Endometriosis is a condition in which the tissue that behaves like the cells lining the uterus (endometrium) grows in other areas of the body, causing pain, irregular bleeding, and possible infertility.
The tissue growth (implant) typically occurs in the pelvic area, outside of the uterus, on the ovaries, bowel, rectum, bladder, and the delicate lining of the pelvis. However, the implants can occur in other areas of the body, too.
Each month a woman's ovaries produce hormones that stimulate the cells of the uterine lining (endometrium) to multiply and prepare for a fertilized egg. The lining swells and gets thicker.
If these cells (called endometrial cells) grow outside the uterus, endometriosis results. Unlike cells normally found in the uterus that are shed during menstruation, the ones outside the uterus stay in place. They sometimes bleed a little bit, but they heal and are stimulated again during the next cycle.
This ongoing process leads to symptoms of endometriosis (pain) and can cause scars (adhesions) on the tubes, ovaries, and surrounding structures in the pelvis.
The cause of endometriosis is unknown, but there are a number of theories. One theory is that the endometrial cells loosened during menstruation may "back up" through the fallopian tubes into the pelvis. Once there, they implant and grow in the pelvic or abdominal cavities. This is called retrograde menstruation. This happens in many women, but there may be something different about the immune system in women who develop endometriosis compared to those who do not get the condition.
Endometriosis is a common problem. Sometimes, it may run in the family. Although endometriosis is typically diagnosed between ages 25 - 35, the condition probably begins about the time that regular menstruation begins.
A woman who has a mother or sister with endometriosis is six times more likely to develop endometriosis than women in the general population. Other possible risk factors include:
Pain is the main symptom for women with endometriosis. This can include:
Note: Often there are no symptoms. In fact, some women with severe cases of endometriosis have no pain at all, whereas some women with mild endometriosis have severe pain.
Tests that are done to diagnose endometriosis include:
Treatment options include:
Treatment depends on the following factors:
Some women who do not ever want children and have mild disease and symptoms may choose to just have regular exams every 6 - 12 months so the doctor can make sure the disease isn't getting worse. They may manage the symptoms by using:
Treatment may involve stopping the menstrual cycle and creating a state resembling pregnancy. This is called pseudopregnancy. It can help prevent the disease from getting worse. It's done using birth control pills containing estrogen and progesterone.
Another treatment involves progesterone pills or injections. Side effects may be bothersome and include depression, weight gain, and spotting of blood.
Some women may be prescribed medicines that stop the ovaries from producing estrogen. These medicines are called gonadotropin agonist drugs and include nafarelin acetate (Synarel) and Depo Lupron.
Surgery is an option for women who have severe pain that does not improve with hormone treatment, or who want to become pregnant either now or in the future.
Hormone therapy and pelvic laparoscopy cannot cure endometriosis. However, it can partially or completely relieve symptoms in many patients for a number of years.
Removing the uterus (hysterectomy), both ovaries and tubes give the best chance of a cure for endometriosis. You may need hormone replacement therapy after your ovaries are removed. Rarely endometriosis can come back, even after a hysterectomy.
Endometriosis may result in infertility, but not in every patient, and especially if the endometriosis is mild. Laparoscopic surgery may help improve fertility. The chance of success depends on the severity of the endometriosis. If the first surgery does not aid in getting pregnant, repeating the laparoscopy is unlikely to help. Patients should consider further infertility treatments.
Endometriosis can lead to problems getting pregnant (infertility). Other complications include:
Other complications are rare. In a few cases, endometriosis implants may cause blockages of the gastrointestinal or urinary tracts.
Very rarely, cancer may develop in the areas of endometriosis after menopause.
Call for an appointment with your health care provider if:
Consider getting screened for endometriosis if your mother or sister has been diagnosed with endometriosis, or if you are unable to become pregnant after trying for 1 year.
Birth control pills may help to prevent or slow down the development of the disease.