Endometriosis is a disorder in which the tissue that forms the lining of your uterus grows outside of your uterine cavity. The lining of your uterus is called the endometrium.
Endometriosis occurs when the endometrium grows on your ovaries, bowel, and tissues lining your pelvis. It’s unusual for endometrial tissue to spread beyond your pelvic region, but it’s not impossible. Endometrial tissue growing outside of your uterus is known as an endometrial implant.
The hormonal changes of your menstrual cycle affect the misplaced endometrial tissue. This means the tissue will grow, thicken, and break down. Over time, the tissue that has broken down has nowhere to go and becomes trapped in your pelvis.
This tissue trapped in your pelvis can cause:
- scar formation
- adhesions, in which tissue binds your pelvic organs together
- severe pain during your periods
- fertility problems
Endometriosis is a common gynecological condition. You’re not alone if you suffer from this disorder.
During a regular menstrual cycle, your body sheds the lining of your uterus. This allows menstrual blood to flow from your uterus through the small opening in the cervix and out through your vagina.
Endometriosis often occurs due to a process called retrograde menstruation. This happens when menstrual blood flows back through your fallopian tubes into your pelvic cavity instead of leaving your body.
The displaced endometrial cells then stick to your pelvic walls and the surfaces of your pelvic organs, such as your bladder, ovaries, and rectum. They continue to grow, thicken, and bleed over the course of your menstrual cycle. It’s also possible for the menstrual blood to leak into the pelvic cavity through a surgical scar, such as after a cesarean delivery.
Doctors believe the condition may also occur if small areas of your abdomen convert into endometrial tissue. This may happen because cells in your abdomen grow from embryonic cells, which can change shape and act like endometrial cells. It’s not known why this occurs.
Endometriosis has four stages or types. It can be any of the following:
Different factors determine the stage of the disorder. These factors can include the:
- depth of the endometrial implants
Stage I: Minimal
In minimal endometriosis, there are small lesions, or wounds, and shallow endometrial implants on your ovary. There may also be inflammation in or around your pelvic cavity.
Stage 2: Mild
Mild endometriosis involves light lesions and shallow implants on an ovary and the pelvic lining.
Stage 3: Moderate
Moderate endometriosis involves deep implants on your ovary and pelvic lining. There can also be more lesions.
Stage 4: Severe
The most severe stage of endometriosis involves deep implants on your pelvic lining and ovaries. There may also be lesions on your fallopian tubes and bowels.
About 2 to 10 percent of childbearing women suffer from endometriosis. It usually develops years after the start of your menstrual cycle. This condition can be painful, but understanding the risk factors can help you determine whether you’re susceptible to this condition and when you should talk to your doctor.
Women of all ages are at risk for endometriosis. It usually affects women age 25 to 40.
Talk to your doctor if you have a family member who has endometriosis. You may have a higher risk of developing the disease.
Pregnancy seems to protect women against endometriosis. Women who haven’t had children run a greater risk of developing the disorder. However, endometriosis can still occur in women who’ve had children.
Talk to your doctor if you have problems regarding your menses. These issues can include shorter cycles, heavier and longer periods, or you began menstruating at a young age. These factors may place you at higher risk.
The symptoms of endometriosis vary. Some women experience mild symptoms, but others can have moderate to severe symptoms. The severity of your pain doesn’t indicate the degree or stage of the condition. You may have a mild form of the disease, yet suffer from agonizing pain. It’s also possible to have a severe form and have very little discomfort.
Pelvic pain is the most common symptom of endometriosis. You may also have the following symptoms:
- painful periods
- pain in the lower abdomen before and during menstruation
- cramps one or two weeks around menstruation
- heavy menstrual bleeding or bleeding between periods
- pain following sexual intercourse
- discomfort with bowel movements
- lower back pain that may occur at any time during your menstrual cycle
You may also have no symptoms. It’s important that you get yearly gynecological exams. This will allow your gynecologist to monitor any changes. This is particularly important if you have two or more symptoms.
Having issues with fertility is the most serious complication. Women with milder forms of endometriosis may be able to conceive and carry a baby to term. According to the Mayo Clinic, about one-third to one-half of women with endometriosis have trouble getting pregnant.
