What is Endometriosis?
Endometriosis is an often
painful disorder of the female reproductive system. In endometriosis, a
specialized type of tissue that normally lines the inside of your uterus (the
endometrium) becomes implanted outside your uterus, most commonly on your
fallopian tubes, ovaries or the tissue lining your pelvis. Rarely, endometrial
tissue may spread beyond your pelvic region. Other sites for these endometrial
growths may include the bladder, bowel, vagina, cervix, vulva, and in abdominal
surgical scars. Less commonly they are found in the lung, arm, thigh, and other
During your menstrual cycle,
hormones signal the lining of your uterus to thicken to prepare for possible
pregnancy. If a pregnancy doesn't occur, hormone levels decrease, causing the
thickened lining of your uterus to shed. This produces bleeding that exits your
body through the vagina — your monthly period.
When endometrial tissue is
located elsewhere in your body, it continues to act in its normal way: It
thickens, breaks down and bleeds each month as your hormone levels rise and
fall. Each month the tissue builds up, breaks down, and sheds. Menstrual blood
flows from the uterus and out of the body through the vagina, but the blood and
tissue shed from endometrial growths has no way of leaving the body. This
results in internal bleeding, breakdown of the blood and tissue from the
lesions, and inflammation -- and can cause pain, infertility, scar tissue
formation, adhesions, and bowel problems.
Trapped blood may lead to the
growth of cysts. Cysts, in turn, may form scar tissue and adhesions — abnormal
tissue that binds organs together. This process can cause pain in the area of
misplaced tissue, often the pelvis, especially during your period. Scars and
adhesions related to endometriosis also can cause fertility problems.
Endometriosis isn't the only
cause of pelvic pain. If you're experiencing pelvic pain, see your doctor to
determine whether endometriosis or another condition is the cause, and to target
What are the Symptoms of
Endometriosis can be mild,
moderate or severe, and it tends to get worse over time without treatment. Some
women with endometriosis have no signs and symptoms at all, and the disease is
discovered only during an unrelated operation, such as a tubal ligation. Other
women may experience one or more of the following signs and symptoms:
Pain before and during
periods. Some cramping during your period is normal. But women with
endometriosis typically describe menstrual pain that's far worse than usual.
They also tend to report that the pain has increased over time.
Pain is a common symptom of endometriosis. However, severity of pain isn't
necessarily a reliable indicator of the extent of the condition. Some women
with mild endometriosis have extensive pain, while others with more severe
scarring may have little pain or even no pain at all.
Pain while having sex
Painful urination during
Painful bowel movements during
Other Gastrointestinal upsets
such as diarrhea, constipation, nausea.
What causes Endometriosis?
The cause is really not known
but some theories have been put forward
The retrograde menstruation
theory (transtubal migration theory) suggests that during menstruation some of
the menstrual tissue backs up through the fallopian tubes, implants in the
abdomen, and grows. Some experts believe that all women experience some
menstrual tissue backup and that an immune system problem or a hormonal
problem allows this tissue to grow in the women who develop endometriosis.
Another theory suggests that
endometrial tissue is distributed from the uterus to other parts of the body
through the lymph system or through the blood system.
A genetic theory suggests that
it may be carried in the genes in certain families or that some families may
have predisposing factors to endometriosis.
Another theory suggests that
remnants of tissue from when the woman was an embryo may later develop into
endometriosis, or that some adult tissues retain the ability they had in the
embryo stage to transform reproductive tissue in certain circumstances.
Endometriosis is most likely to
occur in women who haven't had children. Some women may have an inherited
tendency to develop endometriosis. Endometriosis can affect menstruating women
of any age or race, and it usually takes several years after the onset of
menstruation (menarche) to develop. When menstruation ends permanently with
menopause or temporarily with pregnancy, the signs and symptoms of endometriosis
stop. They can begin again after pregnancy when menstruation resumes. Rarely,
hormone replacement therapy after menopause can reactivate the disorder.
How is Endometriosis
To diagnose endometriosis and
other conditions that can cause pelvic pain, your doctor will ask you to
describe your symptoms, including the location of your pain and when it occurs.
Your doctor will perform a pelvic exam to check for any abnormalities, such as
cysts on your reproductive organs or scars behind your uterus. Often it's not
possible to feel small areas of endometrial implantation, unless they've caused
a cyst to form.
Other tests to check for physical clues of endometriosis include:
* Ultrasound. During a vaginal ultrasound, a wand-shaped
scanner (transducer) is inserted into your vagina. In an ultrasound of the
pelvis via the abdomen, a small scanner is moved across your abdomen. Both tests
use sound waves to provide a video image of your reproductive organs.
Because endometrial implants often cannot be felt or clearly seen in some tests,
a common way a doctor can make a definitive diagnosis of endometriosis is
through a minor surgical procedure called laparoscopy.
You receive a general anesthetic before the procedure begins. Using a special
needle, your abdomen is expanded (distended) with carbon dioxide gas so that the
reproductive organs are easier to see. A tiny incision is made near your navel,
and a slender viewing instrument (laparoscope) is inserted. By moving the
laparoscope around, the surgeon can view the pelvic and other abdominal organs,
looking for signs of endometrial tissue outside the uterus.
Laparoscopic view of
an endometriotic cyst
Cyst wall being peeled
If you have endometriosis, laparoscopy will provide you and your doctor with
information about the location, extent and size of the endometrial implants.
