Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Endometriosis is the abnormal growth of cells (endometrial cells)
similar to those that form the inside of the uterus, but in a location
outside of the uterus.
Endometriosis is most commonly found on other organs of the pelvis.
The exact cause of endometriosis has not been identified.
Endometriosis is more common in women who are experiencing infertility than
in fertile women, but the condition does not fully prevent conception.
Most women with endometriosis have no symptoms, in which case therapy is
neither appropriate nor necessary.
Pelvic pain during menstruation or ovulation can be a symptom of
endometriosis, but may also occur in normal women.
Endometriosis can be suspected based on the woman's pattern
of symptoms, and sometimes during a physical examination, but the definite
diagnosis is confirmed by surgery, usually laparoscopy.
Treatment of endometriosis includes medication and surgery for both pain
relief and treatment of infertility if pregnancy is desired.
What is endometriosis?
Endometriosis is the abnormal growth of cells (endometrial cells) similar to those that form the inside
or lining the tissue of
the uterus, but in a location outside of the uterus. Endometrial cells are cells that are shed each month during menstruation. The cells of endometriosis
attach themselves to tissue outside the uterus and are called endometriosis
implants. These implants are most commonly found on the ovaries, the Fallopian
tubes, outer surfaces of the uterus or intestines, and on the surface lining of
the pelvic cavity. They can also be
found in the vagina, cervix, and bladder, although less commonly than other
locations in the pelvis. Rarely,
endometriosis implants can occur outside the pelvis, on the liver, in old
surgery scars, and even in or around the lung or brain. Endometrial implants,
while they can cause problems, are
benign (not cancerous).
Who is affected by endometriosis?
Endometriosis affects women in their reproductive years. The exact prevalence of endometriosis is not known, since many women may have the condition and have no symptoms. Endometriosis is estimated to affect over one million women (estimates range from 3% to 18% of women) in the United States. It is one of the leading causes of pelvic pain and reasons for
laparoscopic surgery and hysterectomy in this country.
Estimates suggest that between 20% to 50% of women being treated for infertility
have endometriosis, and up to 80% of women with chronic pelvic pain may be
While most cases of endometriosis are diagnosed in women aged around 25 to 35 years, endometriosis has been reported in girls as young as 11 years of age. Endometriosis is rare in postmenopausal women. Endometriosis is more commonly found in white women as compared with African American and Asian women. Studies further suggest that endometriosis is most common in taller, thin women with a low body mass index (BMI). Delaying pregnancy until an older age is also believed to increase the risk of developing endometriosis.
It also is likely that there are genetic factors that predispose a woman to
developing endometriosis, since having a first-degree relative with the
condition increases the chance that a woman will develop the condition.
Most women who have endometriosis, in fact, do not have
symptoms. Of those who do experience symptoms, the common symptoms are pain
(usually pelvic) and infertility. Pelvic pain usually occurs during or just
before menstruation and lessens after menstruation. Some women experience painful
sexual intercourse (dyspareunia) or cramping during intercourse, and or/pain
during bowel movements and/or urination. Even pelvic
examination by a doctor can be painful. The pain intensity can change from month
to month, and vary greatly among women. Some women experience progressive
worsening of symptoms, while others can have resolution of pain without treatment.
Other symptoms related to endometriosis include:
lower abdominal pain,
low back pain,
heavy menstrual bleeding, or
blood in the urine.
Rare symptoms of
endometriosis include chest pain
or coughing blood due to endometriosis in the lungs and headache and/or
seizures due to endometriosis in the brain.