Medications don’t improve fertility. Some women have been able to conceive after having endometrial tissue surgically removed. If this doesn’t work in your case, you may want to consider fertility treatments or in vitro fertilization (IVF) to help improve your chances of having a baby.
You may want to consider having children sooner rather than later if you’ve been diagnosed with endometriosis and you want children. Your symptoms may worsen over time. This can make it difficult to conceive on your own. Talk to your doctor to help understand your options.
The symptoms of endometriosis can be similar to the symptoms of other conditions, such as ovarian cysts and pelvic inflammatory disease. Treating your pain requires an accurate diagnosis.
Your doctor will perform one or more of the following tests:
Your doctor will note your symptoms and personal or family history of endometriosis. A general health assessment may also be performed to determine if there are any other signs of a long-term disorder.
During a pelvic exam, your doctor will manually feel your abdomen for cysts or scars behind the uterus.
Your doctor may use a transvaginal ultrasound or an abdominal ultrasound. In a transvaginal ultrasound, a transducer is inserted into your vagina. Both types of ultrasound provide images of your reproductive organs. They can help your doctor identify cysts associated with endometriosis, but they aren’t effective in ruling out the disease.
The only certain method for identifying endometriosis is by viewing it directly. This is done by a minor surgical procedure known as a laparoscopy.
Understandably, you want quick relief from pain and other symptoms of endometriosis. This condition can disrupt your life if it’s left untreated. Endometriosis has no cure. Medical and surgical options are available to help reduce your symptoms and manage any potential complications. Your doctor may first try conservative treatments. They may then recommend surgery if your condition doesn’t improve.
Everyone reacts differently to these treatment options. Your doctor will help you find the one that works best for you. Treatment options include:
Over-the-counter pain medications such as ibuprofen can be used, but these aren’t effective in all cases.
Taking supplemental hormones can sometimes relieve pain. This therapy helps your body to regulate the monthly changes in hormones that promote the tissue growth that occurs when you have endometriosis.
Hormonal contraceptives decrease fertility by preventing the monthly growth and buildup of endometrial tissue. Birth control pills, patches, and vaginal rings can reduce or even eliminate the pain in less severe endometriosis.
Gonadotropin-Releasing Hormone (GnRH) Agonists and Antagonists
Women take what are called gonadotropin-releasing hormone (GnRH) agonists and antagonists to block the production of estrogens that stimulate the ovary. Estrogen is the hormone that’s mainly responsible for the development of female sexual characteristics. This prevents menstruation and creates an artificial menopause. The therapy has side effects like vaginal dryness and hot flashes. Taking small doses of estrogen and progesterone at the same time can help to limit or prevent these symptoms.
Danazol is another medication used to stop menstruation and reduce symptoms. However, it can have side effects including acne and hirsutism, which is abnormal hair growth on your face and body.
The medroxyprogesterone (Depo-Provera) injection is also effective in stopping menstruation. It stops the growth of endometrial implants. It relieves pain and other symptoms. However, it can also decrease bone production, cause weight gain, and lead to depression in some cases.
Conservative surgery is for women who want to get pregnant or suffer from severe pain. The goal of conservative surgery is to remove or destroy endometrial growths without damaging your reproductive organs.
This can be done through traditional open surgery, in which endometrial growths are removed through a wide incision.
Laparoscopy, a less invasive surgery, is another option. Your surgeon will make some small incisions in your abdomen to remove the growths in this type of surgery.
Radical Surgery (Hysterectomy)
Your doctor may recommend a total hysterectomy as a last resort if your condition doesn’t improve with other treatments. During a total hysterectomy, your surgeon will remove your uterus and cervix. Your doctor will also remove your ovaries because they make estrogen and estrogen causes the growth of endometrial tissue.
You’ll be unable to get pregnant after a hysterectomy. Get a second opinion before agreeing to surgery if you’re thinking about starting a family.
Endometriosis is a chronic condition with no cure. But this doesn’t mean the condition has to impact your daily life. There are effective treatments to manage pain and fertility issues, such as medications, hormone therapy, or surgery. The symptoms of endometriosis usually improve after menopause.