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Endometriosis

What is endometriosis?

Endometriosis is an abnormal growth of the uterine lining tissue outside of the uterus. The uterus (womb) is the organ at the top of the vagina. Babies grow in the uterus, and menstrual blood comes from the uterus. The tissue that lines the inside of the uterus is called the endometrium. Some women have endometrial tissue outside of the uterus and the tissue grows in other places inside the body. This condition is called endometriosis.

The abnormal tissue most often grows around the ovaries, fallopian tubes, and the outside surface of the uterus. It may also grow on the bowel, bladder, rectum, and lining of the abdomen. Very rarely, it may grow in other places.

The misplaced tissue responds to the hormones of the menstrual cycle. It bleeds each month just like the lining of the uterus. However, when the tissue is not in the uterus, the blood has no way to leave the body. It can cause pain, cysts, and scar tissue. The scar tissue may cause organs, such as the ovaries or tubes, to stick together. This can make it hard to get pregnant.

How does it occur?

All women have some endometrial tissue from the uterus that backs up through the fallopian tubes and into the inside of the abdomen during a menstrual period. Usually the immune system destroys the misplaced endometrial tissue, but in some women this does not seem to happen.

Doctors don’t know why some women have endometriosis. There are many theories, but none of them explains all of the cases. Some of the common theories are:

  • You may have an immune system that cannot destroy all of the misplaced tissue.
  • For reasons that are not completely understood, small areas of normal tissue from some parts of the body may change over time into areas of endometriosis.

Some women may inherit a tendency to have endometriosis.

What are the symptoms?

Some women have no symptoms. Symptoms you may have include:

  • pelvic, back, or backside pain that starts just before or during your menstrual period
  • very painful menstrual cramps
  • pain during sex (often in the pelvis)
  • abnormal or heavy menstrual flow
  • painful bowel movements, diarrhea, constipation, or other bowel problems during menstrual periods
  • painful urination or feeling the need to urinate often during menstrual periods
  • trouble getting pregnant

How is it diagnosed?

Your healthcare provider will ask about your symptoms. It may be helpful for you to keep a diary of your symptoms through several menstrual cycles. You will also have a pelvic exam.

If your provider thinks you have endometriosis, you may need a procedure called a laparoscopy for diagnosis. For this procedure, you are given an anesthetic so you will not feel any pain. Then a small cut is made near your belly button. Your abdomen is filled with a gas. Your healthcare provider puts a thin tube with a lens and a light through the cut and into your abdomen to look inside your pelvis. With the scope your provider can see abnormal growths of endometriosis. Sometimes a small piece of tissue is removed to help make a diagnosis. This is called a biopsy.

Other tests you may have are:

  • ultrasound scan
  • CT scan
  • MRI scan
  • an X ray dye test (hysterosalpingogram) to see if your tubes are blocked
  • blood tests

How is it treated?

There are many ways to lessen the symptoms caused by endometriosis. The treatment depends on:

  • how bad your symptoms are
  • where the abnormal tissue is and how much you have
  • your age
  • your plans for having children.

Pain-relief medicine

If your only symptom is mild premenstrual pain, a mild pain-relief medicine, such as aspirin, acetaminophen, ibuprofen, or naproxen, may be all you need. Nonsteroidal anti-inflammatory medicines (NSAIDs), such as ibuprofen, naproxen, and aspirin, may cause stomach bleeding and other problems. These risks increase with age. Read the label and take as directed. Unless recommended by your healthcare provider, do not take for more than 10 days for any reason.

Fish oil supplements can also sometimes help with pain relief.

Hormone medicine

If symptoms are still a problem, your healthcare provider may suggest hormone medicine. Hormones will help shrink the endometriosis and may stop the buildup of cysts, scar tissue, and swelling. Different forms of hormone medicine can be used. Medicines that have female hormones are:

  • birth control pills
  • monthly progesterone shots (Depo-Provera)
  • an intrauterine device (IUD) that contains a progesterone hormone

The most effective hormone treatments use a medicine that keeps the ovaries from making female hormones for about 6 months. This keeps the abnormal endometrial tissue from responding to your usual menstrual cycles (the common cause of endometriosis symptoms). This treatment can also shrink the areas of endometriosis and allow your body to heal as much as possible. Some of the medicines that might be used in this way are:

  • leuprolide acetate (monthly shot)
  • nafarelin (nasal spray used daily)
  • goserelin (medicine implanted under the skin every 4 weeks)

While you are taking this type of hormone medicine, you will probably have symptoms that are similar to menopause, such as hot flashes and vaginal dryness. While you are taking this medicine, you should also take calcium to keep your bones strong.

Surgery

You may need surgery to remove or burn off endometrial tissue. It may help to first take medicines to shrink the endometriosis tissue and then have surgery. Different surgical treatments can be used to treat endometriosis, such as:

  • laparoscopy with a laser or electrocautery (burning with an electric wire)
  • open surgery, which involves a larger cut in your belly.

In the most severe cases, your healthcare provider may recommend more extensive surgery to remove the organs that have growths. The fallopian tubes, uterus, or the ovaries may be removed. If your uterus is removed (a hysterectomy), you will not be able to get pregnant. Although it may seem odd, you may still have symptoms even after your uterus is removed.

How long will the effects last?

Endometriosis can get worse as you get older until you reach menopause. It usually goes away after menopause. Symptoms can also get better with a pregnancy, but this improvement may not last.

Current treatments offer some relief from symptoms but not a cure. Endometriosis may come back or get worse after hormone therapy or surgery.

Scars on the ovaries or tubes can make it hard for you to get pregnant. However, there are treatments and procedures that can help you get pregnant.

How can I take care of myself?

Keep a careful record of your symptoms. One way to do this is to assign a number to each of the symptoms you have and record the numbers on your calendar for 3 months. Record all symptoms and any time lost from work, school, or other activities. Report the symptoms to your healthcare provider and take your calendar with you to your appointment. If you have not yet been diagnosed with endometriosis, your provider may not suspect endometriosis without this information.

Things that might help your milder symptoms include:

  • Take warm baths.
  • Rest.
  • Wear loose clothing.
  • Put a covered hot water bottle or heating pad on your belly.
  • Eat more fiber to help prevent constipation.
  • Do relaxation exercises.
  • Take pain medicine as recommended by your provider.

Some women report that massage therapy or acupuncture helps symptoms, but this has not been proven.

Call your healthcare provider if you have new or worsening:

  • pelvic or back pain
  • abdominal cramps
  • painful bowel movements, diarrhea, constipation, or other bowel problems
  • painful urination or feeling the need to urinate often

For more information, contact the Endometriosis Association. This organization is a support group run by women with endometriosis.

How can I help prevent endometriosis?

Doctors don’t know how to prevent endometriosis.

Developed by RelayHealth.
Published by RelayHealth.
Last modified: 2011-07-08
Last reviewed: 2011-05-17
This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.
© 2011 RelayHealth and/or its affiliates. All rights reserved.
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