Endometrial tissue lines the inside of the uterus. In endometriosis, the same type of tissue also grows in places outside of the uterus.
Implants or patches of endometriosis may develop in the:
Outside surface of the uterus
Pelvis and lower abdomen
Spaces between the bladder, uterus and rectum
Wall of the rectum, bladder, intestines or appendix (less commonly)
Lung, arm, thigh and skin. (This is rare.)
Misplaced endometrial tissue behaves like endometrial tissue in the uterus. It responds to the monthly rise and fall of female hormones. At the time of menstruation, endometrial tissue outside the uterus also can ooze blood, and cause pelvic or abdominal pain.
If the misplaced endometrial tissue enlarges to cover or grow into the ovaries, or if it blocks the fallopian tubes, it can it can interfere with a woman's fertility by blocking the passage of an egg from the ovaries into the uterus.
Endometrial tissue on the ovaries may form into large fluid-filled cysts. These are called endometriomas.
A woman may have an increased risk of endometriosis if:
She has a heavy menstrual flow.
She has a short menstrual cycle (27 days or less).
She has a close female relative with endometriosis.
A woman's risk is probably lower than average if:
She is slightly underweight.
She exercises regularly.
She has had multiple pregnancies.
She has used oral contraceptives.
Many women with endometriosis do not have any symptoms from it. Those who have symptoms may experience:
Severe discomfort, usually with heavy flow, during menstrual periods
Pain in the pelvis or abdomen, usually just before or during menstruation, but sometimes throughout the month
Pain during or immediately after sexual intercourse
Vaginal spotting before menstruation begins
Bowel symptoms, such as:
Painful bowel movements
Rarely, blood in the stool
Painful urination, or, rarely, blood in the urine
Infertility or repeated miscarriages
The doctor will review:
Your medical and gynecological history
Family history of endometriosis
This will be followed by a physical exam and a pelvic exam.
During the pelvic exam, your doctor may be able to feel the following signs of endometriosis.
Endometrial tissue embedded in the ligaments of your pelvis
Displaced pelvic organs
How freely your pelvic organs may be moved
An ovarian endometrioma—a deposit of endometrial tissue on your ovaries
To confirm the diagnosis, your doctor may need to do pelvic laparoscopic surgery. In this surgery, doctors operate through two or three tiny incisions. The surgery can identify endometrial tissue inside your pelvis or abdomen. Abnormal tissue may be removed for biopsy during the surgery.
Without treatment, endometriosis is a long-term problem. It usually lasts until menopause. After menopause, areas of misplaced endometrial tissue tend to become smaller, and are less likely to cause symptoms. That is particularly true if your symptoms have come only during menstrual periods.
There is no way to prevent endometriosis.
The condition may temporarily stop progressing if you:
Use oral contraceptives
Several treatment options are available.
For mild pelvic or abdominal pain, you may try a nonprescription pain medication. Examples include ibuprofen (Advil, Motrin) or naproxen (Aleve). If this doesn't help, your doctor may suggest a prescription-strength nonsteroidal pain reliever.
Stronger medications that contain a mild narcotic, such as codeine, are available. But narcotics pose a risk of drug dependence and addiction. They are prescribed only when other pain medications fail or can't be used because of side effects or allergic reactions.
Treatments that control hormone levels
Some treatments relieve pain by controlling levels of female hormones, particularly if your symptoms occur mainly or only during menstrual periods. These include:
Gonadotropin-releasing hormone (GnRH) agonists. GnRH agonists temporarily, but dramatically, decrease levels of female hormones. Since these hormones encourage the inflammation within patches of endometriosis that cause the symptoms of the disease, decreasing the levels of these hormones often improves the symptoms.
Aromatase inhibitors—drugs used to treat breast cancer that seem to decrease the amount of estrogen in patches of endometriosis (although they are not yet officially approved for such use). The two most commonly used aromatase inhibitors areanastrozole andletrozole.
Conservative surgical treatments
During laparoscopy, your doctor will destroy small areas of extra endometrial tissue that are implanted outside the uterus. He may burn them away or use a laser to vaporize them. Your doctor also may trim away tissue that is displacing your pelvic organs. These procedures often can be done during a diagnostic laparoscopy session.
For more extensive endometriosis, you may need traditional abdominal surgery. This is done through a larger incision. The larger incision provides more room to reach and treat all areas of endometriosis inside your pelvis and abdomen.
The doctor may treat endometriosis by removing the uterus, ovaries and fallopian tubes. Hysterectomy is a last resort when other measures have failed. It is only performed in women with severe disabling pain who no longer want to become pregnant.
The treatment option that is best for you depends on several factors. These include the severity of your symptoms and your plans for pregnancy.
Call your doctor or gynecologist if you experience:
Unusual and severe pain just before or during your menstrual period
Pelvic or abdominal pain
Abnormally heavy menstrual periods
Any other symptom of endometriosis
Also contact your doctor if you have been unable to conceive a child after one year of unprotected intercourse.
The outlook is good, especially when endometriosis is diagnosed and treated early. Medical and surgical treatments can relieve the pain of endometriosis in most women.
Even without treatment, the majority of women with mild endometriosis eventually can become pregnant. Many women who have laparoscopic surgery to improve their fertility become pregnant.
Symptoms of endometriosis go away after menopause, as long as estrogen treatment is not used.
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