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Mature Women's Centre Victoria General Hospital

Hysterectomy Alternatives Program (HAlt)

Common diseases of the Uterus

Endometriosis

Endometriosis is characterized by endometrial tissue that is found not within the uterus. Normally, the inside of the uterus is lined with endometrial tissue. It is stimulated to grow and thicken every month by estrogen and progesterone. If an embryo is not implanted into the endometrial lining, it is shed (known as menstruation). When this endometrial tissue is attached to other organs, such as the fallopian tubes or ovaries, it swells with the influence of these hormones as well. Women who have endometriosis report pain which gets more severe as the menstrual period approaches and is the most severe during menstruation. Having endometriosis for a long time can lead to adhesions in the pelvis which can lead to infertility. Many women do not have any symptoms at all.

There is no known cause for endometriosis but it is possible that during menstruation, endometrial cells migrate back through the tubes and implant outside of the uterus. This is called retrograde menstruation.

Endometriosis is usually diagnosed by direct visualization of the endometrial implants through a laparoscope. Ultrasound does not clearly show endometriosis but a MRI will reveal endometriosis in some women. Usually if a woman reports symptoms of endometriosis, a physician will perform laparoscopy.

The most definitive treatment of endometriosis is hysterectomy and bilateral oopherectomy (removal of both ovaries). Since the ovaries produce the estrogen that stimulates growth of endometrial tissue, only by their removal will these women be cured. It is important to realize that there are other medical treatments and less invasive surgical procedures available to treat endometriosis that can be quite effective in alleviating pain:

Depo-provera® - this is an injectable medication normally used for birth control. It is a synthetic form of progesterone that inhibits estrogen and progesterone production which prevents hormone cycling, ovulation and endometrial growth. Side effects include irregular menstrual bleeding, weight gain, headaches, nausea, and acne but are generally mild. Bone mineral density (BMD) can be reduced with prolonged use of Depo-provera, however reversible and can be prevented by adding low dose estrogen. Women conceive on average 9 months after stopping Depo-provera.