Endometriosis

Endometriosis is a chronic, painful condition that affects around 6 million U.S. women and teens. The condition is the result of endometrium tissue (lines the uterus) growing outside the uterus, such as on the ovaries, abdominal cavity, fallopian tubes, perineum, and ligaments. Other sites for endometrial tissue growth is the outer surface of the uterus, the bladder, bowels, cervix, vulva, and vagina.

 

The misplaced endometrial tissue develops as lesions or growth, and this tissue responds to hormones and the menstrual cycle. Each month, as the uterus lining builds up and sheds, the endometrial growths shed, which results in blood that cannot leave the body. This internal bleeding and breakdown of tissue causes inflammation, pain, scar tissue formation, and infertility.

 

What are the symptoms of endometriosis?

The symptoms of endometriosis include:

  • Infertility
  • Fatigue
  • Pain before and during periods
  • Pain with sex
  • Painful bowel movements
  • Pain with urination
  • Diarrhea
  • Constipation

 

What causes endometriosis?

The exact cause of endometriosis is unknown. One theory suggests that menstrual tissue backs up in the fallopian tubes, implants in the abdominal cavity, and grows there. A hormone or immune system problem allows this tissue to develop into endometriosis. Another theory involves endometrial tissue being distributed via the lymph and blood system. Finally, a genetic theory suggest that women are born with endometrial tissue outside the uterine cavity, which is an inherited trait.

 

Who gets endometriosis?

Any woman can have endometriosis, but symptoms do not occur until puberty. Endometriosis is most often diagnosed between ages 25 and 40 years, but it can be found earlier. The condition also may persist after menopause, but onset at that time is rare.

 

What are the risk factors for endometriosis?

Endometriosis symptoms often start several years after the onset of menstruation. The symptoms end during pregnancy and menopause. Several factors increase the risk for endometriosis, such as:

  • History of pelvic infection
  • Never giving birth
  • Relative with the condition
  • Uterine abnormalities

 

How is endometriosis diagnosed?

Endometriosis is assessed using a surgery procedure called laparoscopy. With this procedure, the doctor inserts a tiny scope through a small abdominal incision, which allows the doctor to look for endometrial growths and implants. A biopsy (taking a small amount of tissue for analysis) confirms the diagnosis.

 

Can endometriosis be treated with medications?

There is no cure for endometriosis, but certain medications are used to reduce the size of the growths to alleviate pain. Options include:

  • Birth control pills
  • Mirena IUD
  • Danazol (danocrine)
  • Gonadotropin-releasing hormone (GnRH agonist)
  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Progestins

 

What surgery is used to treat endometriosis?

For moderate to severe cases of endometriosis, surgery is an option. Surgery is useful for improving pregnancy rates. This involves removal of endometrial tissue implants and growths from the reproductive tract.

Advanced laparoscopic surgery involves resection, vaporization, and/or fulguration of endometriosis implants and nodules. To reduce pain, nerve interruption procedures can be done during the procedure, such as a presacral nerve ablation or uterosacral neurectomy. Scar tissue (adhesions) can be removed and resected using an ovary-tissue sparing technique.

 

What are the complications of endometriosis?

Impaired fertility is the main complication of endometriosis. Approximately 33-50% of women with endometriosis have trouble becoming pregnant. Pregnancy occurs when the egg releases from the ovary and travels to the fallopian tube. There, the sperm fertilizes the egg cell, which implants into the uterus and develops into an embryo. Endometriosis tissue can obstruct the fallopian tube and prevent the sperm and egg from joining.