Endometrial tissue lines the inside of the uterus. In endometriosis, this tissue grows outside of the uterus.

Endometriosis may develop in the:

• Ovaries

• Outside surface of the uterus

• Pelvis and lower abdomen

• Fallopian tubes

• Spaces between the bladder, uterus and rectum

• Wall of the rectum, bladder, intestines or appendix (less commonly)

• Lung, arm, thigh and skin. (This is rare.)

Misplaced endometrial tissue behaves like endometrial tissue in the uterus. It responds to the monthly rise and fall of female hormones. It also can ooze blood during menstruation. This can cause pelvic or abdominal pain.

As misplaced endometrial tissue grows, it can interfere with a woman's fertility. It may cover or grow into the ovaries. Or it may distort or block the fallopian tubes.

Endometrial tissue on the ovaries may form into large fluid-filled cysts. These are called endometriomas.

A woman may have an increased risk of endometriosis if:

• She has a heavy menstrual flow.

• She has a short menstrual cycle (27 days or less).

• She has a close female relative with endometriosis.

A woman's risk is probably lower than average if:

• She is slightly underweight.

• She exercises regularly.

• She has had multiple pregnancies.

• She has used oral contraceptives.

Many women with endometriosis do not have any symptoms from it. Those who have symptoms may experience:

• Severe menstrual discomfort, usually with heavy menstrual flow

• Pain in the pelvis or abdomen, usually just before or during menstruation

• Backache

• Pain during or immediately after sexual intercourse

• Vaginal spotting before menstruation begins

• Bowel symptoms, such as:

  • Painful bowel movements

  • Diarrhea

  • Constipation

  • Rarely, blood in the stool

• Painful urination, or, rarely, blood in the urine

• Infertility or repeated miscarriages

Symptom severity generally depends on the location of the endometriosis rather than its size.

The doctor will review:

• Your symptoms

• Your medical and gynecological history

• Family history of endometriosis

This will be followed by a physical exam and a pelvic exam.

During the pelvic exam, your doctor may be able to feel the following signs of endometriosis.

• Endometrial tissue embedded in the ligaments of your pelvis

• Displaced pelvic organs

• How freely your pelvic organs may be moved

• An ovarian endometrioma

To confirm the diagnosis, your doctor may need to do pelvic laparoscopic surgery. In this surgery, doctors operate through two or three tiny incisions. The surgery can identify endometrial tissue inside your pelvis or abdomen. Abnormal tissue may be removed for biopsy during the surgery.

Without treatment, endometriosis is a long-term problem. It usually lasts until menopause. After menopause, areas of misplaced endometrial tissue tend to become smaller.

There is no way to prevent endometriosis.

The condition may temporarily stop progressing if you:

• Use oral contraceptives

• Become pregnant

Several treatment options are available.

Pain management

For mild pelvic or abdominal pain, you may try a nonprescription pain medication. Examples include ibuprofen (Advil, Motrin) or naproxen (Aleve). If this doesn't help, your doctor may suggest a prescription-strength nonsteroidal pain reliever.

Stronger medications that contain a mild narcotic, such as codeine, are available. But narcotics pose a risk of drug dependence and addiction. They are prescribed only when other pain medications fail or can't be used because of side effects or allergic reactions.

Pain management combined with control of hormone levels

Some treatments relieve pain by controlling levels of female hormones. These include:

• Oral contraceptives

• Progestins

• Danazol (Danocrine)

• Gonadotropin-releasing hormone (GnRH) agonists. GnRH agonists temporarily, but dramatically, decrease levels of female hormones. This allows time for the endometriosis to fade away.

Conservative surgical treatments

During laparoscopy, your doctor will destroy small areas of extra endometrial tissue that are implanted outside the uterus. He may burn them away or use a laser to vaporize them. Your doctor also may trim away tissue that is displacing your pelvic organs. These procedures often can be done during a diagnostic laparoscopy session.

For more extensive endometriosis, you may need traditional abdominal surgery. This is done through a larger incision. The larger incision provides more room to reach and treat all areas of endometriosis inside your pelvis and abdomen.

Hysterectomy

The doctor may treat endometriosis by removing the uterus, ovaries and fallopian tubes. Hysterectomy is a last resort when other measures have failed. It is only performed in women with severe disabling pain who no longer want to become pregnant.

The treatment option that is best for you depends on several factors. These include the severity of your symptoms and your plans for pregnancy.

Call your doctor or gynecologist if you experience:

• Unusual and severe pain just before or during your menstrual period

• Pelvic or abdominal pain

• Abnormally heavy menstrual periods

• Vaginal spotting

• Any other symptom of endometriosis

Also contact your doctor if you have been unable to conceive a child after one year of unprotected intercourse.

The outlook is good, especially when endometriosis is diagnosed and treated early. Medical and surgical treatments can relieve the pain of endometriosis in most women.

Even without treatment, the majority of women with mild endometriosis eventually can become pregnant. Many women who have laparoscopic surgery to improve their fertility become pregnant.

Symptoms of endometriosis go away after menopause, as long as estrogen treatment is not used.

National Institute of Child Health & Human Development
Building 31, Room 2A32
MSC 2425
31 Center Drive
Bethesda, MD 20892-2425
Toll-Free: 1-800-370-2943
Fax: 301-496-7101
http://www.nichd.nih.gov/

Endometriosis Association
8585 N. 76th Place
Milwaukee, WI 53223
Phone: 414-355-2200
Toll-Free: 1-800-992-3636
Fax: 414-355-6065
http://www.endometriosisassn.org/