 What is endometriosis and how common is it? By definition, endometriosis is when the tissue resembles the lining of the uterus, called endometrium, grows outside of the uterus, outside of the cavity of the uterus, which could be on the ovaries, fallopian tubes, on the back of the uterus or any other part of the abdomen. It has been estimated that one out of ten women in this country have endometriosis. What causes endometriosis and how does it develop? When the women menstruate, some of the blood, instead of coming out of the vagina, through their fallopian tubes, goes to the abdomen. And these women, either they have some genetic background or some immune deficiency, and those bloods that goes from the lining of the uterus in the abdomen has cells that grows outside of the uterus and become endometriosis. That theory doesn't explain everything. For example, if the woman has endometriosis in her chest or even in her heart or brain, how do they get endometriosis? Maybe the cells from the lining of the uterus through the lymphatic channel or blood flow goes to the lung or to the brain. Are there different types of endometriosis? Endometriosis could be in the body of the uterus. It is called adenomyosis or could be outside of the uterus called endometriosis external. Adenomyosis is called endometriosis internal and outside of the uterus called external. But when we do surgery or we do laparoscopy, endometriosis lesions look different colors. And that also maybe you are referring to that one. We call them typical endometriosis implants and we call them atypical. Also sometimes we call them superficial endometriosis and some of them are called deep infiltrative endometriosis. What is the best way to diagnose endometriosis? The best way to diagnose endometriosis is by listening to the patients and her company do a thorough examination of the patients and when you have high suspicions do pelvic ultrasound, sometimes MRI and the ultimate diagnosis is by laparoscopy. Laparoscopy is a surgical procedure which is done in the hospital and the general anesthesia and looking inside the abdomen by a special telescope called laparoscopy. What are the symptoms with endometriosis and do all women experience pain? The most common problem with endometriosis is pelvic pain. This pelvic pain could be painful period, painful intercourse, painful ovulation, painful bowel movement, painful urination. If the patient has involvement of her bowel, sometimes patients have blood in their stool or if they have in their bladder, could blood in their urine. If they have in their chest, could cause chest pain. And also if they are involved in the ovaries, could cause cyst which is called chocolate cyst or endometrioma. Endometriosis frequently could cause infertility and if the endometriosis involves on the chest could cause collapse of the lungs during menstrual cycles and chest pain. How do you treat endometriosis? Endometriosis is a very complex condition and it is estrogen dependent. The treatment is combination of the medical therapy which is using medication anti-estrogen and surgical therapy which is essentially means removing or destroying the endometriosis. None of them are perfect. So you have to have both options available when you are treating the women with endometriosis especially for long-term results. What is the role of medical therapy for endometriosis and when should a woman have surgery? That is excellent questions. I start by saying that endometriosis is a complex condition and we do not have one approach to treat endometriosis for every patient. In general, you have to have combination of both medical treatment and surgical treatment available. Medical treatment involves the hormonal therapy which suppresses the estrogen. Surgical treatment involves removing the endometriosis thoroughly and sometimes the involved area that has endometriosis has to be removed. Now, as I said earlier, the most common area of endometriosis is on the ovaries, on the back of the uterus, fallopian tubes, or other organs sometimes on the bowel, on the bladder. So the surgical treatment besides removing the endometriosis lesions involves removing those involved organs based on the severity of the endometriosis. What kind of surgery is done for endometriosis? Is the hysterectomy always necessary? Endometriosis surgery these days and age involves laparoscopy or robotic assisted laparoscopy by experienced surgeons knowledgeable of endometriosis. And the goal of the surgery should be two things. To treat the endometriosis as thoroughly as possible, in the same time, try to preserve the reproductive organs as much as possible because most of these women are young and desire to have future fertility. But unfortunately, endometriosis could be severe enough that has damaged the ovaries or fallopian tubes or uterus that at times they have to be removed. If endometriosis involves the uterus which is called adenomyosis or patient has fibroids which is very common in women with endometriosis and conservative management has not helped. Unfortunately, hysterectomy is going to be the final solution. What is at most risk for developing endometriosis and is it preventable? Endometriosis could involve any woman but we know the women that have family history of endometriosis and somebody like their sister or mother had endometriosis have seven times higher chance of developing endometriosis or very commonly we see endometriosis in the same family, the sisters or twin sisters. So we know there are some sort of the family background that could make them prone to have endometriosis. How could you prevent endometriosis? Unfortunately right now we don't have any method. But we know endometriosis most of the time is a progressive disease. What it means changes from stage 1 to 2 to 3 and 4. So if we find endometriosis in earlier stage and medically and surgically treated we could prevent it from becoming more severe. Can endometriosis become cancerous? The answer is yes. Endometriosis could transform to malignancy. The most common area of the endometriosis become malignant is ovaries. As a matter of fact we have different types of the ovarian cancer and certain of them the background is endometriosis. This is one area of my research and my interest that I have published about it and I always give lectures about it that women with endometriosis have to be followed carefully and especially if they have ovarian cysts called chocolate cysts be watched for possible malignant transformation. However endometriosis becoming malignant in other parts of the body has been reported and I have seen it. Endometriosis of the bowel becomes malignant. Are all women who suffer from endometriosis at risk for infertility? I get asked this question frequently. Endometriosis could compromise infertility. In some women the only reason for infertility is endometriosis and in some women endometriosis is part of their infertility. So another word endometriosis could compromise their infertility. We see women that have severe endometriosis and they don't have any problem getting pregnant and on the other side we see women that they have mild endometriosis and they have infertility and when endometriosis is treated getting pregnant. Is it true that endometriosis can affect parts of the body other than the reproductive system? This is true. Endometriosis could affect any part of the body. The most common organs of course are reproductive organs, uterus, tubes, ovaries, but other parts like bowel, large bowel, colon, small bowel, appendix and could evolve other parts of the body like lung, chest, brain, even heart, even spleen has been reported to involve endometriosis. It is very important to have a multidisciplinary team involved with treatment of endometriosis including gynecologist, thoracic surgeon, colorectal surgeon and urologist. For more information about our endometriosis center at NYU Winthrop, call 866 Winthrop or visit us online on NYUWinthrop.org