Overview, Causes, & Risk Factors

The endometrium is the tissue that lines the inside of the uterus. Endometriosis occurs when this tissue travels outside the uterus.

What is going on in the body?

The female hormones estrogen and progesterone encourage the growth of endometrial tissue during a woman’s monthly cycle. If no fertilized egg implants itself in this lining, it is shed as menstrual flow. In a woman with endometriosis, some of the endometrial tissue is found outside the uterus. This tissue also responds to cyclic hormonal signals. However, it cannot be cast off each month. Instead, the cells cause bleeding and scars. Adhesions, or scar tissue, may weld together organs. These include the fallopian tubes and ovaries. This can cause daily or monthly cyclic pain.

Endometriosis often appears in the pelvis or abdominal cavity. Rarely, distant areas like the lungs or brain are affected.

What are the causes and risks of the condition?

The cause of endometriosis is unknown. Several theories have been proposed. It is possible that:

  • delayed childbearing increases the risk for endometriosis
  • during menstruation, some of the endometrial tissue backs up through the fallopian tubes into the abdomen
  • genetics play a role, with some families being more prone to endometriosis
  • the immune system activates cells that secrete factors to stimulate endometriosis
  • Symptoms & Signs

    What are the signs and symptoms of the condition?

    Some women with severe endometriosis have no symptoms. If symptoms do occur, they generally start years after the woman’s first menstrual period. The symptoms usually increase gradually as the area of endometriosis grows. After menopause, the symptoms subside as the abnormal tissue shrinks.

    The most common symptom of endometriosis is increasingly painful periods, or dysmenorrhea. The woman may experience a steady dull or severe pain in the lower abdomen, vagina, and/or back. This pain can begin 5 to 7 days before a period.

    Symptoms of endometriosis may include:

  • blood in the urine
  • difficulty urinating
  • dyspareunia, or painful intercourse
  • heavy menstrual bleeding
  • irregular or more frequent periods
  • nausea and vomiting
  • pain with bowel movements
  • pelvic pain after intercourse or exercise
  • spotty bleeding just before the period starts
  • Diagnosis & Tests

    How is the condition diagnosed?

    Diagnosis of endometriosis begins with a medical history and physical exam, including a pelvic exam. A laparoscopy may be done to confirm the diagnosis. A small incision is made, and a lighted tube is inserted into the pelvis. The healthcare provider looks for abnormal cells and other abnormalities. If the endometriosis is severe, an exploratory laparotomy may be done. This involves a larger incision in the abdomen. The provider can then use tiny surgical tools to identify problems.

    Prevention & Expectations

    What can be done to prevent the condition?

    Endometriosis is not preventable. Early diagnosis and treatment may limit cell growth and help prevent adhesions. Pregnancy, oral contraceptives, and other hormones seem to delay its onset.

    What are the long-term effects of the condition?

    Many women with endometriosis have no long-term problems. Others may have the following conditions:

  • bowel obstruction
  • constant bladder or rectal pain
  • constant pelvic pain
  • damage to the kidneys and ureters
  • irritable bowel syndrome
  • pelvic or abdominal adhesions
  • Thirty to 40% of women with endometriosis face infertility. Less than 1% of women with endometriosis develop endometrial cancer.

    What are the risks to others?

    Endometriosis is not contagious and poses no risk to others.

    Treatment & Monitoring

    What are the treatments for the condition?

    Endometriosis may never be cured or eliminated. Women with mild symptoms are usually treated only with pain medicines as needed. Antiprostaglandins, such as ibuprofen or acetaminophen, are effective.

    Different types of hormones can control the growth of the endometriosis and the symptoms. Oral contraceptives or high doses of progestin may slow abnormal tissue growth. Danazol, a weak male hormone, can shrink cell growth. It is only given to women who do not want to get pregnant.

    Gonadotropin-releasing hormone (GnRH) agonists may also be used. These medicines stop the ovary from making hormones and releasing an egg. Because bone loss is possible, GnRH agonists are used for only 6 months.

    Surgery is an option for women with severe endometriosis or infertility. Laser surgery, laparoscopy, or laparotomy may be done to remove endometrial tissue and adhesions. For women with severe pelvic pain, cutting certain nerves in the pelvis may help. Hysterectomy and the removal of ovaries may be done if an older woman does not want children.

    What are the side effects of the treatments?

    Hormones may cause depression and irregular menstrual bleeding. They may also cause weight gain, headaches, and mood swings. Surgery may cause bleeding, infection, or allergic reaction to anesthesia.

    What happens after treatment for the condition?

    Endometriosis recurs in 10% to 30% of cases. Despite treatment, pelvic pain may return. Fertility may be impaired. After previously infertile women have had surgery, pregnancy occurs in about:

  • 75% of those who had mild disease
  • 50% to 60% of those who had moderate disease
  • 30% to 40% of those who had severe disease
  • How is the condition monitored?

    Any new or worsening symptoms should be reported to the healthcare provider.

    Article type: xmedgeneral