Endometriosis
Definition:
Endometriosis is an often painful disorder in which tissue that normally lines the inside of your uterus — the endometrium
— grows outside your uterus.
Endometriosis most commonly involves your ovaries, bowel or the tissue lining your pelvis. Rarely, endometrial tissue may spread beyond your pelvic region.
In endometriosis, displaced endometrial tissue continues to act as it normally would: It thickens, breaks down and bleeds with each menstrual cycle. And because this displaced tissue has no way to exit your body, it becomes trapped. Surrounding tissue can become irritated, eventually developing scar tissue and adhesions
— abnormal tissue that binds organs together.
This process can cause pain
— sometimes severe
— especially during your period.
Fertility problems also may develop. Fortunately, effective treatments are available.
Symptoms:
The primary symptom of endometriosis is pelvic pain, often associated with your menstrual period. Although many women experience cramping during their menstrual period, 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.
Common signs and symptoms of endometriosis may include:
Endometriosis is sometimes mistaken for other conditions that can cause pelvic pain, such as pelvic inflammatory disease (PID) or ovarian cysts. It may be confused with irritable bowel syndrome (IBS), a condition that causes bouts of diarrhea, constipation and abdominal cramping. IBS can accompany endometriosis, which can complicate the diagnosis.
When to see a doctor
See your doctor if you have signs and symptoms that may indicate endometriosis. The cause of chronic or severe pelvic pain may be difficult to pinpoint. But discovering the problem early may help you avoid unnecessary complications and pain.
Causes:
A process called retrograde menstruation is a likely explanation for endometriosis. In retrograde menstruation, menstrual blood containing endometrial cells flows back through the fallopian tubes and into the pelvic cavity instead of out of the body. These displaced endometrial cells stick to the pelvic walls and surfaces of pelvic organs, where they grow and continue to thicken and bleed over the course of the menstrual cycle.
Retrograde menstruation alone may not cause endometriosis, though. Instead, the condition may develop when one or more small areas of the abdominal lining turns into endometrial tissue. This is possible because the cells lining the abdominal and pelvic cavities are descended from embryonic cells with the potential to specialize and take on the structure and function of endometrial cells. What activates that potential remains unknown.
Complications:
The main complication of endometriosis is impaired fertility. Approximately one-third to one-half of women who have endometriosis have difficulty getting pregnant.
For pregnancy to occur, an egg must be released from an ovary, travel through the neighboring fallopian tube, become fertilized by a sperm cell and attach itself to the uterine wall to begin development. Endometriosis may obstruct the tube and keep the egg and sperm from uniting, but the condition also seems to affect fertility in less-direct ways.
Even so, many women with mild to moderate endometriosis are still able to conceive and carry a pregnancy to term. Doctors sometimes advise women with endometriosis not to delay having children because the condition may worsen with time. The longer you have endometriosis, the greater your chance of becoming infertile.
Treatments and drugs:
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 become pregnant.
Generally, doctors recommend trying conservative treatment approaches first, opting for surgery as a last resort.
Pain medications
Your doctor may recommend that you take an over-the-counter pain reliever, such as ibuprofen (Advil, Motrin, others), 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 symptoms.
Hormone therapy
Supplemental hormones are sometimes 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.
Hormonal therapies used to treat endometriosis include:
Conservative surgery
If you have endometriosis and are trying to become pregnant, surgery to remove endometrial implants may increase your chances of success. If you have severe pain from endometriosis, you may also benefit from surgery.
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. Guided by the laparoscope, your doctor inserts other instruments through another small incision to remove endometrial implants. Such instruments might include a laser, small surgical instruments or a cautery — an instrument that destroys tissue with heat.
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.
Hysterectomy
In severe cases of endometriosis, surgery to remove the uterus and cervix (total hysterectomy) as well as both ovaries may be the best treatment. Hysterectomy alone is not effective — the estrogen your ovaries produce can stimulate any remaining endometriosis and cause pain to persist. Surgery is typically considered a last resort, especially for women still in their reproductive years. You can't get pregnant after a hysterectomy.
Definition:
Endometriosis is an often painful disorder in which tissue that normally lines the inside of your uterus — the endometrium
— grows outside your uterus.
Endometriosis most commonly involves your ovaries, bowel or the tissue lining your pelvis. Rarely, endometrial tissue may spread beyond your pelvic region.
In endometriosis, displaced endometrial tissue continues to act as it normally would: It thickens, breaks down and bleeds with each menstrual cycle. And because this displaced tissue has no way to exit your body, it becomes trapped. Surrounding tissue can become irritated, eventually developing scar tissue and adhesions
— abnormal tissue that binds organs together.
This process can cause pain
— sometimes severe
— especially during your period.
Fertility problems also may develop. Fortunately, effective treatments are available.
Symptoms:
The primary symptom of endometriosis is pelvic pain, often associated with your menstrual period. Although many women experience cramping during their menstrual period, 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.
