Endometriosis is a condition in which the tissue that behaves like the cells lining the uterus (endometrium) grows in other areas of the body, causing pain, irregular bleeding, and possible infertility.
The tissue growth (implant) typically occurs in the pelvic area, outside of the uterus, on the ovaries, bowel, rectum, bladder, and the delicate lining of the pelvis. However, the implants can occur in other areas of the body, too.
Causes, incidence, and risk factorsEach month a woman's ovaries produce hormones that stimulate the cells of the uterine lining (endometrium) to multiply and prepare for a fertilized egg. The lining swells and gets thicker.
If these cells (called endometrial cells) grow outside the uterus, endometriosis results. Unlike cells normally found in the uterus that are shed during menstruation, the ones outside the uterus stay in place. They sometimes bleed a little bit, but they heal and are stimulated again during the next cycle.
This ongoing process leads to symptoms of endometriosis (pain) and can cause scars (adhesions) on the tubes, ovaries, and surrounding structures in the pelvis.
The cause of endometriosis is unknown, but there are a number of theories. One theory is that the endometrial cells loosened during menstruation may "back up" through the fallopian tubes into the pelvis. Once there, they implant and grow in the pelvic or abdominal cavities. This is called retrograde menstruation. This happens in many women, but there may be something different about the immune system in women who develop endometriosis compared to those who do not get the condition.
Endometriosis is a common problem. Sometimes, it may run in the family. Although endometriosis is typically diagnosed between ages 25 - 35, the condition probably begins about the time that regular menstruation begins.
A woman who has a mother or sister with endometriosis is six times more likely to develop endometriosis than women in the general population. Other possible risk factors include:
Pain is the main symptom for women with endometriosis. This can include:
Note: Often there are no symptoms. In fact, some women with severe cases of endometriosis have no pain at all, whereas some women with mild endometriosis have severe pain.
Signs and testsTests that are done to diagnose endometriosis include:
Treatment options include:
Treatment depends on the following factors:
Some women who do not ever want children and have mild disease and symptoms may choose to just have regular exams every 6 - 12 months so the doctor can make sure the disease isn't getting worse. They may manage the symptoms by using:
Treatment may involve stopping the menstrual cycle and creating a state resembling pregnancy. This is called pseudopregnancy. It can help prevent the disease from getting worse. It's done using Birth Control pills containing estrogen and progesterone.
Another treatment involves progesterone pills or injections. Side effects may be bothersome and include depression, weight gain, and spotting of blood.
Some women may be prescribed medicines that stop the ovaries from producing estrogen. These medicines are called gonadotropin agonist drugs and include nafarelin acetate (Synarel) and Depo Lupron.
Surgery is an option for women who have severe pain that does not improve with hormone treatment, or who want to become pregnant either now or in the future.
Hormone therapy and pelvic laparoscopy cannot cure endometriosis. However, it can partially or completely relieve symptoms in many patients for a number of years.
Removing the uterus (hysterectomy), both ovaries and tubes give the best chance of a cure for endometriosis. You may need hormone replacement therapy after your ovaries are removed. Rarely endometriosis can come back, even after a hysterectomy.
Endometriosis may result in infertility, but not in every patient, and especially if the endometriosis is mild. Laparoscopic surgery may help improve fertility. The chance of success depends on the severity of the endometriosis. If the first surgery does not aid in getting pregnant, repeating the laparoscopy is unlikely to help. Patients should consider further infertility treatments.
ComplicationsEndometriosis can lead to problems getting pregnant (infertility). Other complications include:
Other complications are rare. In a few cases, endometriosis implants may cause blockages of the gastrointestinal or urinary tracts.
Very rarely, cancer may develop in the areas of endometriosis after menopause.
Calling your health care providerCall for an appointment with your health care provider if:
Consider getting screened for endometriosis if your mother or sister has been diagnosed with endometriosis, or if you are unable to become pregnant after trying for 1 year.
PreventionBirth control pills may help to prevent or slow down the development of the disease.
ReferencesLobo R. Endometriosis: etiology, pathology, diagnosis, management. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap. 19.
Mounsey AL. Diagnosis and management of endometriosis. Am Fam Physician. 2006;74(4):594-600.
Davis L, Kennedy S. Modern combined oral contraceptives for pain associated with endometriosis. Cochrane Database Syst Rev. 2007;(3):CD001019.
Levy BS. The complex nature of chronic pelvic pain. J Fam Pract. 2007;56:S16-S17.
Bulun SE. Endometriosis. N Engl J Med. 2009;360:268-279.
Jacobson TZ, Barlow DH, Koninckx PR, Olive D, Farquhar C. Laparoscopic surgery for subfertility associated with endometriosis. Cochrane Database Syst Rev;2002;(4):CD001398.
Endometriosis is a female health disorder that occurs when cells from the lining of the womb (uterus) grow in other areas of the body. This can lead to pain, irregular bleeding, and problems getting pregnant (infertility).
Causes, incidence, and risk factorsEvery month, a woman's ovaries produce hormones that tell the cells lining the uterus (womb) to swell and get thicker. The body removes these extra cells from the womb lining (endometrium) when you get your period.
If these cells (called endometrial cells) implant and grow outside the uterus, endometriosis results. The growths are called endometrial tissue implants. Women with endometriosis typically have tissue implants on the ovaries, bowel, rectum, bladder, and on the lining of the pelvic area. They can occur in other areas of the body, too.
