From the Guidelines
Yes, endometriosis can cause adhesions, as it may induce infertility as a result of anatomic distortion caused by invasive growth and adhesions. According to the American College of Obstetricians and Gynecologists 1, endometriosis can lead to the formation of adhesions, which are bands of scar tissue that can form between organs and tissues, causing them to stick together.
Causes of Adhesions
The inflammatory response triggered by endometrial-like tissue growing outside the uterus can lead to scarring and adhesion formation as the body attempts to heal the affected areas. These adhesions commonly develop in the pelvis, connecting organs like the uterus, ovaries, fallopian tubes, and bowel.
Symptoms and Complications
The severity of adhesions correlates with the stage of endometriosis, with more advanced cases typically having more extensive adhesion formation. Adhesions can cause significant pain, especially during movement, sexual intercourse, or bowel movements, and may contribute to fertility issues by distorting pelvic anatomy.
Treatment Options
Treatment options include laparoscopic surgery to remove both the endometriosis lesions and adhesions, though adhesions can recur after surgery. Hormonal treatments that suppress endometriosis activity may help prevent new adhesion formation but typically don't resolve existing adhesions, as stated by the ACOG committee 1.
Key points to consider:
- Endometriosis can cause adhesions, leading to infertility and pelvic pain
- Adhesions can form between organs and tissues in the pelvis
- Treatment options include laparoscopic surgery and hormonal treatments
- Adhesions can recur after surgery, and hormonal treatments may not resolve existing adhesions 1
From the Research
Endometriosis and Adhesions
- Endometriosis is a chronic inflammatory disorder that can cause adhesions, which may lead to infertility, dyspareunia, chronic pelvic pain, intestinal obstruction, and complications at subsequent surgery 2.
- Adhesions may play a role in the development of some forms of the disease, such as ovarian endometriomas and possibly deep invasive nodules 2.
- The pathogenesis of endometriosis is multifactorial, and several theories have been proposed to explain it, including retrograde menstruation, celomic metaplasia, embryologic rests, and lymphovascular spread 3.
Prevalence of Adhesions in Endometriosis
- A retrospective review of patients undergoing laparoscopy for chronic pelvic pain found that 94% of women had either right- or left-sided colon-to-sidewall adhesions, and these adhesions were more common than any other type of intraabdominal adhesion 4.
- A prospective study revealed that women with pelvic pain had a higher rate of colon-to-sidewall adhesions than controls (93.3% vs 13.3%) and a correspondingly higher rate of visualized endometriosis (73.3% vs 6.7%) 4.
Mechanisms of Adhesion Formation
- The molecular mechanisms responsible for the development of fibrosis in endometriosis are not yet defined, but members of the transforming growth factor (TGF)-β family, as well as the receptor Notch, or the bioactive sphingolipid sphingosine 1-phosphate (S1P), play a role in the development of tissue fibrosis 5.
- The main cell types involved in the development of fibrosis are platelets, myofibroblasts, macrophages, and sensory nerve fibers 5.
Clinical Implications
- Prevention of adhesions is one of the most important and surprisingly neglected aspects of the treatment of endometriosis 2.
- Three randomized controlled trials have been published documenting some partial success with Interceed, Oxiplex/AP gel or Adept solution in reducing adhesions extent at second look laparoscopy performed a few weeks after initial surgery 2.