Endometriosis

Overview

Endometriosis is a condition in which the tissue that lines the inside of the uterus (the endometrium) implants outside of the uterus. During the typical menstrual cycle, the endometrium thickens with blood, and then sheds if the woman is not impregnated. This lining and blood are discharged through the vagina during a menstrual period. With endometriosis, this tissue can be found instead on the inside walls of the abdomen (the peritoneum), the ovaries, the appendix and the bowel. When a woman has her period, this tissue also can bleed. Up to 30 percent of women are thought to have endometriosis.

Symptoms

Most women with endometriosis have no symptoms. Some women experience brief episodes of abdominal pain before their periods and/or deep pain with intercourse. Other symptoms include pain with bowel movements and urination.

Causes

Estrogen, a natural hormone produced by ovaries, is thought to promote endometriosis. Endometriosis most likely stems from a combination of factors:
  • Vaginal blockage: Most menstrual blood flows out of the uterus through the vagina. Sometimes, however, the blood travels up through the fallopian tubes into the abdominal cavity. This is called “retrograde menstruation.” Women who have a blockage of their vagina, perhaps caused by a closed hymen or vaginal septum, are at higher risk of developing endometriosis.
  • Familial tendency: Endometriosis can run in families, but the genetic basis is unknown.

Diagnosis

If your doctor believes your symptoms are consistent with endometriosis, he or she may recommend treatment that may or may not involve surgery. If your symptoms do not improve, or if you cannot take medication, the doctor may recommend an operation to confirm that you have endometriosis and, potentially, to treat it surgically. This would be more likely if an ovarian cyst is discovered by ultrasound. Although surgery is the definitive way to diagnose endometriosis, most women do not require an operation.

Endometriosis may cause many long-term problems for patients:
  • Pain: Some women have pain so severe that it limits their daily activities.
  • Scar tissue: Some women develop scar tissue in the pelvic area. Rarely severe cases can cause blood in bowel movements and even bowel scarring, which can cause a blockage.
  • Infertility: Although most women with endometriosis are fertile, scarring may result in difficulty becoming pregnant.

Treatments

Most treatments are designed to either increase progesterone levels (to counteract estrogen’s effects) or reduce estrogen levels. Once a woman has gone through menopause and her estrogen level declines, endometriosis usually subsides. The goals of treating endometriosis are to decrease menstrual bleeding, to thin the endometrial tissue, and to reduce associated pain. Existing treatments include:
  • Birth control pills, which decrease the thickness of endometrial tissue
  • Progesterone therapy
  • Injection - depot medroxyprogesterone acetate (Depo Provera)
  • Lupron Depot (this medication decreases estrogen production to a menopausal level, suppressing the shedding of the endometrium)
  • Pelvic physical therapy
  • Pain medications
  • Laparoscopy.
Surgery may be indicated to confirm the diagnosis of endometriosis, to treat or remove endometriosis tissue, remove cysts from ovaries, or to remove the ovaries (which decreases estrogen levels and is recommended only in rare circumstances). Combinations of the above therapies may be needed to achieve the best control. .

Self Care

If you think you may have endometriosis, keep a careful diary of your periods and symptoms. Then talk with your provider about diagnosis and/or treatment options.