Dr Drew and Endometriosis: Is It a “Garbage Bag Diagnosis?”

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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I did not choose OB/GYN as a specialty but I will never forget my OB/GYN rotation in medical school, scrubbing into surgeries (exploratory laparotomies) for women with endometriosis. Tissue from the lining of the uterus, with a classic appearance to the naked eye, covering the bladder, colon, fallopian tubes, etc. To see what this looked like was dramatic. Endometriosis is a condition that causes painful periods for many women. Many women I take care of in primary care suffer from this (women who don’t have a “functional disorder,” as per Dr Drew).

Endometriosis is a common cause of painful periods, pelvic pain and infertility. It is an estrogen-dependent disorder and is defined as the presence of endometrial glands at sites outside of the uterus.

What causes it? Considerable controversy remains as to the exact cause but there are several interesting leading theories.

1. The implantation theory. This theory guesses that endometrial tissue from the uterus is shed during menstruation and transported through the fallopian tubes, thus allowing endometrial cells access to pelvic structures. The “direct transplantation theory” is the probable explanation for endometriosis that develops in episiotomy, cesarean section, and other scars after surgery.

2. The coelomic metaplasia theory. This theory proposes that the coelomic (abdominal) cavity contains cells capable of changing into endometrial tissue (kind of cool, right?). This theory is based on embryologic studies demonstrating that all pelvic organs, including the endometrium, come from cells lining the abdominal cavity and these cells have the ability to become whatever they want to become.

3. The woman’s immune system. The development of endometriosis may be related to your immune system’s ability to eliminate the refluxed menstrual debris. This theory proposes that in women who go on to develop endometriosis, the endometrial cells escape being cleared by the immune/inflammatory response and attach and invade other areas in the pelvis. The immune system may play a role in determining who will develop endometriosis, as well as the extent of the disease.

4. Endometriosis and other autoimmune diseases. There may be altered immune surveillance in women who develop endometriosis. A survey of women with endometriosis found that they had higher rates of autoimmune inflammatory diseases, hypothyroidism, fibromyalgia, chronic fatigue syndrome, allergies, and asthma, when compared with the general female population.

5. Genetics. Genetic factors likely influence an individual’s susceptibility to endometriosis. If a woman has endometriosis, a first-degree relative has a 7 percent likelihood of developing the disorder, compared with 1 percent in unrelated persons.

There may never be a “one theory fits all” explanation for endometriosis, but there are good treatments. Yes, it’s a bummer but you are not alone.

Thoughts?

Dr O.

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