Endometriosis is a condition affecting women in which cells similar to those that form the lining of the uterus (endometrium) grow outside of the uterus. Common locations for the abnormal growth of endometrial cells include the ovaries, Fallopian tubes, intestines, and the lining of the pelvic cavity. Unlike the normal endometrial cells lining the uterus that are shed each month during menstruation, endometriosis cells remain attached to the tissues to which they have spread. With each menstrual cycle, these cells can thicken, break down, and can even bleed. While not always symptomatic, endometriosis frequently causes pelvic pain (often associated with periods), irregular bleeding, and scarring (adhesions) on the ovaries, Fallopian tubes, and bowel.
How does endometriosis occur? Although the exact cause is uncertain, there are several theories as to how endometriosis develops. The most commonly held belief is that endometriosis occurs because of “retrograde menstruation”. This means that instead of the endometrial tissue exiting the uterus through the cervix during a menstrual period, some of it “backs up” through the Fallopian tubes into the pelvic cavity. If this tissue attaches and grows on nearby structures, endometriosis occurs. Endometriosis also appears to be related to having higher levels of estrogen, since it is most common in women during their childbearing years (teens to late 30s).
Who is most likely to develop endometriosis? Risk factors for the development of endometriosis include: 1) never having had a child, 2) having a mother or sister with endometriosis, 3) shorter menstrual cycles with bleeding lasting more than 7 days, and 4) starting menstruation at an early age.
What are the symptoms of endometriosis? The most common symptom of endometriosis is pain. The location of the pain depends primarily on where the endometriosis implants are growing. Many women with endometriosis experience severe pain during their menstrual periods, but it can occur at other times also, such as during intercourse or with bowel movements. Excessive or irregular bleeding with menstrual periods are other common features. Endometriosis can also be responsible for infertility, even without causing symptoms. Conditions that can mimic the symptoms of endometriosis include pelvic infection, ovarian cysts, and irritable bowel syndrome.
How is endometriosis diagnosed? The three primary measures used in diagnosing endometriosis are: 1) the pelvic examination, 2) ultrasound, and 3) laparoscopy. Although both the pelvic examination and transvaginal ultrasound can provide clues to the presence of endometriosis, the best way to confirm the diagnosis is by direct visualization with a surgical procedure known as laparoscopy. Pelvic laparoscopy is sometimes called “band-aid” surgery because only small incisions need to be made to accommodate the small surgical instruments that are used to view the abdominal contents and perform the surgery.
How is endometriosis treated? The decision of how to treat endometriosis depends on a number of factors including the age of the individual, the severity of her symptoms, and whether she hopes to become pregnant in the future. Although there is no cure for endometriosis, treatment options include:
- Non-steroidal anti-inflammatory drugs such as ibuprofen (Advil) and naproxen (Aleve) may be helpful in milder cases by relieving cramping and pain.
- Birth control pills help to shrink endometriosis implants by controlling the hormones responsible for the monthly growth of endometrial tissue. Since symptoms of endometriosis typically improve during pregnancy, birth control pills are sometimes given continuously for several months to simulate pregnancy.
- Progestins are drugs that behave like the female hormone progesterone and provide benefit to some women with endometriosis. They are usually given as a long-acting injection (DepoProvera).
- Drugs known as gonadotropin agonists and antagonists block the production of ovary stimulating hormones, resulting in a marked lowering of estrogen levels. The gonadotrophin agonist, leuprolide acetate (Depo Lupron), temporarily causes ovulation or menstruation to stop. The resulting low-estrogen state, however, can cause side effects similar to those associated with menopause, such as hot flashes. The gonadotrophin antagonist, danazol (Danocrine), blocks the production of ovarian-stimulating hormones, but is associated with many androgenic (male) side effects, including weight gain, increased body hair and acne.
- If symptoms do not improve with medication or in women who want to become pregnant, surgery may be an option. In milder cases, surgery may be performed through a laparoscope. In more extensive cases an incision on the abdomen (laparotomy) may be required. In severe cases of endometriosis, a total hysterectomy (removal of uterus, cervix, and ovaries) is the treatment of last resort.
- Women who are near to menopause may want to try to manage their symptoms with medicines rather than surgery since endometriosis usually stops causing problems when periods stop.
Can endometriosis be prevented? Because its exact cause remains unknown, there are no confirmed ways to prevent the development of endometriosis. In some women, taking birth control pills does appear to prevent or slow down the development of the disease.