Endometriosis

What is endometriosis?

The uterus, or womb, is the place where a baby grows when a woman is pregnant. It is lined with tissue (endometrium). Endometriosis is a disease in which tissue that is similar to the lining of the uterus grows in other places in your body. These patches of tissue are called "implants," "nodules," or "lesions." They are most often found:

• On or under the ovaries
• On the fallopian tubes, which carry egg cells from the ovaries to the uterus
• Behind the uterus
• On the tissues that hold the uterus in place
• On the bowels or bladder

In rare cases, the tissue may grow on your lungs or in other parts of your body.

What causes endometriosis?

The cause of endometriosis is unknown.

Who is at risk for endometriosis?

Endometriosis is most commonly diagnosed in women in their 30s and 40s. But it can affect any female who menstruates. Certain factors can raise or lower your risk of getting it.

You are at higher risk if:

• You have a mother, sister, or daughter with endometriosis
• Your period started before age 11
• Your monthly cycles are short (less than 27 days)
• Your menstrual cycles are heavy and last more than 7 days

You have a lower risk if:

• You have been pregnant before
• Your periods started late in adolescence
• You regularly exercise more than 4 hours a week
• You have a low amount of body fat

What are the symptoms of endometriosis?

The main symptoms of endometriosis are:

• Pelvic pain, which affects about 75% of women with endometriosis. It often happens during your period.
• Infertility, which affects up to half of all women with endometriosis

Other possible symptoms include:

• Painful menstrual cramps, which may get worse over time
• Pain during or after sex
• Pain in the intestine or lower abdomen
• Pain with bowel movements or urination, usually during your period
• Heavy periods
• Spotting or bleeding between periods
• Digestive or gastrointestinal symptoms
• Fatigue or lack of energy

How is endometriosis diagnosed?

Surgery is the only way to know for sure that you have endometriosis. First, however, your health care provider will ask about your symptoms and medical history. You will have a pelvic exam and may have some imaging tests.

The surgery to diagnose endometriosis is a laparoscopy. This is a type of surgery that uses a laparoscope, a thin tube with a camera and light. The surgeon inserts the laparoscope through a small cut in the skin. Your provider can make a diagnosis based on how the patches of endometriosis look. He or she may also do a biopsy to get a tissue sample.

What are the treatments for endometriosis?

There is no cure for endometriosis, but there are treatments for the symptoms. Your health care provider will work with you to decide which treatments would be best for you.

Treatments for endometriosis pain include:

• Pain relievers, including nonsteroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen and a prescription medicine specifically for endometriosis. Providers may sometimes prescribe opioids for severe pain.
• Hormone therapy, including birth control pills, progestin therapy, and gonadotropin-releasing hormone (GnRH) agonists. GnRH agonists cause a temporary menopause, but also help control the growth of endometriosis.
• Surgical treatments for severe pain, including procedures to remove the endometriosis patches or cut some nerves in the pelvis. The surgery may be a laparoscopy or major surgery. The pain may come back within a few years after surgery. If the pain is very severe, a hysterectomy may be an option. This is a surgery to remove the uterus. Sometimes providers also remove the ovaries and fallopian tubes as part of a hysterectomy.

Treatments for infertility caused by endometriosis include:

• Laparoscopy to remove the endometriosis patches
• In vitro fertilization

NIH: National Institute of Child Health and Human Development