Endometriosis

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Introduction

What is endometriosis?

Endometriosis is the abnormal growth of endometrial, or uterine lining, tissue in areas other than the uterine lining, such as on the ovaries, in the fallopian tubes, the pelvic lining, or on the intestines. Less commonly, endometriosis may develop at other distant locations anywhere in the body. This condition affects 10% of all premenopausal females and 25% of infertile women.

The cause of endometriosis is not completely understood, but it may be a result of the endometrial cells going in the reverse direction, backing up through the fallopian tube and into the pelvis. It is also possible that factors related to the immune system play a role in its development or that endometrial tissue develops in abnormal locations in affected women.

Endometriosis is most common in women between the ages of 25 and 35. It also has a strong familial link. If your sister or mother has the condition, then you are approximately five to six times more likely to develop it (Source: NIH).

The symptoms of endometriosis may occur frequently or not at all. Some women with endometriosis do not have symptoms, while others experience pain and prolonged vaginal bleeding during menstruation. The pain can be cyclical and can occur during sexual activity (dyspareunia). The symptoms may occur during menstruation or up to 10 days before or after a woman’s menstrual period.

Treatment options range from medications to surgical procedures. The severity of symptoms, location of the endometriosis, and age of the woman are considered when making the appropriate decision for treatment.

Seek immediate medical care (call 911) for serious symptoms, such as severe abdominal pain, persistent vomiting, or inability to urinate or have a bowel movement. Seek prompt medical care if you are being treated for endometriosis but mild symptoms recur or are persistent, or if you experience blood in the urine or difficulty urinating.

Symptoms

What are the symptoms of endometriosis?

Endometriosis is the abnormal growth of endometrial tissue outside the uterine lining that can result in a number of symptoms. Cyclical pain in the pelvic area is the most common symptom, but the severity of the pain does not relate to the amount of endometriosis that is present. The symptoms can vary in intensity among individuals.

Common symptoms of endometriosis

You may experience endometriosis symptoms daily or only occasionally. Any of the following symptoms can be severe:

  • Abdominal, pelvic, or lower back pain during and after menstrual period

  • Abdominal, pelvic, or lower back pain during and after menstrual period

  • Cramps in pelvis before, during and after menstrual period

  • Difficulty or inability to get pregnant (subfertility)

  • Fatigue

  • Heavy bleeding during menstrual period (menorrhagia)

  • Lower back pain

  • Menstrual periods that are very painful

  • Pain during or after sexual intercourse

  • Painful bowel movements

Serious symptoms that might indicate a life-threatening condition

In some cases, endometriosis can be life threatening. Seek immediate medical care (call 911) if you, or someone you are with, have any of these life-threatening symptoms including:

  • Inability to have a bowel movement
  • Inability to urinate
  • Persistent vomiting
  • Severe abdominal pain
Causes

What causes endometriosis?

Endometriosis develops in women when endometrial tissue grows in areas outside of the uterus. Like the uterine lining, this extra-uterine tissue responds to the hormonal changes of each menstrual cycle by swelling, thickening, and possibly bleeding. However, unlike the uterine lining, which is shed off each month, this abnormal endometrial tissue remains where it is located. Eventually, this extra-uterine tissue may scar, forming an adhesion that may be painful or cause more symptoms.

The cause of endometriosis is not entirely understood. It is possible that it could be due to the reverse movement of endometrial cells as they shed from the wall of the uterus during the normal menstrual cycle, or it could be due to immune factors or to the development of endometrial tissue in abnormal sites.

What are the risk factors for endometriosis?

A number of factors increase the risk of developing endometriosis. Not all people with risk factors will develop endometriosis. Risk factors include:

  • Blocked flow of menstrual blood during the period, possibly due to a closed hymen

  • Family history of endometriosis

  • Frequent menstrual cycles

  • No history of pregnancy or breastfeeding

  • Short menstrual cycles

  • Young age at start of menstruation

Treatments

How is endometriosis treated?

Treatment for endometriosis begins with seeking medical care from your health care provider. To determine whether you have endometriosis, your health care provider will ask you to undergo a pelvic examination.

Some women with endometriosis never have any symptoms, but when symptoms do occur, there are several treatment options available. Your health care provider will determine the best treatment options for you based on your age, the severity of your symptoms, and whether or not you plan to have children.

Treatment options for endometriosis

A number of different treatment options for endometriosis are possible. The choice of treatment depends upon the severity of the condition, a woman’s desire for fertility, and the overall health and age of the patient. Options include:

  • Hormone medications, such as a gonadotropin-releasing hormone agonists and antagonists, oral contraceptives, or progestins to slow the growth of endometriosis and to reduce the size of endometriosis implants

  • Hysterectomy (partial or total)

  • Nonsteroidal pain medications, such as ibuprofen (Advil), acetaminophen (Tylenol), and naproxen (Aleve)

  • Surgical removal or destruction of endometriosis

  • Treatments for infertility, if indicated

What are the potential complications of endometriosis?

Infertility is the main complication of endometriosis. You can help minimize your risk of serious complications by following the treatment plan you and your health care professional design specifically for you. Complications of endometriosis include:

  • Chronic pain

  • Gastrointestinal blockage

  • Hemorrhage

  • Infertility

  • Pelvic cysts that have the potential to rupture (endometriomas)

  • Perforation of affected organ

  • Urinary blockage

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2018 Nov 12
  1. Endometriosis. Medline Plus, a service of the National Library of Medicine National Institutes of Health. http://www.nlm.nih.gov/medlineplus/ency/article/000915.htm.
  2. Pain management of endometriosis. ACOG American Congress of Obstetricians and Gynecologists. http://www.acog.org/About_ACOG/News_Room/News_Releases/2010/Pain_Management_of_Endometriosis.
  3. Engemise S, Gordon C, Konje JC. Endometriosis. BMJ 2010; 340:c2168.
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