What is endometriosis?

The tissue that normally lines the inside of the uterus is called the endometrium. In some women endometrium grows outside the uterus. When this happens a woman has a condition called endometriosis. The most common areas for this abnormal growth of endometrium are the reproductive organs (ovaries, fallopian tubes, uterus). Endometrium may also grow on the intestines, bladder, or even in the rectum.

This misplaced tissue responds to the hormones of the menstrual cycle and bleeds each month in the same way the lining of the uterus responds to hormones. However, if the tissue is not in the uterus, the blood shed from the tissue has no way to leave the body. When the tissue bleeds, cysts, adhesions, and scar tissue form and the area around the endometriosis thickens.

How does it occur?

Why some women develop endometriosis is not known. There are many theories, but none of them explains all cases. One theory suggests that in some women some of the endometrial tissue flows backward during menstrual flow into the fallopian tubes and abdomen, where it attaches and grows.

Another theory suggests that some endometrial tissue in the uterus backs up in all women. The immune system may then destroy the misplaced tissue. Women who develop endometriosis, however, may have an immune system that is not able to destroy the misplaced tissue.

What are the symptoms?

Some women have no symptoms. If symptoms occur they may include:

• abnormal or heavy menstrual flow

• back or flank pain before or during the menstrual period

• very painful menstrual cramps

• painful intercourse

• pelvic pain, especially before or during the menstrual period

• painful bowel movements, diarrhea, constipation or other intestinal upsets during the menstrual period

• painful urination or feeling the need to urinate often during the menstrual period

• difficulty becoming pregnant.

How is it diagnosed?

First, the doctor will ask you about your symptoms. You will need a pelvic exam to check for cysts or nodules or any abnormal tenderness or thickening in your pelvic area. Usually, the doctor will need to do a one-day surgical procedure in the hospital called a laparoscopy. You are given an anesthetic before the procedure so you will not feel any pain. Then a small cut is made near the navel and your abdomen is filled with a gas (carbon dioxide). The surgeon inserts an instrument called a laparoscope through the cut and into the abdomen to look at the organs and the pelvic cavity.

With laparoscopy the doctor can see the size, location, and number of endometrial growths. Sometimes a piece of tissue is removed (a biopsy) to help make a diagnosis.

Before treatment can begin, a definite diagnosis is required.

How is it treated?

There is no cure for endometriosis. It is a disease that can get more severe as you grow older. However, there are many ways to lessen the symptoms and complications. The treatment depends on the severity of the symptoms, the location and degree of endometriosis, your age, and your plans for childbearing.

If the only symptom is mild premenstrual pain, the only treatment necessary may be a medication such as aspirin or ibuprofen to relieve the pain.

If you have a diagnostic laparoscopy, your doctor may use a laser to remove the abnormal tissue at the time of the laparoscopy, especially if you have a mild case of endometriosis.

The doctor may prescribe birth control pills, progesterone pills, or other drugs to control your hormones. The purpose of these medicines is to control the hormone stimulation of the endometriosis areas. These are usually prescribed for six months, but the length of time varies with individual circumstances.

If you take a drug to control your hormones, both the lining of the uterus and the misplaced endometrial tissue will decrease or stop bleeding each month. This should stop the buildup of cysts and scar tissue and swelling outside the uterus. Drug treatment also allows your body to heal the endometriosis as much as possible.

Some of the drugs used for treatment of endometriosis are very expensive. They are mainly used if you have endometriosis and are also trying to become pregnant.

How long will the effects last?

No treatment has been found yet that is 100% effective. All current therapy offers at least some relief from the symptoms but not a cure. Endometriosis may recur or progress after hormone therapy or surgery.

In severe cases, possible treatment is to surgically remove the organs containing the growths (such as the fallopian tubes, uterus, or the ovaries). If your uterus is removed, you can never become pregnant.

How can I take care of myself?

Keep a careful record of your symptoms. The easiest way to do this is to assign a number to each of the symptoms you have and record them by number on your calendar for three months. Record all symptoms, including any time lost from work and leisure activities. Report the symptoms to your doctor. Take your calendar with you to your appointment. If you have not yet been diagnosed with endometriosis, your doctor may not suspect endometriosis without this information.

Try the following recommendations for easing your pain:

• Take warm baths.

• Rest.

• Wear loose clothing.

• Use a hot water bottle or heating pad on your abdomen.

• Avoid constipation by increasing the fiber in your diet.

• Do relaxation exercises.

• Listen to soft music and breathe slow, deep breaths.

• Take pain medication as recommended by your doctor.

You may want to join a chapter of the Endometriosis Association. This organization is a support group run by women with endometriosis.

Endometriosis Association International Headquarters
8585 North 76th Place
Milwaukee, WI 53223

(800) 992-3636

http://www.endometriosisassn.org

What can be done to help prevent endometriosis?

Endometriosis is a condition that cannot be prevented or cured. However, treatment can help control the symptoms.