Obstetrics and Gynecology

Endometriosis

What is endometriosis?

Endometriosis is a condition in which tissue normally found in the lining of a woman’s uterus – known as the endometrium – grows elsewhere in the body, typically in the pelvic region. The tissue growth often occurs on the ovaries, bowel, or the lining of the pelvis.

Each month, this displaced tissue responds as it normally would during a woman's menstrual cycle, thickening and then shedding through bleeding. However, because it has no way to exit the body, it becomes trapped and can irritate the surrounding tissue, causing scar tissue (known as adhesions).

This ongoing process can cause pain, difficulty getting pregnant, and in some cases infertility.

While there is no cure for endometriosis, a variety of treatment options are available to help relieve pain and preserve or restore fertility.

What causes endometriosis?

The cause of endometriosis is not yet known.

One common theory is that menstrual blood containing endometrial cells flows backward through the fallopian tubes and into the pelvic cavity instead of out of the body. These displaced cells stick to the pelvic walls and surfaces of the reproductive organs, where they grow and continue to thicken and bleed during each menstrual cycle. This theory is known as retrograde menstruation.

Additional theories suggest the cause is related to genes, the endocrine system, or the immune system, among others.  

What are the risk factors for endometriosis?

Any woman who has menstrual periods can get endometriosis, however, it is most common in women between ages 25 and 40.

Possible risk factors include:

  • Never gave birth
  • One or more relatives (mother, aunt or sister) with endometriosis
  • Frequent menstrual cycles
  • Periods that last longer than eight days
  • Starting menstruation at an early age
  • Any medical condition that prevents the normal passage of menstrual flow
  • A history of pelvic infection

What are the symptoms of endometriosis?

Symptoms may include:

  • Pain before or during the menstrual cycle, including cramping, lower back pain, and abdominal pain
  • Pain during or after intercourse
  • Pain during bowel movements or when urinating
  • Excessive bleeding or bleeding between periods
  • Infertility

Many women with endometriosis have no symptoms. In some cases, it may not be diagnosed until a woman has difficulty getting pregnant.

How is endometriosis diagnosed?

Diagnosis starts with a detailed medical history and a physical exam, including pelvic exam. Diagnostic testing may include:

Laparoscopy – a tiny tube with a camera on the end (laparoscope) is inserted through a small incision in the abdomen to view the internal organs and look for signs of endometriosis. A small tissue sample (biopsy) may be removed during the procedure and examined under a microscope to confirm the diagnosis.

Ultrasound – uses sound waves to create images of the reproductive organs 

How is endometriosis treated?

Treatment depends on the individual patient, the severity of symptoms and disease, and whether the woman wants to become pregnant in the future.

Treatment strategies include:

Pain medications – including over-the-counter nonsteroidal anti-inflammatory drugs and prescription painkillers.

Hormone therapies – to relieve pain, shrink or slow the growth of endometrial tissue, and prevent new growth. Hormone therapies help control or prevent the menstrual cycle that is responsible for the buildup of endometrial tissue each month.

Surgery – to remove the areas of endometriosis and scar tissue, which may help improve fertility. Surgery may be performed laparoscopically, a minimally invasive approach, or through traditional pelvic surgery.

Hysterectomy – to remove the uterus and both ovaries, in cases of severe pain that doesn’t respond to other treatments. Because the woman will no longer be able to get pregnant following a hysterectomy, it is considered a last resort for women still in their reproductive years.