Common signs and symptoms of endometriosis may include:
- Painful periods (dysmenorrhea). Pelvic pain and cramping may begin before and extend several days into your period and may include lower back and abdominal pain.
- Pain with intercourse. Pain during or after sex is common with endometriosis.
- Pain with bowel movements or urination. You're most likely to experience these symptoms during your period.
- Excessive bleeding. You may experience occasional heavy periods (menorrhagia) or bleeding between periods (menometrorrhagia).
- Infertility. Endometriosis is first diagnosed in some women who are seeking treatment for infertility.
- Other symptoms. You may also experience fatigue, diarrhea, constipation, bloating or nausea, especially during menstrual periods.
Endometriosis is sometimes mistaken for other conditions that can cause pelvic pain, such as pelvic inflammatory disease (PID) or ovarian cysts. It may be confused with irritable bowel syndrome (IBS), a condition that causes bouts of diarrhea, constipation and abdominal cramping. IBS can accompany endometriosis, which can complicate the diagnosis.
When to see a doctor
See your doctor if you have signs and symptoms that may indicate endometriosis. The cause of chronic or severe pelvic pain may be difficult to pinpoint. But discovering the problem early may help you avoid unnecessary complications and pain.
Causes:
A process called retrograde menstruation is a likely explanation for endometriosis. In retrograde menstruation, menstrual blood containing endometrial cells flows back through the fallopian tubes and into the pelvic cavity instead of out of the body. These displaced endometrial cells stick to the pelvic walls and surfaces of pelvic organs, where they grow and continue to thicken and bleed over the course of the menstrual cycle.
Retrograde menstruation alone may not cause endometriosis, though. Instead, the condition may develop when one or more small areas of the abdominal lining turns into endometrial tissue. This is possible because the cells lining the abdominal and pelvic cavities are descended from embryonic cells with the potential to specialize and take on the structure and function of endometrial cells. What activates that potential remains unknown.
Complications:
The main complication of endometriosis is impaired fertility. Approximately one-third to one-half of women who have endometriosis have difficulty getting pregnant.
For pregnancy to occur, an egg must be released from an ovary, travel through the neighboring fallopian tube, become fertilized by a sperm cell and attach itself to the uterine wall to begin development. Endometriosis may obstruct the tube and keep the egg and sperm from uniting, but the condition also seems to affect fertility in less-direct ways.
Even so, many women with mild to moderate endometriosis are still able to conceive and carry a pregnancy to term. Doctors sometimes advise women with endometriosis not to delay having children because the condition may worsen with time. The longer you have endometriosis, the greater your chance of becoming infertile.
Treatments and drugs:
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 become pregnant.
Generally, doctors recommend trying conservative treatment approaches first, opting for surgery as a last resort.
Pain medications
Your doctor may recommend that you take an over-the-counter pain reliever, such as ibuprofen (Advil, Motrin, others), 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 symptoms.
Hormone therapy
Supplemental hormones are sometimes 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.
Hormonal therapies used to treat endometriosis include:
- Hormonal contraceptives. Birth control pills,
patches and vaginal rings help control the hormones responsible for the
buildup of endometrial tissue each month. Most women have lighter and
shorter menstrual flow when they're using a hormonal contraceptive.
Using hormonal contraceptives — especially continuous cycle regimens —
can reduce or eliminate the pain of mild to moderate endometriosis.
- 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. Taking a low dose of
estrogen or progestin along with Gn-RH agonists and antagonists may
decrease such side effects. If Gn-RH agonists don't relieve your pain,
it's unlikely that endometriosis is responsible for your symptoms.
- Danazol. 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.
- Medroxyprogesterone (Depo-Provera). This injectable
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, decreased bone production and
depressed mood.
- Aromatase inhibitors. Although not specifically approved for the treatment of endometriosis, studies suggest that aromatase inhibitors may significantly reduce endometriosis-related pain. Aromatase inhibitors work by blocking the conversion of hormones such as androstenedione and testosterone into estrogen and by blocking the production of estrogen from endometrial implants themselves. This deprives endometriosis of the estrogen it needs to grow. To reduce the risk of side effects, such as bone loss and follicular cysts, aromatase inhibitors must be taken in combination with a Gn-RH agonist or an oral estrogen-progestin contraceptive.
Conservative surgery
If you have endometriosis and are trying to become pregnant, surgery to remove endometrial implants may increase your chances of success. If you have severe pain from endometriosis, you may also benefit from surgery.
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. Guided by the laparoscope, your doctor inserts other instruments through another small incision to remove endometrial implants. Such instruments might include a laser, small surgical instruments or a cautery — an instrument that destroys tissue with heat.
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.
Hysterectomy
In severe cases of endometriosis, surgery to remove the uterus and cervix (total hysterectomy) as well as both ovaries may be the best treatment. Hysterectomy alone is not effective — the estrogen your ovaries produce can stimulate any remaining endometriosis and cause pain to persist. Surgery is typically considered a last resort, especially for women still in their reproductive years. You can't get pregnant after a hysterectomy.
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