Every month when the uterus contracts to squeeze out the endometrial lining during menstruation, some tissue and blood is propelled backward through the fallopian tubes and into the abdominal cavity. Since we have been doing laparoscopies, we have observed that this backflow probably occurs among all women. However, it does not always cause problems. Most women's bodies are able to resist the implantation of endometrial tissue in surfaces surrounding the uterus. In other women, there are varying degrees of resistance, leading to anything from mild to severe endometriosis.

Current medical thinking holds that women with endometriosis have some immunological defect that renders them incapable of rejecting implantation of misplaced endometrial tissue. In other words, their immune systems are unable to mount a defense against the implants.

Most commonly, endometrial implants lodge either in a pouch-like area behind the uterus called the cul de sac and/or around the fallopian tubes. endometrial tissue can also attach itself to the ovaries. If it does, the monthly blood flow becomes trapped, leading to the formation of a cyst called an endometrioma. When the endometrial tissue is forced into the wall of the uterus and takes root, the condition is called adenomyosis. The blood and tissue shed each month become trapped in the wall. Adenomyosis can be extremely painful and may cause heavy bleeding or infertility. The condition is often indistinguishable from fibroids.

Treating Endometriosis
Remarkable new drugs as well as some very sophisticated surgical techniques have made it possible to eradicate endometrial implants and associated adhesions simply and quickly. However, even the latest approaches have their limitations. None will put a permanent end to the problem. There is nothing we can do to insure that endometriosis does not recur after successful drug treatment and/or surgery. Until we can eliminate the risk of recurrence once and for all, a women prone to endometriosis may need repeated courses of drug treatment and/or repeated surgery.

The Latest Drugs
Two types of drugs are the mainstays of endometriosis treatment today. They are Danocrine and two newer medications, Lupron and Synarel, which are called GnRH agonists. All three of these drugs have the same effect: They induce a temporary menopause by blocking estrogen production. Since the endometrial tissue requires estrogen to grow, endometriosis is temporarily halted.