Endometriosis and CPP
Endometriosis is the disease that results when the endometrium (the inside lining of the uterus) implants and begins to grow in other areas of the body, such as near the ovaries or bowels. The two most common symptoms of endometriosis are infertility (which is usually not discovered until a woman unsuccessfully tries to get pregnant) and severe pelvic pain. In fact, in some cases the pelvic pain can be so excruciating that a woman is literally unable to function.
What is Pelvic Pain?
Pelvic pain is pain felt in the area below the belly-button and between the hips. Women experiencing pelvic pain for more than six months are said to have chronic pelvic pain (CPP). Sometimes CPP is a symptom of anther disease, but it can also be a condition in its own right. Among the many possible causes of CPP are: pelvic inflammatory disease (PID), endometriosis, and ovarian remnant resulting from a hysterectomy.
Severity and Onset of Endometriosis
Many women suffering from endometriosis begin to have pain during their teenage years. While sometimes mistaken for menstrual cramps, the pain experienced by girls with endometriosis is much more severe than regular menstrual pain.
According to statistics, up to 15% of pre-menopausal women and up to 35% of women experiencing infertility suffer from pelvic pain caused by endometriosis. Since endometriosis is also genetic, women whose mothers suffered from endometriosis are more likely to develop the condition themselves.
In the best-case scenario, pelvic pain is limited to a few days during a woman's period (menstrual cycle). In the worst-case scenario, pelvic pain can occur 24/7.
A suspected case of endometriosis is diagnosed via a laparoscopic examination and a tissue biopsy. Laparoscopy has increasingly become a prominent diagnostic tool in the evaluation of chronic pelvic pain. Patients presenting with the following symptoms are candidates for a laparoscopic examination: chronic pelvic pain unresponsive to medications, a mass identified by an ultrasound or pelvic exam, painful and irregular vaginal bleeding, progressive dysmenorrhea, suspected cases of pelvic inflammatory disease (PID).
Medical treatments consist of oral contraceptives that suppress the menstrual cycle, or more powerful medications such as injectable GnRH analogs that restrict the growth of endometriosis adhesions by reducing the body's production of estrogen.
If drug treatments are insufficient, the next treatment step is open surgery or laparoscopic surgery to remove the tissue deposits (adhesions), relieve symptoms of pelvic pain, and allow natural fertility to return. However to remove all of the diseased pelvic areas all the way down to the normal tissue requires technically intricate surgery, and if not performed by a specialist with expertise in this area surgery can result in only a partial removal of the endometriosis, opening the door for re-growth and for a recurrence of painful symptoms for the patient.