Your Health

Endometriosis

Definition

Normally, endometrial tissue is found only inside the uterus. The uterus is the reproductive organ where a fetus develops. Hormones cause the tissue to form there, preparing the body for a fertilized egg. If you do not become pregnant, the tissue leaves the body during menstruation.
In endometriosis, endometrial-like tissue is found outside the uterus. For example, it may be found on organs in the abdomen or pelvis. In these places, the tissue still responds to hormones. It swells, breaks down, and bleeds. But it is unable to leave when you menstruate. Surrounding tissue becomes inflamed. There is often scarring.
Endometriosis
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Lesions were created by swelling and breakdown of endometrial tissue outside the uterus.
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Causes

Possible causes include:
  • Menstrual tissue backs up through the fallopian tubes and spills into the abdomen
  • Immune system may allow the tissue to implant on other organ surfaces and develop into endometriosis
  • Lymph system may carry endometrial cells from the uterus
  • Certain cells left behind on abdominal organs during embryonic development can turn into endometrial tissue
Hormones and growth factors cause the disease to progress.

Risk Factors

Factors that may increase your risk of endometriosis include:
  • Family history—a mother or sister with endometriosis
  • Early onset of menstruation
  • Not having children—Pregnancy slows or stops the disease from progressing. The condition usually resolves at menopause . The symptoms may return with hormone replacement therapy .
  • Prolonged menstrual bleeding—more than 7-8 days
  • Abnormal development of the uterus, with a blocked segment

Symptoms

Symptoms range from mild to severe. You may have many large growths with little pain. Or, you may have small areas with intense pain.
Symptoms include:
  • Cramping and pelvic pain—especially just before and during menstrual bleeding
  • Pain during sex— dyspareunia
  • Heavy periods
  • Low back pain
  • Pain during bowel movements or urination
  • Infertility
  • Miscarriage

Diagnosis

You will be asked about your symptoms and medical history. A pelvic exam will be done. These are best done early in the menstrual period. Since you may not have any symptoms, diagnosis is usually confirmed with a laparoscopy . This test allows the doctor to see if there are patches of endometrial tissue and scar tissue.

Treatment

The goals of treatment are to:
  • Control pain
  • Slow endometrial growth
  • Restore or preserve fertility
Treatment options depend on:
  • Severity of symptoms
  • Size, number, and location of growths
  • Degree of scarring
  • Extent of the disease
  • Age and whether you want to have a baby
Treatment includes:

Pain Medication

Your doctor may recommend:
  • Over-the-counter pain relievers to ease mild symptoms
  • Nonsteroidal anti-inflammatory drugs to reduce inflammation and help with cramping—best when taken on a regular basis
  • Prescription pain relievers—often needed

Hormonal Therapy

Hormones are an option for women who are not trying to become pregnant. Birth control pills and other injectable drugs interfere with estrogen production. These medications may decrease pain and shrink the size and number of endometrial growths. But, symptoms and endometrial growths tend to come back when the hormones are stopped. If birth control pills are prescribed to manage endometriosis, then they are often used continuously, so that you do not menstruate. After surgery, birth control pills may reduce the chance of these growths returning.

Surgery

If you have severe symptoms or you want to get pregnant, doctors can try to remove endometrial growths. This is often done with laparoscopic surgery. In severe, unmanageable cases it may be advised to also remove the uterus and ovaries . But this means that you cannot get pregnant.

Prevention

There is no known way to prevent this condition.

RESOURCES

The American College of Obstetricians and Gynecologists http://www.acog.org

Endometriosis Association http://www.endometriosisassn.org

CANADIAN RESOURCES

The Society of Obstetricians and Gynaecologists of Canada http://www.sogc.org

Women's Health Matters http://www.womenshealthmatters.ca

References

American Academy of Family Physicians. Endometriosis: what you should know. Am Fam Physician. 2006 Aug 15;74(4):601-2. Available at: http://www.aafp.org/afp/2006/0815/p601.html. Accessed September 23, 2014.

The American College of Obstetricians and Gynecologists. The Management of Endometriosis. Practice bulletin No. 114; July 2010.

Endometriosis. The National Institute of Child Health and Human Development website. Available at: http://www.nichd.nih.gov/health/topics/endometri/Pages/default.aspx. Updated June 24, 2013. Accessed September 23, 2014.

3/12/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Seracchioli R, Mabrouk M, Frascà C, et al. Long-term cyclic and continuous oral contraceptive therapy and endometrioma recurrence: a randomized controlled trial. Fertil Steril. 2010;93(1):52-56.

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