What is endometriosis?
Endometriosis is a common, yet poorly understood,
disease that can strike women of any socioeconomic class, age or race. It is
estimated that between 10 percent and 20 percent of American women of
childbearing age have endometriosis. The disease can affect nearly every aspect
of a woman's life--her ability to work, her ability to reproduce, and her
relationships with her mate, her child, and everyone around her.
The name endometriosis comes from the word
"endometrium," the tissue that lines the inside of the uterus. If a
woman is not pregnant, this tissue builds up and is shed each month and
discharged as menstrual flow at the end of each cycle. In endometriosis, tissue
that looks and acts like endometrial tissue is found outside the uterus,
usually inside the abdominal cavity. This misplaced tissue acts like it would
if it were inside the uterus. However, unlike menstrual fluid from the uterus,
which is discharged from the body during menstruation, blood from the misplaced
tissue has no place to go. Tissues surrounding the area of endometriosis may
become inflamed or swollen, leading to the development of scar tissue. These
endometrial tissue sites may develop into what are called "lesions,"
"implants," "nodules" or "growths." After
menopause, the abnormal implants shrink away and the symptoms subside.
What are the symptoms of
Most commonly, the symptoms of endometriosis
start years after menstrual periods begin. Over the years, the symptoms tend to
gradually increase as the endometriosis areas increase in size.
The most common symptom is pain, especially
excessive menstrual cramps (dysmenorrhea), which may be felt in the abdomen or
lower back or during or after sexual activity (dyspareunia). Infertility occurs
in about 30 percent to 40 percent of women with endometriosis. Rarely, the
irritation caused by endometrial implants may progress into infection or
abscesses causing pain independent of the menstrual cycle. Endometrial patches
may also be tender to the touch or to pressure, and intestinal pain may also
result from endometrial patches on the walls of the colon or intestine. The
amount of pain is not always related to the severity of the disease. Some women
with severe endometriosis have no pain; while others with just a few small
growths have incapacitating pain.
Does endometriosis cause endometrial
Endometrial cancer is very rarely associated
with endometriosis, occurring in less than 1 percent of women who have the
disease. When it does occur, it is usually found in more advanced patches of
endometriosis in older women and the long-term outlook in these unusual cases
is reasonably good.
Does endometriosis make you
Severe endometriosis with extensive scarring
and organ damage may affect fertility. It is considered one of the three major
causes of female infertility. However, unsuspected or mild endometriosis is a
common finding among infertile women and how this type of endometriosis affects
fertility is still not clear. While the pregnancy rates for patients with
endometriosis remain lower than those of the general population, most patients
with endometriosis do not experience fertility problems.
What is the cause of
The cause of endometriosis is still unknown.
One theory is that during menstruation some of the menstrual tissue backs up
through the fallopian tubes into the abdomen, where it implants and grows.
Another theory suggests that endometriosis may be a genetic process or that
certain families may have predisposing factors to endometriosis.
How would my health care provider know if I
Diagnosis of endometriosis begins with a
gynecologist evaluating the patient's medical history. A complete physical
exam, including a pelvic examination, is also necessary. However, diagnosis of
endometriosis is only complete when proven by laparoscopy, a minor surgical
procedure in which a laparoscope (a tube with a light in it) is inserted into a
small incision in the abdomen. The laparoscope is moved around the abdomen,
which has been distended with carbon dioxide gas to make the organs easier to
see. The surgeon can then check the condition of the abdominal organs and see
the endometrial implants. The laparoscopy will show the locations, extent and
size of the growths and will help the patient and her doctor to make
better-informed decisions about treatment.
What is the treatment for
While the treatment for endometriosis has
varied over the years, doctors now agree that if the symptoms are mild, no
further treatment other than medication for pain may be needed. For those
patients with mild or minimal endometriosis who wish to become pregnant,
doctors are advising that, depending on the age of the patient and the amount
of pain associated with the disease, the best course of action is to have a
trial period of unprotected intercourse for six months to one year. If
pregnancy does not occur within that time, then further treatment may be
For patients not seeking to become pregnant and
where a definitive diagnosis of endometriosis by laparoscopy has been made, a
physician may suggest hormone suppression treatment. Since this therapy shuts
off ovulation, women being treated for endometriosis will not get pregnant
during such therapy, although some may elect to become pregnant shortly after
therapy is stopped. Depending on the severity of the endometriosis, some women
may seek surgical treatment to remove the diseased tissue without risking
damage to healthy surrounding tissue. This surgery is called laparotomy and is
performed in a hospital under anesthesia.
For more information, contact the following
National Institutes of Health