What is Endometriosis?

Endometriosis is a common and often painful disorder of the female reproductive system. In this condition, a specialized type of tissue that normally lines the inside of your uterus (the endometrium) becomes implanted outside your uterus, most commonly on your fallopian tubes, ovaries or the tissue lining your pelvis. In rare cases, endometrial tissue may spread beyond your pelvic region.

During your menstrual cycle, hormones signal the lining of your uterus to thicken to prepare for possible pregnancy. If a pregnancy doesn’t occur, your hormone levels decrease, causing the thickened lining of your uterus to shed. This produces bleeding that exits your body through the vagina — your monthly period.

When endometrial tissue is located in other parts of your body, it continues to act in its normal way: It thickens, breaks down and bleeds each month as your hormone levels rise and fall. However, because there’s nowhere for the blood from this mislocated tissue to exit your body, it becomes trapped, and surrounding tissue can become irritated.

Trapped blood may lead to the growth of cysts. Cysts, in turn, may form scar tissue and adhesions — abnormal tissue that binds organs together. This process can cause pain in the area of this misplaced tissue, usually the pelvis, especially during your period. Endometriosis can also cause fertility problems. In fact, scars and adhesions on ovaries or fallopian tubes can prevent pregnancy.

Signs and Symptoms

Endometriosis can be mild, moderate or severe, and it tends to get worse over time without treatment. Some women with endometriosis have no signs and symptoms at all, and the disease is discovered only during an unrelated operation, such as a tubal ligation. Others may experience one or more of the following signs and symptoms:

  • Painful periods (dysmenorrhea). Pelvic pain and cramping may begin before and extend several days into your period and may include lower back and abdominal pain.
  • Pain at other times. You may experience pelvic pain during ovulation, a sharp pain deep in the pelvis during intercourse, or pain during bowel movements or urination.
  • Excessive bleeding. You may experience occasional heavy periods (menorrhagia) or bleeding between periods (menometrorrhagia).
  • Infertility. Endometriosis is first diagnosed in some women who are seeking treatment for infertility.

Some cramping during your period isn’t abnormal. But women with endometriosis typically describe menstrual pain that’s far worse than normal. They also tend to report that the pain has increased over time.

Pain is a common symptom of endometriosis. However, severity of pain isn’t necessarily a reliable indicator of the extent of the condition. Some women with mild endometriosis have extensive pain, while others with more severe scarring may have little pain or no pain at all.

Endometriosis is sometimes mistaken for other conditions that can cause pelvic pain, such as pelvic inflammatory disease (PID) or ovarian cysts. It may 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.

Treatment

Treatment for endometriosis is with medications or procedures. The approach you and your CHCW doctor choose will depend on the severity of your signs and symptoms and whether you hope to become pregnant in the future.

  • Pain medications. Your doctor may recommend that you take an over-the-counter pain reliever, such as ibuprofen (Advil), to help ease painful menstrual cramps. However, if you find that taking the maximum dose doesn’t provide full relief, you may need to try another treatment approach to manage your symptoms.
  • Hormone therapy. Supplemental hormones are effective in reducing or eliminating the pain of endometriosis. That’s because the rise and fall of hormones during a woman’s menstrual cycle causes endometrial implants to thicken, break down and bleed. In fact, if hormonal therapy has little to no effect on your symptoms, consider questioning the diagnosis of endometriosis or its relationship to your symptoms.
  • Conservative procedures. Although hormone therapies are effective in reducing or eliminating symptoms of endometriosis, they prevent pregnancy. If you have endometriosis and are trying to become pregnant, procedures to remove implants may increase your chances of success. If you have severe pain from endometriosis, you may also benefit from the procedure.

    Conservative procedures remove endometrial growths, scar tissue and adhesions without removing your reproductive organs. Your doctor may do this procedure laparoscopically or through traditional abdominal procedures in more extensive cases. In laparoscopic procedures, a slender viewing instrument (laparoscope) is inserted through a small incision near your navel. The laparoscope is equipped with a laser, a cautery – an instrument that destroys tissue with heat – or small procedural instruments. Assisted reproductive technologies are sometimes preferable to conservative procedure, and doctors often suggest these approaches if conservative procedures are ineffective.

  • Hysterectomy. In severe cases of endometriosis, a total hysterectomy and the removal of both ovaries may be the best treatment. Hysterectomy alone is also effective, but removing the ovaries ensures that endometriosis will not return. Either type of procedure is typically considered a last resort, especially for women still in their reproductive years. You can’t get pregnant after a hysterectomy.

Although no single treatment option is ideal for everyone, most women who seek help for endometriosis find some, if not complete, relief from their symptoms. If your pain persists or if finding a treatment that works takes some time, you can try measures at home to relieve your discomfort. Warm baths and a heating pad can help relax pelvic muscles, reducing cramping and pain.