Endometriosis occurs when cells from the lining of your womb (uterus) grow in other areas of your body. This can cause pain, heavy bleeding, bleeding between periods, and problems getting pregnant (infertility).
Every month, a woman's ovaries produce hormones that tell the cells lining the uterus to swell and get thicker. Your uterus sheds these cells along with blood and tissue through your vagina when you have your period.
Endometriosis occurs when these cells grow outside the uterus in other parts of your body. This tissue may attach on your:
It can grow in other areas of the body, too.
These growths stay in your body--they do not shed when you have your period. But, like the cells in your uterus, these growths react to the hormones from your ovaries. They grow and bleed when you get your period. Over time, the growths may add more tissue and blood. The buildup of blood and tissue in your body leads to pain and other symptoms.
No one knows what causes endometriosis. One idea is that when you get your period, the cells may travel backwards through the fallopian tubes into the pelvis. Once there, the cells attach and grow. However, this backward period flow occurs in many women. Researchers think that the immune system in women with endometriosis may cause the condition.
Endometriosis is common. Sometimes, it may run in families. Endometriosis probably starts when a woman begins having periods. However, it usually isn't diagnosed until ages 25 - 35.
You are more likely to develop endometriosis if you:
Pain is the main symptom of endometriosis. You may have:
You may not have any symptoms. Some women with a lot of tissue in their pelvis have no pain at all, while some women with milder disease have severe pain.
Your health care provider will perform a physical exam, including a pelvic exam. You may have one of these tests to help diagnose the disease:
What type of treatment you have depends on:
There are different treatment options.
If you have mild symptoms, you may be able to manage cramping and pain with:
These medicines can stop endometriosis from getting worse. They may be given as pills, nasal spray, or shots. Only women who are not trying get pregnant should have this therapy. Hormone therapy will prevent you from getting pregnant. Once you stop therapy, you can get pregnant again.
Birth control pills. With this therapy, you take pills for 6 - 9 months without stopping. Taking these pills relieves most symptoms. However, it does not prevent scarring or treat any damage that has already occurred.
Progesterone pills or injections. This treatment helps shrink growths. However, side effects can include weight gain and depression.
Gonadotropin-agonist medications. These medicines stop your ovaries from producing the hormone estrogen. This causes a menopause-like state. Side effects include hot flashes, vaginal dryness, and mood changes. Treatment is usually limited to 6 months because it can weaken your bones.
Your doctor may recommend surgery if you have severe pain that does not get better with other treatments.
Hormone therapy and laparoscopy cannot cure endometriosis. However, in some women, these treatments may help relieve symptoms for years.
Removal of the uterus, fallopian tubes, and both ovaries (a hysterectomy) gives you the best chance for a cure.
Endometriosis can lead to problems getting pregnant. However, most women with mild symptoms can still get pregnant. Laparoscopy to remove growths and scar tissue may help improve your chances of becoming pregnant. If it does not, you may want to consider fertility treatments.
Other complications of endometriosis include:
In rare cases, endometriosis tissue may block the intestines or urinary tract.
Very rarely, cancer may develop in the areas of tissue growth after menopause.
Call for an appointment with your health care provider if:
You may want to get screened for endometriosis if:
Birth control pills may help to prevent or slow down the development of the endometriosis.
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Lobo 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.
Updated by: Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Bellevue, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.
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