Endometriosis is the formation of endometrial cells outside the uterus and occurs in five to ten percent of women.  The cells, which are still responsive to hormones, grow on the ovaries, fallopian tubes and other abnormal sites, causing various levels of pain.  Endometriosis is primarily a disease of the reproductive years, although it also occurs in premenarche and postmenopausal women.

Endometriosis is still not well understood.  The most popular explanation is retrograde menstruation, in which refluxed menstrual fluid carries endometrial tissue back into the body, where it implants on other organs.  The tissue, still under the influence of cyclic hormones, bleeds and increases in size, sometimes forming cysts.

However, retrograde menstruation does not explain the entire spectrum of the disease, such as instances in which endometrial tissue has been found in the lung or even the nose.  Another theory, called “coelomic metaplasia”, maintains that peritoneal epithelium – the cells lining the abdominal cavity – can be “transformed” into endometrial tissue.   The extraneous endometrial tissue may also be differentiated müllerian remnants, pieces of the embryonic Müllerian ducts that develop into the female reproductive organs.  Either of these two other theories may help to explain the extraordinary circumstances not covered by retrograde menstruation.


The most common symptom of endometriosis is recurrent pelvic pain.  The intensity of pain varies between women.  Other common symptoms include:

  • Dysmenorrhea:  painful, sometimes disabling menstrual cramps
  • Dyspareunia:  painful sex
  • Dyschezia:  painful bowel movements
  • Dysuria:  urinary urgency and frequency, sometimes painful voiding
  • Nausea, vomiting, or diarrhea – particularly when associated with the menstrual period
  • Frequent or short menses
  • Heavy or long menstrual periods
  • Mood swings and fatigue

Endometriosis-Associated Infertility

The most common that endometriosis is diagnosed is 25-29, though it can be delayed in women who suffer from infertility rather than pain.  Endometriosis can lead to anatomical distortions, as the lesions connect organs and move them.  It has also been suggested that the lesions release factors which are harmful to gametes or embryos.  An alternative theory suggests that endometriosis might be a result of infertility caused by other factors; in these cases, it is preferable to refer to the state as endometriosis-associated infertility.


Physical examinations may lead a physician to suspect endometriosis, and ultrasounds or MRIs might identify large endometriotic areas, such as nodules or cysts.  However, these imaging tests often miss smaller areas, and thus laparoscopy is the only method for a complete confirmation and diagnosis.  Laparoscopy also allows for surgical treatment of endometriosis.


Endometriosis is staged at four levels which are established via a complex point system that assesses lesions and adhesions in the pelvic organs.

  • Stage I (Minimal):  Findings restricted to only superfical lesions and possibly a few filmy adhesions.
  • Stage II (Mild):  In addition, some deep lesions are present in the Douglas cul-de-sac, or rectouterine pouch, the extension of the peritoneal cavity between the rectum and the back wall of the uterus.
  • Stage III (Moderate):  Lesions in the cul-de-sac, plus the presence of small endometriomas on the ovary and more adhesions.
  • Stage IV (Severe):  As above, plus larger endometriomas, extensive adhesions.


There is no cure for endometriosis; rather, the main goal is to provide pain relief and treat infertility, if present.  In many patients, menopause (natural or surgical), will abate the process, as the hormones will no longer affect the tissue.  In women still seeking to become pregnant, treatment is conservative, though it can include surgical removal of the tissue.  For those who do not wish to become pregnant, treatment includes:

  • Hysterectomy and/or removal of the ovaries
  • Non-steroidal anti-inflammatory drugs (NSAIDs)
  • Progesterone or Progestins:  to counteract estrogen and inhibit the growth of the endometrium
  • Oral contraceptives

If you have concerns that you may be suffering from endometriosis or endometriosis-associated infertility, please schedule a consultation with the Women’s Specialists of Plano at (972) 379-2416 or visit our online appointment center.