Endometriosis is often not well understood. It is a disorder that
can result in either of two important clinical problems, infertility
or pelvic pain (especially during the menstrual flow). Typically,
endometriosis afflicts women of reproductive age (yet rare cases
of endometriosis in females prior to puberty or after menopause
and even rarer cases of endometriosis in males have been reported).
Endometriosis occurs when endometrial glands and stroma (normal
components of the tissue that lines the uterine cavity) implant
and grow outside the body of the uterus. Most often, endometriosis
is located in the pelvis near or on the reproductive structures.
However endometriosis can occur in virtually any tissue of the
body, including distant sites like the lung, the knee and the
The two major clinically significant problems associated with
endometriosis are infertility and pelvic pain. A common area of
misunderstanding is whether these symptoms are linked to one another.
Infertility and pelvic pain can and often do occur without the
other symptom. That is, a patient can have incapacitating pain
due to endometriosis and normal fertility. Also, a patient can
have infertility associated with endometriosis with absolutely
no pain at all. This fact frequently surprises couples but is
commonly seen by infertility specialists.
There are no reliable nonsurgical diagnostic tests for endometriosis.
The diagnosis of pelvic endometriosis requires surgery. Ultrasonography
shows no specific pattern for pelvic endometriosis, but is often
helpful in diagnosing persistent nonfunctioning ovarian cysts
that may represent endometriomas (chocolate cysts). Although some
specialists seem to think that they can diagnose an endometrioma
with certainty using ultrasound, there are abundant scientific
reports confirming the nonspecific nature of the ultrasound for
this purpose. MRI also has no specific findings, with a reported
sensitivity and specificity of only about 60% for the discovery
of endometriosis. Blood tests for CA 125 may be elevated with
endometriosis, but are also elevated with a tremendous number
of other pelvic inflammatory processes so an elevated CA 125 in
a reproductive age woman has little value (unless possibly used
as a tumor marker when following a patient with known cancer).
Endometriotic lesions (foci of endometriosis) appear to depend
upon stimulation by estrogens. The lining of the uterus (endometrium)
is one of the most complex tissues in the body in that it continuously
changes (grows, modifies its structure, alters its own production
of molecular messengers) in response to stimulation by circulating
sex steroids. Endometriosis is rarely found in low estrogen environments,
such as prior to puberty, after menopause, or following surgical
"castration." Endometriosis discovered after menopause
is almost always associated with hormone replacement medication