This information will help your doctor guide you through treatment options.
Sometimes, symptoms and signs are obvious enough that a laparoscopy isn't
* Blood test. Cancer antigen 125
(CA 125) is a blood test often used to detect tumor markers for certain cancers,
but it's also used to detect a certain protein found in the blood of women with
endometriosis. Although CA 125 commonly reveals an elevation in such blood
protein in women with advanced endometriosis, it's not as sensitive to mild or
moderate disease. As with cancer, CA 125 doesn't perform well as a screening
test for endometriosis because it's least sensitive when the disease is in its
The main complication of
endometriosis is impaired fertility. Approximately one-third to one-half of
women who have difficulty becoming pregnant have endometriosis.
For pregnancy to occur, an egg must be released from an ovary and travel through
the fallopian tube to the uterus (womb), where it can be fertilized by a male's
sperm and then attach to the uterine wall to begin development. Endometriosis
can produce adhesions that can trap the egg near the ovary. It may inhibit the
mobility of the fallopian tube and impair its ability to pick up the egg. In
most cases, however, endometriosis probably interferes with conception in more
Despite these possible complications, many women with endometriosis are still
able to conceive. It may take them a little longer to get pregnant, but most
women with mild to moderate endometriosis can become pregnant. During pregnancy,
most women have no signs or symptoms of endometriosis.
Doctors sometimes advise women with endometriosis not to delay having children
because endometriosis tends to worsen with time. The longer you have
endometriosis, the greater your chance of becoming infertile.
Although cancerous changes may occur in endometrial implants, the rate of cancer
in this tissue hasn't been shown to be higher than that in other tissues. Having
endometriosis doesn't increase your risk of uterine cancer or ovarian cancer.
What are your treatment
options if you have Endometriosis?
Treatment for endometriosis is
usually with medications or surgery. The approach you and your doctor choose
will depend on the severity of your signs and symptoms and whether you hope to
Your doctor may recommend that you take an over-the-counter pain reliever,
such as ibuprofen, mefanamic acid etc, to help ease painful menstrual cramps.
However, if you find that taking the maximum dose doesn't provide full relief,
you may need to try another treatment approach to manage your signs and
Supplemental hormones are effective in reducing or eliminating the pain of
endometriosis. That's because the rise and fall of hormones during a woman's
menstrual cycle causes endometrial implants to thicken, break down and bleed. In
fact, if hormonal therapy has little to no effect on your symptoms, consider
questioning the diagnosis of endometriosis or its relationship to your symptoms.
Hormonal therapies used to treat endometriosis include:
* Oral contraceptives. Birth control pills
help control the hormones responsible for the buildup of endometrial tissue each
month. Taking the pill long term can reduce or eliminate the pain of
endometriosis. Most women also have lighter and shorter menstrual flow when
they're taking the pill.
* Gonadotropin-releasing hormone (Gn-RH) agonists and antagonists. These drugs
block the production of ovarian-stimulating hormones. This action prevents
menstruation and dramatically lowers estrogen levels, causing endometrial
implants to shrink. Gn-RH agonists and antagonists can force endometriosis into
remission during the time of treatment and sometimes for months or years
afterward. These drugs create an artificial menopause that can sometimes lead to
troublesome side effects, such as hot flashes and vaginal dryness. A low dose of
estrogen may be taken along with these drugs to decrease such side effects.
* Danazol (Danocrine). Another drug that blocks the production of
ovarian-stimulating hormones, preventing menstruation and the symptoms of
endometriosis, is danazol. In addition, it suppresses the growth of the
endometrium. However, danazol may not be the first choice because it can cause
unwanted side effects, such as acne and facial hair.
* Progesterone. This drug is effective in halting menstruation and the growth of
endometrial implants, thereby relieving the signs and symptoms of endometriosis.
Its side effects can include weight gain and depressed mood. However it is one
of the most cost effective treatments available.
Although hormone therapies are effective in reducing or eliminating symptoms
of endometriosis, they prevent pregnancy. If you have endometriosis and are
trying to become pregnant, surgery to remove implants may increase your chances
of success. If you have severe pain from endometriosis, you may also benefit
Conservative surgery removes endometrial growths, scar tissue and adhesions
without removing your reproductive organs. Your doctor may do this procedure
laparoscopically, or through traditional abdominal
surgery in more extensive cases. In laparoscopic surgery, a slender viewing
instrument (laparoscope) is inserted through a small incision near your navel.
The laparoscope is equipped with a laser, a cautery — an instrument that
destroys tissue with heat — or small surgical instruments.
Assisted reproductive technologies to help you become
pregnant are sometimes preferable to conservative surgery, and doctors often
suggest these approaches if conservative surgery is ineffective.
In severe cases of endometriosis, a total hysterectomy and the removal of
both ovaries may be the best treatment. Hysterectomy alone is also effective,
but removing the ovaries ensures that endometriosis will not return. Either type
of surgery is typically considered a last resort, especially for women still in
their reproductive years. You can't get pregnant after a hysterectomy.
Although no single treatment option is ideal for everyone, most women who seek
help for endometriosis find some, if not complete, relief from their symptoms.
If your pain persists or if finding a treatment that works takes some time, you
can try measures at home to relieve your discomfort. Warm baths and a heating
pad can help relax pelvic muscles, reducing cramping and pain.
"Uterine Endometriosis" or Adenomyosis