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Endometriosis

The endometrium is the tissue that lines the inside of the uterus. Endometriosis (Endo) occurs when this tissue travels outside the uterus.

What is happening in the body?

The female hormones estrogen and progesterone encourage the growth of endometrial tissue during a woman's monthly cycle. If no fertilized egg implants itself in this lining, it is shed as menstrual flow. In a woman with endometriosis, some of the endometrial tissue is found outside the uterus.

This tissue also responds to cyclic hormonal signals. However, it cannot be cast off each month. Instead, the cells cause bleeding and scars. Adhesions, or scar tissue, may weld together organs. These include the fallopian tubes and ovaries. This can cause daily or monthly cyclic pain.

Endometriosis often appears in the pelvis or abdominal cavity. Rarely, distant areas like the lungs or brain are affected.

What are the causes and risks of the condition?

The cause of Endometriosis is unknown. Several theories have been proposed. It is possible that:

delayed childbearing increases the risk for Endo

during menstruation, some of the endometrial tissue backs up through the fallopian tubes into the abdomen

genetics play a role, with some families being more prone to Endometriosis

the immune system activates cells that secrete factors to stimulate Endometriosis

What are the signs and symptoms of the condition?

Some women with severe endo have no symptoms. If symptoms do occur, they generally start years after the woman's first menstrual period. The symptoms usually increase gradually as the area of endo grows. After menopause, the symptoms subside as the abnormal tissue shrinks.

The most common symptom of endo is increasingly painful periods, or dysmenorrhea. The woman may experience a steady dull or severe pain in the lower abdomen, vagina, and/or back. This pain can begin 5 to 7 days before a period.

Symptoms of endo may include:

blood in the urine

difficulty urinating

dyspareunia, or painful intercourse

heavy menstrual bleeding

irregular or more frequent periods

nausea and vomiting

pain with bowel movements

pelvic pain after intercourse or exercise

spotty bleeding just before the period starts

How is the condition diagnosed?

Diagnosis of endo begins with a medical history and physical exam, including a pelvic exam. A laparoscopy may be done to confirm the diagnosis. A small incision is made, and a lighted tube is inserted into the pelvis. The healthcare provider looks for abnormal cells and other abnormalities. If the endo is severe, an exploratory laparotomy may be done. This involves a larger incision in the abdomen. The provider can then use tiny surgical tools to identify problems.

What can be done to prevent the condition?

Endo is not preventable. Early diagnosis and treatment may limit cell growth and help prevent adhesions. Pregnancy, oral contraceptives, and other hormones seem to delay its onset.

What are the long-term effects of the condition?

Many women with endo have no long-term problems. Others may have the following conditions:

bowel obstruction

constant bladder or rectal pain

constant pelvic pain

damage to the kidneys and ureters

irritable bowel syndrome

pelvic or abdominal adhesions

Thirty to 40% of women with endo face infertility. Less than 1% of women with endo develop endometrial cancer.

What are the risks to others?

Endo is not contagious and poses no risk to others.

What are the treatments for the condition?

Endo may never be cured or eliminated. Women with mild symptoms are usually treated only with pain medicines as needed. Antiprostaglandins, such as ibuprofen or acetaminophen, are effective.

Different types of hormones can control the growth of the endo and the symptoms. Oral contraceptives or high doses of progestin may slow abnormal tissue growth. Danazol, a weak male hormone, can shrink cell growth. It is only given to women who do not want to get pregnant.

Gonadotropin-releasing hormone (GnRH) agonists may also be used. These medicines stop the ovary from making hormones and releasing an egg. Because bone loss is possible, GnRH agonists are used for only 6 months.

Surgery is an option for women with severe endo or infertility. Laser surgery, laparoscopy, or laparotomy may be done to remove endometrial tissue and adhesions. For women with severe pelvic pain, cutting certain nerves in the pelvis may help. Hysterectomy and the removal of ovaries may be done if an older woman does not want children.

What are the side effects of the treatments?

Hormones may cause depression and irregular menstrual bleeding. They may also cause weight gain, headaches, and mood swings. Surgery may cause bleeding, infection, or allergic reaction to anesthesia.

What happens after treatment for the condition?

Endo recurs in 10% to 30% of cases. Despite treatment, pelvic pain may return. Fertility may be impaired. After previously infertile women have had surgery, pregnancy occurs in about:

75% of those who had mild disease 50% to 60% of those who had moderate disease 30% to 40% of those who had severe disease

How is the condition monitored?

Any new or worsening symptoms should be reported to the healthcare provider.

SBI!