Endometriosis

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Definition | Causes | Risk Factors | Symptoms | Diagnosis | Treatment | Prevention | Organizations

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Definition

Endometriosis is a chronic disease involving the endometrial tissue. Normally endometrial tissue is found only inside the uterus, the reproductive organ where a fetus develops. Hormones direct the tissue to build up to prepare for a fertilized egg. If conception does not occur, the tissue passes out of the body during menstruation. Endometriosis occurs when tissue from the uterine lining is found outside the uterus. It may attach to 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.

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 in the abdomen transform into endometrial tissue.

Whatever the cause, the disease progresses due to the release of hormones and growth factors. Pregnancy slows or stops the disease from advancing. The condition usually resolves at menopause but symptoms may return with hormone replacement therapy.

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.

• A mother or sister with endometriosis
• Early onset of menstruation
• Delaying pregnancy
• Regular periods with prolonged menstrual bleeding (more than 7-8 days)

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

The doctor will ask about your symptoms and medical history, and perform a pelvic exam. This 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. Knowing the size, number and location of growths 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
• Your reproductive 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. Birth control pills and other 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. These drugs are harmful to a developing fetus. You must use a barrier method of birth control while taking them.

Surgery

For severe symptoms or for women who want to get pregnant, doctors can try to remove endometrial growths, often with laser surgery. Unlike hormonal therapy, surgery can restore fertility and is associated with a lower recurrence rate. In severe cases, it may be necessary to remove the uterus and/or ovaries along with the abnormal growths. This eliminates the possibility of pregnancy.

Prevention

Studies suggest that regular exercise, starting before age 15, may reduce the chance of endometriosis.

Organizations

Endometriosis Association
http://www.endometriosisassn.org/

SOURCES:

Conn's Current Therapy 2001, 53rd ed. W. B. Saunders Company, 2001.

Griffith's 5-Minute Clinical Consult, 1999 ed. Lippincott Williams and Wilkins, 1999.

Kistner's Gynecology & Women's Health, 7th ed., Mosby-Year Book, 1999.

American Academy of Family Physicians

National Institute of Child Health and Human Development

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Last reviewed June 2001 by Medical Review Board