Endometriosis is an often painful disorder in which tissue that normally lines the inside of your uterus — the endometrium — grows outside your uterus. Endometriosis most commonly involves your ovaries, fallopian tubes and the tissue lining your pelvis. Rarely, endometrial tissue may spread beyond pelvic organs.
With endometriosis, displaced endometrial tissue continues to act as it normally would — it thickens, breaks down and bleeds with each menstrual cycle. Because this displaced tissue has no way to exit your body, it becomes trapped. When endometriosis involves the ovaries, cysts called endometriomas may form. Surrounding tissue can become irritated, eventually developing scar tissue and adhesions (abnormal bands of fibrous tissue that can cause pelvic tissues and organs to stick to each other).
Endometriosis can cause pain especially during your period. Fertility problems also may develop. Fortunately, effective treatments are available.
Causes and Risk Factors of Endometriosis
Although the exact cause of endometriosis is not certain, different exeperts try to give different explanations to it.
There are several factors that place a greater risk of developing endometriosis, such as:
- Never giving birth.
- Starting your period at an early age.
- Going through menopause at an older age.
- Short menstrual cycles for instance, less than 21 days.
- Having higher levels of estrogen in your body or a greater lifetime exposure to estrogen your body produces.
- Low body mass index.
- Alcohol consumption.
- One or more relatives (mother, aunt or sister) with endometriosis.
- Any medical condition that prevents the normal passage of menstrual flow out of the body.
- Uterine abnormalities.
Endometriosis usually develops several years after the onset of menstruation (menarche). Signs and symptoms of endometriosis end temporarily with pregnancy and end permanently with menopause, unless you’re taking estrogen.
Symptoms of Endometriosis
The primary symptom of endometriosis is pelvic pain, often associated with your menstrual period. Although many women experience cramping during their menstrual period, women with endometriosis typically describe menstrual pain that’s far worse than usual. They also tend to report that the pain increases over time.
Common signs and symptoms of endometriosis may include:
- Pelvic pain and cramping may begin before your period and extend several days into your period. You may also have lower back and abdominal pain.
- Pain during or after sex is common with endometriosis.
- Pain with bowel movements or urination.
- You may experience occasional heavy periods (menorrhagia) or bleeding between periods (menometrorrhagia).
- Endometriosis is first diagnosed in some women who are seeking treatment for infertility.
- You may also experience fatigue, diarrhea, constipation, bloating or nausea, especially during menstrual periods.
Treatment of Endometriosis
Treatment for endometriosis is usually with medications or surgery. The approach you and your doctor choose will depend on the severity of your signs and symptoms and whether you hope to become pregnant. Generally, doctors recommend trying conservative treatment approaches first, opting for surgery as a last resort.
Your doctor may recommend that you take an over-the-counter pain reliever, such as the nonsteroidal anti-inflammatory drugs (NSAIDs) ibuprofen (Advil, Motrin IB, others) or naproxen (Aleve, others), to help ease painful menstrual cramps.
Supplemental hormones are sometimes effective in reducing or eliminating the pain of endometriosis. The rise and fall of hormones during the menstrual cycle causes endometrial implants to thicken, break down and bleed. Hormone medication may slow endometrial tissue growth and prevent new implants of endometrial tissue. Hormone therapy isn’t a permanent fix for endometriosis. You could experience a return of your symptoms after stopping treatment.
If you have endometriosis and are trying to become pregnant, surgery to remove as much endometriosis as possible while preserving your uterus and ovaries (conservative surgery) may increase your chances of success. If you have severe pain from endometriosis, you may also benefit from surgery however, endometriosis and pain may return.
Assisted reproductive technologies, such as in vitro fertilization, to help you become pregnant are sometimes preferable to conservative surgery. Doctors often suggest one of these approaches if conservative surgery doesn’t work.
In severe cases of endometriosis, surgery to remove the uterus and cervix (total hysterectomy) as well as both ovaries may be the best treatment. A hysterectomy is typically considered a last resort, especially for women still in their reproductive years. You can’t get pregnant after a hysterectomy. Long-term health risks after hysterectomy may include an increased risk of heart and blood vessel (cardiovascular) diseases and certain metabolic conditions, especially if you have the surgery before age 35.
Complications of Endometriosis
The main complication of endometriosis is impaired fertility. For pregnancy to occur, an egg must be released from an ovary, travel through the neighboring fallopian tube, become fertilized by a sperm cell and attach itself to the uterine wall to begin development. Endometriosis may obstruct the tube and keep the egg and sperm from uniting. But the condition also seems to affect fertility in less-direct ways, such as damage to the sperm or egg.
Some studies suggest that endometriosis may increase the risk of ovarian cancer. These studies are however, not conclusive.