What is endometriosis?
Endometriosis is an abnormal condition of the female reproductive system in which tissue (endometrium) that normally only covers the inside cavity of the uterus grows outside the body of the uterus. Endometriosis is associated with two important symptoms, progressive pelvic pain (especially around the time of the menstrual flow) and infertility (more)
What are the types and stages of endometriosis?
Types and stages of endometriosis can be distinguished by location (such as bowel, bladder and ovarian endometriosis), the extent or depth of invasion (forming the basis for clinical staging), or visual appearance (such as red flame lesions, powder burn marks and clear vesicles).
Endometriosis is most often located on, or invading through, the peritoneal lining that covers the uterus, the fallopian tubes, the ovaries, the bowel, or the bladder. Distant (non-pelvic) locations for endometriosis are uncommon but can include virtually any tissues of the body.
Endometriosis on the bladder
The number, size and depth of endometriosis implants can be described and this information forms the basis for clinical staging. Minimal, or stage I, endometriosis has only a few superficial implants. Severe, or stage IV, endometriosis may have many implants (some of which invade deeply into the peritoneum covering the pelvic structures) as well as ovarian endometriomas (ovarian cysts containing endometriosis) and thick pelvic adhesions (scar tissues). It is important to recognize that clinical staging is based on appearance (number and depth of implants and adhesions) rather than symptoms (such as degree of pelvic pain or reduced fertility).
Stage IV endometriosis
The visual appearance of endometriosis can vary from clear vesicles (blister like lesions following chronic irritation) to red flame implants (inflamed, raised, and brightly colored red lesions) to classic powder burn marks (small areas of blackened necrotic tissue) to white stellate tissue (blanched scar like lesions). (more)
Endometriosis and Pelvic Adhesions
Clear vesicles on the peritoneum covering the uterus
What causes endometriosis?
The cause of endometriosis is generally not determined for any specific woman undergoing medical treatment, but medical researchers believe that most cases of endometriosis are caused by one of three mechanisms. The mechanisms that cause endometriosis are back flow of endometrium (that is being shed) through the fallopian tube during menses, spread of endometrium through blood vessels that are opened during the menstrual flow, or a change in the lining tissue that normally covers pelvic organs into endometrial like tissue. (more)
How common is endometriosis?
Endometriosis is not rare, but it is under-diagnosed and therefore it is under-treated.
Although the number of women with endometriosis is uncertain, endometriosis doctors believe that up to 10% of all reproductive age women and up to 40% of women with a fertility problem have endometriosis.
Endometriosis can run in families due to a genetic predisposition. Women with a first-degree relative (mother or sister) with endometriosis have up to a six fold increased likelihood of endometriosis compared to the general population.
Additionally, up to 55% of teenagers undergoing laparoscopy for pelvic pain are found to have endometriosis. (more)
These two drawings attempt to illustrate some of the possible locations of endometriosis
Endometriosis and Pelvic Adhesions Drawing
Photographs taken during surgery can demonstrate the varied appearance of endometriosis. (more endometriosis photos)
Endometriosis and Pelvic Adhesions
Endometriosis can present as pain, initially endometriosis often causes pelvic and lower back pain during the menstrual flow. Over time, this pain may become progressively more intense or even debilitating in nature. The pelvic pain can then occur for longer periods of time (ultimately continuously throughout the entire cycle) and involve surrounding structures to result in painful bowel movements or intercourse. Alternatively, there are some women with endometriosis, even severe forms of endometriosis, who do not have any pelvic pain. (more on pelvic pain as a symptom of endometriosis)
Endometriosis can also cause reduced fertility or infertility. All stages of endometriosis, from minimal endometriosis to severe endometriosis, can potentially reduce a woman's chances of success when trying to get pregnant. However, some women with endometriosis, even severe stage endometriosis, do not have a problem getting pregnant. (more on infertility as a symptom of endometriosis)
Endometriosis can be treated to reduce pelvic pain or to enhance fertility.
When pelvic pain is thought to be due to endometriosis, medications have been shown to reduce the pain significantly in up to 85% of women, but it often takes several months of treatment to achieve this level of pain relief. Medications also only work reliably on superficial implants of endometriosis. Medication is ineffective for treatment of pelvic pain due to scar tissue (adhesions) or deeper implants of endometriosis. Also, all of the medications used to treat endometriosis should be avoided in pregnancy and most actually cause transient infertility. (more on medical management of pelvic pain due to endometriosis)
Surgery can be used to effectively reduce pelvic pain related to all stages of endometriosis, as well as pain related to most other pelvic pathology, by removing endometriosis and repairing the pelvis. Use of the ultrapulse CO2 laser during laparoscopy to completely vaporize endometriosis lesions down to their base has been highly successful in significantly reducing or eliminating pelvic pain due to endometriosis. Advanced operative laparoscopy with this ultrapulse laser is by far the most reliable and effective treatment for pelvic pain at our offices. (more on endometriosis surgery for pelvic pain)
When endometriosis is thought to cause female infertility, medications have not been shown to increase fertility. Surgical pelvic repair, including the lysis of pelvic adhesions (scar tissue) and removal of all implants of endometriosis, appears to increase fertility rates. At our offices, we have had some remarkable success with laparoscopic pelvic repair using the ultrapulse CO2 laser in terms of increasing a woman's ability to get pregnant. (more on endometriosis infertility treatment)
Many women with persistent pelvic pain, or infertility, due to endometriosis have a difficult time finding effective treatment since this condition is under-diagnosed. It is common for women with endometriosis to undergo evaluations with 4 or 5 doctors before a diagnosis of endometriosis is made.
At our office, we have the expertise and experience to effectively diagnose and treat endometriosis. Our office is comfortable and our staff is caring. We also understand that the economy is bad and money is usually tight, so we make every effort to provide state of the art treatment that is surprisingly affordable for almost all of our patients.
Dr. Daiter is a board certified Reproductive Endocrinology and Infertility expert with greater than 15 years of clinical experience in the diagnosis and treatment of endometriosis. (more)
Many physicians who have worked directly with Dr. Daiter have written kind testimonials describing him in and out of the operating room. (more)
Many patients who have been treated by Dr. Daiter have also written warm sincere notes about their care at the office.
Additionally, several patients volunteered to participate in a video describing their experience at our office. (more)
(scroll down to patient testimonials at the bottom of the navigation bar to the left)
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Consumers' Research Council of America adds Dr. Eric Daiter to their list of America's Top Obstetricians and Gynecologists
Dr. Eric Daiter has been chosen by the Consumers' Research Council of America to be listed in their Guide to America's Top
Obstetricians and Gynecologists for 2007, 2008, 2009, 2010 and 2011. For more information on this organization visit
Consumers' Research Council of America.
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