CCRM FERTILITY OF PARK RIDGE, IL
Endometriosis treatment in Park Ridge, IL
What is endometriosis?
Endometriosis is an inflammatory state and can cause distortion of the pelvic and/or abdominal anatomy with implants or development of adhesions.
The uterus is comprised of 3 layers. The outer layer is called the serosa, the middle layer is the uterine muscle (myometrium), and the inner layer, which is located in the uterine cavity, is called the endometrium. The endometrium is the layer that is shed during a period.
When the cells of the endometrium implant in the pelvic and/or abdominal cavity outside of the uterine muscle, it is called endometriosis. The hormone estrogen is produced by the ovary and stimulates endometriosis.
What are the symptoms?
- Continuous or cyclic pelvic pain.
- Painful periods.
- Painful intercourse.
- Infertility.
If the bowel or bladder is involved, symptoms of bleeding in the stool or urine, bloating, painful bowel movements or urination and/or altered habits may be present.
Endometriosis can implant along the ureter causing urinary obstruction, flank pain and dilated kidney. However, most women with endometriosis do not experience any symptoms.
What causes endometriosis?
There are several theories as to why and how endometriosis occurs:
- The menstrual blood flows backwards through the fallopian tubes into the pelvic cavity and the cells of the endometrium implant on pelvic structures.
- Endometrial cells travel through the blood stream or lymphatic channels to get to their location of implantation, causing endometriosis outside of the pelvic cavity.
- Genetic predisposition.
A few more theories exist, however, no one definitive cause can be identified.
The stages of endometriosis
Endometriosis is staged from 1 through 4 depending on the amount of disease present when visibly inspected.
- Stage 1 is minimal disease where a few, small implants are identified without adhesions in the pelvis.
- Stage 2 is mild disease where there are more implants located in the pelvis and on the ovaries without adhesions.
- Stage 3 is moderate disease where the implants are multiple and deep with small endometriomas (cysts of ovaries containing old blood from endometriosis) and pelvic adhesions.
- Stage 4 is severe disease containing large endometriomas, adhesions, and multiple implants. There is a greater chance for infertility the higher the stage of endometriosis is diagnosed.
The amount of pain or symptoms, however, does not correlate with the amount of disease present. For example, a woman with stage 4, severe endometriosis may have no symptoms, but a woman with stage 1, minimal disease may be experiencing severe pain or dysfunction. Therefore, it may be difficult to diagnose the cause of pelvic pain as endometriosis and further work-up may be needed to rule out other causes of pelvic pain depending on the symptoms experienced.
How is endometriosis diagnosed?
We use the Painful Periods Screening Tool (PPST) to better identify patients with endometriosis. Validated based on FDA guidelines, the PPST meets the requirements for good research practices and patient-reported outcome instruments set forth by both the FDA and the International Society for Pharmacoeconomics and Outcomes Research
On physical exam, the physician will perform a bimanual exam of the pelvis. The uterus is palpated to check for mobility and tenderness. The tubes and ovaries on both sides are assessed to check if they are enlarged, tender and mobile. A finger in the rectum may be inserted during a pelvic exam to assess behind the uterus where endometriosis can also deposit causing nodules with or without tenderness.
Women can still have endometriosis even if the pelvic exam is completely normal. If the pelvic exam is inconclusive, a transvaginal ultrasound may be performed to check if there are any endometriomas (ovarian cysts with endometriosis), otherwise, an ultrasound may not be helpful in visualizing endometrial implants and adhesions.
The most definitive method for diagnosis is laparoscopy. This provides the surgeon direct visualization of the amount of implants, adhesions and size of endometriomas if present. Endometrial implants have many different colors and shapes. Implants can be clear vesicles and/or red, purple, dark brown or black spots or nodules. There can be areas where a “window” is created in the lining of the pelvis (peritoneum).
Adhesions can be thin and filmy or thick, causing organs to stick together. The appendix is also inspected because endometriosis can implant there, but also to make sure that it appears normal to rule out as a cause of pain.
When no disease is found on laparoscopy, endometriosis may be ruled out as a factor for infertility and pain, however, implants that are too small for the human eye to detect can be present and the woman is treated based on her symptoms.
CCRM Fertility of Park Ridge
1700 Luther Lane, Suite 3150
Park Ridge, IL 60068
Phone: (847) 593-1040
Fax: (630) 428-0336
Hours
Monday – Thursday: 6:00am – 4:00pm
Friday: 6:00am – 3:00pm