What is endometriosis?

The tissue that lines the uterus (the womb) is known as the endometrium. Normally, this tissue is only found in the uterus. When this tissue grows in other parts of the body, outside of the uterus, it is called endometriosis. Typically, the tissue lining the uterus grows and then sheds about every 28 days - this shedding is known as a period. In people with endometriosis, the endometrial tissue outside of the uterus also grows and then sheds during a period, but unlike the tissue in the uterus, there is no way for it to leave the body. This tissue buildup can cause damage to the other tissues and organs in the area around it, which can cause inflammation and pain.  

Where does endometriosis happen?

Endometriosis usually affects areas around the uterus, such as the fallopian tubes, ovaries, bladder, and bowels. In some rare cases, the tissue can grow in other parts of the body, such as the areas around the heart and lungs.

What causes endometriosis?

While scientists aren’t completely sure about how endometriosis happens, they do have some ideas. Some explanations include:

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1. Problems with the flow of menstrual fluids. During menstruation (also called a period), the period fluid can flow backward into the uterus and into other parts of the body, like the pelvis. When this happens, some of the endometrial tissue may be left in those areas instead of exiting the body.
2. Genetic factors.  Some other explanations suggest that it may be inherited through genetics.
3. Immune system dysfunction. Another possibility is that the immune system is not working properly to eliminate the endometrial tissues growing outside of the uterus.
   
   

Although the exact cause of endometriosis is unclear, evidence suggests that estrogen (a natural hormone made by the human body) influences the growth of this tissue.

Who gets endometriosis?

The World Health Organization (WHO) estimates that endometriosis affects about 10% of women aged 15 to 49 years old, worldwide. Endometriosis is more common in women in their 30s and 40s, but it can happen to anyone who experiences a period.

What are the symptoms of endometriosis?

Some common symptoms of endometriosis include:

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• Pain. This is the most common symptom, and you might experience pain, such as:
  
  • Pelvic pain
  • Painful menstruation (period) cramps
  • Pain during or after sex
  • Pain in the abdomen
  • Painful bowel movements (pooping) or urination (peeing) during your period
• Heavy periods
• Bleeding or spotting between periods
• Fatigue
• Digestive symptoms such as diarrhea, constipation, bloating, or nausea
• Infertility (not able to become pregnant)

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Keep in mind that some people with endometriosis may not have any symptoms at all. Talk to your doctor or healthcare provider if you are experiencing any of these symptoms.

How do I know if I have endometriosis?

Only your doctor or healthcare provider can tell you if you have endometriosis. They will ask about your symptoms and may use some of the following tests to find out if you have endometriosis:

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• Pelvic exams. The doctor may feel for things such as tenderness or nodules.
• Imaging tests such as an ultrasound.
• Laparoscopy. This is a type of surgery where the doctor makes a small cut to the skin and inserts a thin tube with a small camera attached that allows the doctor to check inside the abdomen or pelvis for any signs of endometriosis.
• Biopsy. The doctor may use a surgical tool to take a tissue sample and have it examined in a laboratory for any signs of endometriosis.

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The only way to be certain you have endometriosis is through surgery such as laparoscopy or biopsy. Because of this, many women may go undiagnosed for years. If you have any concerns about having endometriosis, be sure to talk to a healthcare provider, such as your doctor.

How is endometriosis treated?

There is no cure for endometriosis. However, there are multiple options available to treat the symptoms of endometriosis. Treatment options include:

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• Pain relievers. Nonsteroidal anti-inflammatory drugs (NSAIDS), such as ibuprofen and naproxen, can help reduce pain and inflammation. Although some NSAIDS may be found over-the-counter, your doctor may prescribe higher strengths that are only available with a prescription.
• Hormone therapy such as birth control pills, hormonal IUD, gonadotropin-releasing hormone (GnRH) medicines, and aromatase inhibitors. Hormone therapies can help control the growth of endometrial tissue by managing your hormone levels.
• Surgery. When there is severe pain or medications have failed to treat the endometriosis, the doctor may recommend surgery. Surgery may involve removing the endometrial growths, ovaries, or removing the uterus entirely (also called a hysterectomy).

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Some of these treatments may be used alone or in combination with other treatments. Your doctor will determine what treatment is best for you based on your preferences, whether or not you are pregnant or plan to become pregnant, the severity of the endometriosis, and your medical history.

Can I get pregnant if I have endometriosis?

Yes, many women with endometriosis have successful pregnancies. However, endometriosis can make it harder to become pregnant. There are treatment options available to help increase the chances of pregnancy, such as surgery to remove endometrial growths, in vitro fertilization (IVF), and intrauterine insemination (IUI).

This article is for informational purposes only and should not be substituted for professional medical advice, diagnosis, or treatment. Information is subject to change. Consult your healthcare provider for guidance on medical issues and before starting, changing, or terminating any medical treatment.

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References

• American College of Obstetricians & Gynecologists: Laparoscopy
• Facts, Views and Vision in ObGyn: Surgery for endometriosis-associated infertility: do we exaggerate the magnitude of effect?
• Fertility and Sterility: Aromatase inhibitors for the treatment of endometriosis
• John Hopkins Medicine: Endometriosis
• MedlinePlus: Endometriosis
• The Journal of Medicine and Life (JML): Endometriosis still a challenge
• The Lancet: Endometriosis is a chronic systemic disease: clinical challenges and novel innovations.
• The Office on Women's Health (OWH): Endometriosis
• World Health Organization (WHO): Endometriosis

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