An often painful disorder that affects millions of women, endometriosis (en-doe-me-tree-O-sis) is a condition where tissue that normally lines the uterine cavity or womb grows outside of your uterus or womb where it doesn’t belong. The clumps of tissue that grow outside your uterus are called implants.
When you have endometriosis, the implants of tissue outside your uterus act just like the tissue lining your uterus. During your menstrual cycle, they get thicker, then break down and bleed. But the implants are outside your uterus, so the blood cannot flow out of your body.
Although endometriosis growths are benign (not cancerous), they can still cause problems. The implants can get irritated and painful and sometimes form scar tissue or blood-filled sacs within the ovaries called cysts.
What causes endometriosis?
Experts don’t know what causes endometrial tissue to grow outside your uterus. What they do know is that the female hormone estrogen makes the problem worse. Women have high levels of estrogen during their childbearing years —usually from their teens into their 40s – so that is the most common time for women to develop this disorder. Estrogen levels drop when menstrual periods stop (menopause), and symptoms usually improve.
Symptoms of Endometriosis
The primary symptom of endometriosis is pelvic pain, often associated with your menstrual period. Many women experience cramping during their menstrual period, but women with endometriosis typically experience more severe pain.
Common signs and symptoms of endometriosis may include:
- Painful periods - Pelvic pain and cramping may begin before and extend several days into your period and may include lower back and abdominal pain.
- Pain with intercourse - Pain during or after sex is common with endometriosis.
- Pain with bowel movements or urination - You’re most likely to experience these symptoms during your period.
- Excessive bleeding - You may experience occasional heavy periods or bleeding between periods.
- Infertility - Endometriosis is first diagnosed in some women who are seeking treatment for infertility.
- Other non-specific symptoms – You may also experience fatigue, diarrhea, constipation, bloating or nausea, especially during menstrual periods.
The severity of your pain isn’t necessarily a reliable indicator of the extent of the condition. Some women with mild endometriosis have extensive pain, while others with advanced endometriosis may have little or no pain at all.
Risk Factors
There are several factors that place you at greater risk of developing endometriosis:
- Never giving birth
- 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
- History of pelvic infection
- Uterine abnormalities
How is Endometriosis Diagnosed?
Endometriosis is sometimes mistaken for other conditions that can cause pelvic pain, such as pelvic inflammatory disease (PID) or ovarian cysts. It may also be confused with irritable bowel syndrome (IBS), a condition that causes bouts of diarrhea, constipation and abdominal cramping. IBS can accompany endometriosis, which can complicate the diagnosis.
To determine if you have endometriosis, your doctor may start by asking questions about your symptoms, your periods, your past health, and your family history. Your doctor may next perform a pelvic exam. If your doctor suspects you have a cyst, they may order an ultrasound, MRI or CT scan of your pelvis.
The only way to be sure you have endometriosis is to have a type of surgery called laparoscopy (lap-uh-ROSS-kuh-pee). During this surgery, the doctor puts a thin, lighted tube through a small cut in your belly. If the doctor finds implants, scar tissue, or cysts, he or she can remove them during the same surgery.
How is endometriosis treated?
Although there is no cure for endometriosis, there are good treatments. The approach you and your doctor choose will depend on the severity of your symptoms and whether or not you hope to become pregnant.
Here are some common treatment options:
- Pain medications: Over-the-counter pain medicines like ibuprofen (such as Advil or Motrin) or naproxen (such as Aleve). These medicines called anti-inflammatory drugs, or NSAIDs, can reduce bleeding and pain.
- Birth Control: Birth control pills are often used to treat endometriosis. Most women can use them safely for years, but they are not an option if you want to get pregnant.
- Hormone therapy: Hormone therapy stops your periods and shrinks the implants, but in order to be effective, they have to be taken long term. Like birth control pills, hormone therapy will keep you from getting pregnant.
- Surgery: If you have endometriosis and are trying to become pregnant, surgery to remove as much endometriosis as possible while preserving your uterus and ovaries may increase your chances of success. You may also benefit from surgery if you are experience severe pain from endometriosis. Your doctor may do this procedure laparoscopically or through traditional abdominal surgery in more extensive cases.
In severe cases of endometriosis, surgery to remove the uterus and cervix (total hysterectomy) as well as both ovaries may be the best treatment. Hysterectomy alone is not effective — the estrogen your ovaries produce can stimulate any remaining endometriosis and cause pain to persist. Hysterectomy is typically considered a last resort, especially for women still in their reproductive years.
Can I prevent endometriosis?
You can’t prevent endometriosis, but you can reduce your chances of developing it by lowering the levels of the hormone estrogen in your body. Some things to consider:
- Talk to your doctor about hormonal birth control methods, such as pills, patches or rings with lower doses of estrogen.
- Regular exercise and a lower amount of body fat help decrease the amount of estrogen circulating through the body.
- Large amounts of alcohol raises estrogen levels. No more than one drink per day is recommended for women who choose to drink alcohol.
- Studies show that drinking more than one caffeinated drink a day, especially sodas and green tea, can raise estrogen levels.
When to See Your Doctor
See your doctor if you have symptoms that may indicate endometriosis. The cause of your pelvic pain may be difficult to pinpoint, but discovering the problem early may help you avoid unnecessary complications and more pain in the future.
For more information about endometriosis, please visit these websites:
- National Library of Medicine (www.nlm.nih.gov)
- American Congress of Obstetricians and Gynecologists (www.acog.org)
- American Association of Gynecologic Laparoscopists (www.aagl.org)