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Endometriosis

Endometriosis, occurs when tissue from the lining (endometrium) of the uterus becomes implanted in the outer surface of the uterus, the fallopian tubes or the ovaries. It can also implant beyond the reproductive organs and pelvic region. The endometrial tissue is normally located inside your uterus, and if a woman is not pregnant this tissue builds up and is shed each month. It is discharged as menstrual flow at the end of each cycle. Endometriosis is often painful, and scar tissue can form in your pelvic area. Endometriosis can affect females between puberty and menopause, but is most common between ages 20 and 30.

Frequent sign and symptoms

Endometriosis affects each woman differently. When you have your period, the endometrial tissue outside the uterus swells and bleeds, just like the lining of your uterus. The following symptoms may begin abruptly or develop over many years:

  • Increased pelvic pain during menstrual periods, especially the last days, or the pelvic pain may occur at anytime
  • Pain with sexual intercourse
  • Premenstrual spotting
  • Blood in the urine
  • Back pain
  • Pain with intestinal contractions
  • Blood in the stool (sometimes)
  • Infertility

Risk factors

  • Women who don't become pregnant or who delay childbirth
  • Women with family history of endometriosis
  • Medical conditions that block or constrict the cervix or vagina

What to expect

  • Without treatment, endometriosis becomes increasingly severe. It subsides after menopause when estrogen production decreases.
  • Symptoms can be relieved with medication, and/or surgery.
  • Women with severe disease have less success with treatment.
  • Pregnancy should occur if desired, but may depend on severity of disease.

Complications

  • Infertility (implants can cause adhesions or scar tissue and can constrict the fallopian tubes)
  • Scar tissue can cause adhesions and lead to pelvic pain.
  • Recurrences of endometriosis are fairly common.
  • Implants on the ovary can lead to large cysts and pelvic masses called endometriomas.

Treatment (General Measures)

  • Diagnosing is usually by laparoscopy. A laparoscope is inserted into the abdomen through a small incision, and visual examination of abdominal organs is possible.
  • Treatment after diagnosis will vary depending on the extent of disease and your desire to have children.
  • If you want children, consider pregnancy as soon as possible. Pregnancy may offer some relief from your symptoms. Delaying pregnancy may result in infertility.
  • Both heat and cold therapies have been used with varying degrees of success.
  • Laser surgery or electrocoagulation may be used to remove the abnormal growths.
  • Surgery to remove implants, or a hysterectomy to remove the uterus, fallopian tubes and ovaries is sometimes recommended.
  • Additional information: Endometriosis Association

Medication

You may use nonprescription drugs, such as nonsteroidal anti-inflammatory drugs (NSAIDs), to relieve minor pain.
Oral contraceptives, progestogens, danazol, gonadotropin-releasing hormones (Gn-RH) are commonly-used drugs for the treatment of endometriosis.

Activity

  • Exercise, such as walking, can help in relieving pain.
  • Some activity restrictions may apply following surgical therapies.

More information from The American College of Obstetricians and Gynecologists>

Last Updated: 1/7/2014