Chronic Pelvic Pain and Endometriosis

Sometimes normal uterine lining (endometrial) cells seep through the fallopian tubes and implant into and proliferate through the inner pelvic coating (peritoneum). This results in different degrees of irritation of the pelvic peritoneum. Such a phenomenon is called endometriosis.

It is estimated that approximately 10% of women in their reproductive years, or nearly 90 million women world-wide, suffer from endometriosis. The fact is that there is no way to establish accurate figures because the only way to confirm a diagnosis is by a surgical procedure known as laparoscopy. But if only 10% of women have it, that makes endometriosis one of the most common diseases on the face of the earth—more common than AIDS - more common than cancer.

Endometriosis may affect one or more of the peritoneum lined pelvic organs as well, including the uterus, ovaries, tubes, rectosigmoid (bowel) and bladder. Pain is the main symptom, including persistent, chronic pelvic pain. Additional pathology consists of large ovarian "chocolate" cysts (endometriomas), pelvic adhesions/scarring, infertility, bowel and bladder dysfunction. Endometriosis may even invade bladder, bowel and other pelvic structures, possibly causing severe complications to the patient.

Estrogen promotes growth and expansion of endometriosis. Therefore, treatment is aimed at counteracting or eliminating the estrogen effects.

A conservative approach comes first. Initial estrogen neutralizing therapy consists of different hormonal agents, including birth control pills and oral or injection progesterone. If this fails, then estrogen abolishing treatment is provided in the form of Lupron injection (GnRH-a, gonadotropin releasing hormone agonist). These treatments take several months and may produce severe side effects, including menopause-like symptoms. Usually, the therapeutic impact lasts as long as these agents are given.

Surgery is the last resort (after exhausting conservative options) in treating severe endometriosis. Conservative approach includes laparoscopic resection or evaporation of the endometriosis infiltrated areas. Such approach is important in order to preserve the fertility potential but is not as successful as the definitive solution in the form of Laparoscopic Supracervical Hysterectomy (LSH).

Learn more about Laparoscopic Supracervical Hysterectomy (LSH).