It requires discussion with the patient."
The very last resort option may be a hysterectomy, with removal of the uterus, tubes and ovaries.
