Definition
Endometriosis is a chronic disease involving endometrial tissue. Normally, endometrial tissue is found only inside the uterus, the reproductive organ where a fetus develops. Hormones direct the tissue to accumulate there, in preparation for a fertilized egg. If conception does not occur, the tissue passes out of the body during menstruation. In endometriosis, endometrial-like tissue is found outside the uterus. It may be found on organs in the abdomen, pelvis, or another location. Outside the uterus, the tissue continues to respond to hormones. It swells, breaks down, and bleeds, but it is unable to pass from the body during menstruation. Surrounding tissue becomes inflamed, often with scarring.
Endometrial Lesions
Causes
The cause of endometriosis is unknown. Possible causes include:
• Menstrual tissue backs up through the fallopian tubes and spills into the abdomen.
• The immune system may allow the tissue to implant and develop into endometriosis.
• The lymph system may carry endometrial cells from the uterus.
• Certain cells that cover organs in the abdomen transform into endometrial tissue.
Whatever the cause, the disease progresses due to the release of hormones and growth factors.
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition. Precise risk factors for endometriosis have not been well-established. However, there is some evidence that endometriosis is associated with:
• Family history, a mother or sister with endometriosis
• Early onset of menstruation
• Delayed pregnancy (Pregnancy slows or stops the disease from advancing. The condition usually resolves at menopause, but symptoms may return with hormone replacement therapy.)
• Prolonged menstrual bleeding (more than 7-8 days)
• Abnormal development of the uterus, with a blocked segment
Symptoms
Symptoms range from mild to severe. Some women with many large growths have little pain. Others with small areas of endometriosis have intense pain.
Symptoms include:
• Cramping
• Pelvic pain
• Pain during sex
• Pain just before and during the menstrual period
• Heavy periods
• Low back pain
• Pain during bowel movements or urination
• Pain when urinating
• Infertility
• Miscarriage
Diagnosis
Your healthcare provider will ask about your symptoms and medical history, and perform a pelvic exam. The history and exam is best done early in the menstrual period. Since most women with endometriosis have no symptoms, diagnosis is usually confirmed with a laparoscopy. Laparoscopy allows the doctor to see if there are patches of endometrial tissue and scar tissue. Knowing the size, number, and location of growths, as well as the degree of scarring, affects treatment decisions.
Treatment
The goals of treatment are to:
• Control the pain
• Slow endometrial growth
• Restore or preserve fertility
Treatment options depend on:
• Severity of symptoms
• Location of endometrial growths
• Extent of the disease
• Age and reproductiive plans (your family planning wishes)
Treatments include:
Pain Medication
Over-the-counter pain relievers ease mild symptoms. However, prescription pain relievers are often needed. Nonsteroidal anti-inflammatory drugs reduce inflammation and help with cramping. They work best when taken on a regular basis.
Hormonal Therapy
Hormones are an option for women who are not trying to become pregnant. Oral contraceptive pills and other injectable drugs that interfere with estrogen production may decrease pain and shrink the size and number of endometrial growths. But endometrial growth tends to recur when the hormones are stopped. A common way to take the oral contraceptive pills is continuously, without a break, and without menses.
Surgery
For severe symptoms or for women who want to get pregnant, doctors can try to remove endometrial growths, often with laparoscopic surgery. In severe cases, it may be advisable to remove the uterus and ovaries along with the endometriosis. Of course, this eliminates the possibility of future pregnancy.
Prevention
There are no known preventative measures against endometriosis.
