What it is
Endometriosis is a common health problem in women. It gets its name from the word endometrium, the tissue that lines the uterus (womb). In women with this problem, tissue that looks and acts like the lining of the uterus grows outside of the uterus in other areas. These areas can be called growths, tumors, implants, lesions, or nodules.
Most endometriosis is found:
* on or under the ovaries
* behind the uterus
* on the tissues that hold the uterus in place
* on the bowels or bladder
This "misplaced" tissue can cause pain, infertility, and very heavy periods.
Growths of endometriosis are almost always benign or not cancerous, but still can cause many problems. To see why, it helps to understand a woman's monthly cycle. Every month, hormones cause the lining of a woman's uterus to build up with tissue and blood vessels. If a woman does not get pregnant, the uterus sheds this tissue and blood, leaving her body through the vagina as her menstrual period.
Patches of endometriosis also respond to a woman's monthly cycle. Each month the growths add extra tissue and blood, but there is no place for the built-up tissue and blood to exit the body. For this reason, growths tend to get bigger and the symptoms of endometriosis often get worse over time.
Tissue and blood that is shed into the body can cause inflammation, scar tissue, and pain. As the misplaced tissue grows, it can cover or grow into the ovaries and block the fallopian tubes. This can make it hard for women with endometriosis to get pregnant. The growths can also cause problems in the intestines and bladder.
No one knows for sure what causes this disease, but scientists have a number of theories.
They know that endometriosis runs in families. If your mother or sister has endometriosis, you are six times more likely to get the disease than other women. So, one theory suggests that endometriosis is caused by genes.
Another theory is that during a woman's monthly periods, some endometrial tissue backs up into the abdomen through the fallopian tubes. This transplanted tissue then grows outside the uterus. Many researchers think a faulty immune system plays a part in endometriosis. In women with the disease, the immune system fails to find and destroy endometrial tissue growing outside of the uterus. Plus, a recent study shows that immune system disorders (health problems in which the body attacks itself) are more common in women with endometriosis. More research in this area may help doctors better understand and treat endometriosis.
Pain is one of the most common symptoms of endometriosis. Usually the pain is in the abdomen, lower back, and pelvis. The amount of pain a woman feels does not depend on how much endometriosis she has. Some women have no pain, even though their disease affects large areas. Other women with endometriosis have severe pain even though they have only a few small growths. Symptoms of endometriosis include:
* Very painful menstrual cramps
* Pain with periods that gets worse over time
* Chronic pain in the lower back and pelvis
* Pain during or after sex
* Intestinal pain
* Painful bowel movements or painful urination during menstrual periods
* Heavy and/or long menstrual periods
* Spotting or bleeding between periods
* Infertility (not being able to get pregnant)
Women with endometriosis may also have gastrointestinal problems such as diarrhea, constipation, or bloating, especially during their periods.
Who is at risk?
About five million women in the United States have endometriosis. This makes it one of the most common health problems for women.
In general, women with endometriosis:
* get their monthly period
* are 27-years-old on average
* have symptoms for two to five years before finding out they have the disease
Women who have gone through menopause (when a woman stops having her period) rarely still have symptoms.
You are more likely to develop endometriosis if you:
* began getting your period at an early age
* have heavy periods
* have periods that last more than seven days
* have a short monthly cycle (27 days or less)
* have a close relative (mother, aunt, sister) with endometriosis
Some studies suggest that you may lower your chances of developing endometriosis if you:
* exercise regularly
* avoid alcohol and caffeine
If you think you have this disease, talk with your obstetrician/gynecologist (OB/GYN). Your doctor will talk to you about your symptoms and health history. Then she or he will do a pelvic exam. Sometimes during the exam, the doctor can find signs of endometriosis.
Usually doctors need to run tests to find out if a woman has endometriosis. Sometimes doctors use imaging tests to "see" large growths of endometriosis inside the body. The two most common imaging tests are:
* ultrasound, which uses sound waves to see inside the body
* magnetic resonance imaging (MRI), which uses magnets and radio waves to make a "picture" of the inside of the body
The only way to know for sure if you have endometriosis is to have a surgery called laparoscopy. In this procedure, a tiny cut is made in your abdomen. A thin tube with a light is placed inside to see growths from endometriosis. Sometimes doctors can diagnose endometriosis just by seeing the growths. Other times, they need to take a small sample of tissue, or a biopsy, and study it under a microscope.
There is no cure for endometriosis, but there are many treatments for the pain and infertility that it causes. Talk with your doctor about what option is best for you. The treatment you choose will depend on your symptoms, age, and plans for getting pregnant.
Pain Medication. For some women with mild symptoms, doctors may suggest taking over-the-counter medicines for pain. These include: ibuprofen (Advil and Motrin) or naproxen (Aleve). When these medicines don't help, doctors may advise using stronger pain relievers available by prescription.
Hormone Treatment. When pain medicine is not enough, doctors often recommend hormone medicines to treat endometriosis. Only women who do not wish to become pregnant can use these drugs. Hormone treatment is best for women with small growths who don't have severe pain.
Hormones come in many forms including pills, shots, and nasal sprays. Many hormones are used for endometriosis including:
- Birth control pills block the effects of natural hormones on endometrial growths. So, they prevent the monthly build-up and breakdown of growths. This can make endometriosis less painful. Birth control pills also can make a woman's periods lighter and less uncomfortable. Most birth control pills contain two hormones, estrogen and progestin. This type of birth control pill is called a "combination pill." Once a woman stops taking them, the ability to get pregnant returns, but so may the symptoms of endometriosis.
- Progestins or progesterone medicines work much like birth control pills and can be taken by women who can't take estrogen. When a woman stops taking progestins, she can get pregnant again. But, the symptoms of endometriosis return too.
Surgery. Surgery is usually the best choice for women with endometriosis who have a severe amount of growths, a great deal of pain, or fertility problems. There are both minor and more complex surgeries that can help. Your doctor might suggest one of the following:
- Laparoscopy can be used to diagnose and treat endometriosis. During this surgery, doctors remove growths and scar tissue or destroy them with intense heat. The goal is to treat the endometriosis without harming the healthy tissue around it. Women recover from laparoscopy much faster than from major abdominal surgery.
- Laparotomy or major abdominal surgery is a last resort treatment for severe endometriosis. In this surgery, the doctor makes a much bigger cut in the abdomen than with laparoscopy. This allows the doctor to reach and remove growths of endometriosis in the pelvis or abdomen. Recovery from this surgery can take up to two months.
- Hysterectomy should only be considered by women who do not want to become pregnant in the future. During this surgery, the doctor removes the uterus. She or he may also take out the ovaries and fallopian tubes at the same time. This is done when the endometriosis has severely damaged them.