Unlike the endometrial cells found in the uterus, the tissue implants outside the uterus stay in place when you get your period. They sometimes bleed a little bit. They grow again when you get your next period. This ongoing process leads to pain and other symptoms of endometriosis.
The cause of endometriosis is unknown. One theory is that the endometrial cells shed when you get your period travel backwards through the fallopian tubes into the pelvis, where they implant and grow. This is called retrograde menstruation. This backward menstrual flow occurs in many women, but researchers think the immune system may be different in women with endometriosis.
Endometriosis is common. Sometimes, it may run in the family. Although endometriosis is typically diagnosed between ages 25 - 35, the condition probably begins about the time that regular menstruation begins.
A woman who has a mother or sister with endometriosis is much more likely to develop endometriosis than other women. You are more likely to develop endometriosis if you:
Pain is the main symptom of endometriosis. A woman with endometriosis may have:
Note: There may be no symptoms. Some women with a large number of tissue implants in their pelvis have no pain at all, while some women with milder disease have severe pain.
Signs and testsThe health care provider will perform a physical exam, including a pelvic exam. Tests that are done to help diagnose endometriosis include:
Treatment depends on the following factors:
If you have mild symptoms and do not ever want children, you may choose to have regular exams every 6 - 12 months so the doctor can make sure the disease isn't getting worse. You can manage your symptoms by using:
For other women, treatment options include:
Treatment to stop the endometriosis from getting worse often involves using birth control pills continously for 6 - 9 months to stop you from having periods and create a pregnancy-like state. This is called pseudopregnancy. This therapy uses estrogen and progesterone birth control pills. It relieves most endometriosis symptoms. However, it does not prevent scarring or reverse physical changes that have already occured as the result of the endometriosis.
Other hormonal treatments may include:
Surgery may be recommended if you have severe pain that does not get better with other treatments. Surgery may include:
Hormone therapy and laparoscopy cannot cure endometriosis. However, these treatments can help relieve some or all symptoms in many women for years.
Removal of the womb (uterus), fallopian tubes, and both ovaries (a hysterectomy) gives you the best chance for a cure. Rarely, the condition can return.
ComplicationsEndometriosis can lead to problems getting pregnant (infertility). Not all women, especially those with mild endometriosis, will have infertility. Laparoscopy to remove scarring related to the condition may help improve your chances of becoming pregnant. If it does not, fertility treatments should be considered.
Other complications of endometriosis include:
In a few cases, endometriosis implants may cause blockages of the gastrointestinal or urinary tracts. This is rare.
Very rarely, cancer may develop in the areas of endometriosis after menopause.
Calling your health care providerCall for an appointment with your health care provider if:
Consider getting screened for endometriosis if your mother or sister has been diagnosed with endometriosis, or if you are unable to become pregnant after trying for 1 year.
PreventionBirth control pills may help to prevent or slow down the development of the endometriosis.
ReferencesLobo R. Endometriosis: etiology, pathology, diagnosis, management. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap. 19.
Brown J, Pan A, Hart RJ. Gonadotrophin-releasing hormone analogues for pain associated with endometriosis. Cochrane Database Syst Rev. 2010 Dec 8;(12):CD008475.
Giudice LC. Clinical practice. Endometriosis. N Engl J Med. 2010 Jun 24;362(25):2389-98.
de Ziegler D, Borghese B, Chapron C. Endometriosis and infertility: pathophysiology and management. Lancet. 2010 Aug 28;376(9742):730-8.
ACOG Practice Bulletin No. 110: noncontraceptive uses of hormonal contraceptives. Obstet Gynecol. 2010 Jan;115(1):206-18.
Reviewed ByReview Date: 07/25/2011
Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Redmond, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
I talk about this, dealing with endometriosis on my YouTube channel: WestAfricanExoticals
Endometriosis is noncommunicable disease.
Mirena can reduce the symptoms of endometriosis
The Romanian language equivalent of "endometriosis" is "endometrioză".
Endometriosis does not necessarily have an odor, or at least not one that you would be able to detect, since endometriosis is inside of you. If you are experiencing vaginal odor, it is most likely not endometriosis, and you should visit your OB GYN with your concerns.
Yes. Having a child does not protect you from endometriosis. While having endometriosis often makes becoming pregnant difficult for women, becoming pregnant will also reduce the symptoms of endometriosis. So, being diagnosed with endometriosis after having a child makes it rather difficult for your doctor to determine whether you had endometriosis prior to the pregnancy or if it became an issue post-pregnancy - especially if you were positively diagnosed with endometriosis shortly after giving birth.
All women are different. Some women with endometriosis will not have regular periods. However, there are also women with endometriosis that either have irregular periods, or even those that have very regular periods. If you think you may have endometriosis, see your OB GYN.
617.3 is the diagnosis code for pelvic peritonial endometriosis
World Endometriosis Research Foundation was created in 2006.
Endometriosis can also appear in the teen years, but never before the start of menstruation
You can have PCOS and endometriosis at the same time, but one does not mean you have the other.
There are various proposed theories about the aetiology of endometriosis. Dr Stephen Kennedy of Oxford University has an interest in genetic endometriosis research. There does seem to be evidence that for some families, endometriosis is hereditary for first degree relatives and that it may be more symptomatic in the second family member.
Yes. The most common areas for endometriosis adhesions are in the abdominopelvic cavity, but there have been documented cases of endometriosis appearing on the lungs and even in the mucous membranes of the nose!