Endometriosis is
the growth of tissue outside of the uterine cavity.
What
is Endometriosis?
Endometriosis
is the growth of tissue that is normally found in the lining of the
uterus (endometrium) in a location outside of the uterine cavity. It
can occur on the ovaries, surface of the uterus, on the intestine, or
on or in other organs. With the changing hormone levels during the
menstrual cycle, the tissue may grow and break down, leading to pain
and eventual scar formation. Over 5.5 million American women have
symptoms of endometriosis.
What
is Endometriosis?
Endometriosis
is the growth of tissue that is normally found in the lining of the
uterus (endometrium) in a location outside of the uterine cavity. It
can occur on the ovaries, surface of the uterus, on the intestine, or
on or in other organs. With the changing hormone levels during the
menstrual cycle, the tissue may grow and break down, leading to pain
and eventual scar formation. Over 5.5 million American women have
symptoms of endometriosis.
Endometriosis
or Menstrual Cramps?
Most
women report having mild pain with menstruation, and over-the-counter
medications may provide relief. If your menstrual pain is persistent,
severe enough to interfere with normal activity, or lasts longer than 2
days, consult your doctor.
Endometriosis
in Teens
Endometriosis
can begin in teens as early as the first menstrual period. It’s
important to consult a physician if a teenager has menstrual pain that
is severe enough to interfere with normal activity. Over-the-counter
pain medications and careful recording of the symptoms may be the first
step in management. Treatment options for teens and adults are the
same.
Endometriosis
Infertility
Infertility
can be the first sign of endometriosis in many women. About 30% to 40%
of women with endometriosis have some trouble conceiving. The reason
for this is not well understood, and scarring of the reproductive tract
may play a role. Hormonal factors also may be involved. Fortunately,
treatments to overcome infertility are effective for many women.
Endometriosis
or Uterine Fibroids?
Severe
menstrual pain can be caused by other conditions, including fibroid
tumors. Fibroid tumors are noncancerous growths of the muscle tissue of
the uterus. They can cause heavier than normal menstrual bleeding and
cramping. Both endometriosis and fibroids can cause pain at other times
of the month as well.
What
Causes Endometriosis?
The
reason that endometriosis develops is not well understood. Hereditary
factors seem to play a role, and some areas of endometrial cells
outside of the uterus may be present at birth. It is also possible that
endometrial cells may travel to abnormal areas during menstrual
bleeding, during surgeries, or through the bloodstream. Immunological
factors may be involved, as a defect in the immune system could cause
failure to eliminate the misplaced endometrial cells.
The
brown cells seen here are endometrial cells removed from an abnormal
growth on an ovary.
Who Is at Risk For Endometriosis?
Risk factors for
endometriosis are varied. It is most common in women:
·
Who are in their 30s and 40s
·
Who have not given birth
·
Who have periods that last longer than 7 days
·
Who started menstruating before age 12
·
Who have short menstrual cycles (shorter than 28 days)
·
Who have a family history (mother or sister) of the
condition
Endometriosis Diagnosis: Tracking Symptoms
Taking notes
about your pattern of symptoms can help your doctor determine if you
have endometriosis.
When tracking
endometriosis symptoms, note the following:
·
The severity of the pain
·
When the pain occurs
·
The duration of the pain
·
Any changes such as worsening of the pain
·
Pain during sex, urination, or bowel movements
·
Pain that restricts normal activities
Endometriosis Diagnosis: Tracking Symptoms
Taking notes
about your pattern of symptoms can help your doctor determine if you
have endometriosis.
When tracking
endometriosis symptoms, note the following:
·
The severity of the pain
·
When the pain occurs
·
The duration of the pain
·
Any changes such as worsening of the pain
·
Pain during sex, urination, or bowel movements
·
Pain that restricts normal activities
Endometriosis
Diagnosis: Pelvic Exam
A
pelvic examination will help your doctor identify anything abnormal in
the ovaries, cervix, or uterus. This exam can sometime reveal masses,
scars, or cysts that are due to endometriosis. The pelvic exam can
sometimes identify other conditions that can cause similar symptoms.
Endometriosis
Diagnosis: Pelvic Imaging
Even
though imaging studies cannot confirm the diagnosis of endometriosis,
ultrasound, CT, or MRI scans are sometimes used to help in diagnosis as
these scans can detect larger areas of endometriosis or cysts related
to endometriosis.
Endometriosis
Diagnosis: Laparoscopy
Laparoscopy,
a surgical procedure, is the only way to definitively diagnose
endometriosis. In this procedure, the surgeon examines the inside of
the abdomen and pelvis with a viewing instrument inserted through a
small incision. Small tissues samples (biopsies) can be taken for
examination by a pathologist to confirm the diagnosis.
Treating
Endometriosis Pain
Medications
like acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs)
such as ibuprofen can help relieve the pain, but these do not affect the
endometriosis itself.
Medical Marijuana for Endometriosis
The
functioning of the uterus is related to the body’s internal cannabinoid
system, which has led researchers to explore pain treatments for
endometriosis using medical marijuana. A 2010 study looked at the
effects cannabinoids had on controlling endometriosis growth and pain.
Researchers called the results of the study on rats “promising,”
although it drew few conclusions.
Birth
Control Pills for Endometriosis
Taking
oral contraceptives to reduce the amount of menstrual flow can often
reduce the pain associated with endometriosis symptoms while producing
shorter and lighter menstrual cycles. Sometimes the pills are taken
continuously, without breaks for a menstrual period. Progesterone-only
therapy (as opposed to combined estrogen and progesterone therapy) can
be given by injection or pill form. The endometriosis symptoms may
return after the therapy is discontinued.
Hormone
Therapy for Endometriosis
Other
hormonal therapies mimic the hormonal state of menopause, eliminating
menstrual periods and reducing the pain of endometriosis. GnRH agonists
interrupt the production of female hormones.
List of GnRH Agonists
·
leuprolide (Lupron)
·
nafarelin (Synarel)
·
goserelin (Zoladex)
These
agonists can have unpleasant side effects such as hot flashes, vaginal
dryness, bone loss, and changes in mood. Danazol (Danocrine) is another
medication that lowers estrogen levels and has some weak male hormone
activity. Its side effects can include acne, facial hair development,
weight gain, reduction in breast size, and voice and mood changes.
Endometriosis
Treatment: Excision
At
the time of laparoscopy, the surgeon can remove endometriosis growths
or scars. Most women will have pain relief after this is done, but
recurrence of endometriosis symptoms occurs in about 45% of women a
year later. Recurrence is more likely with time. Hormone treatments
after surgery may reduce the chance that endometriosis symptoms will
return.
Endometriosis
Treatment: Open Surgery
Very
severe cases of endometriosis may require open abdominal surgery to
remove endometrial growths, or even a hysterectomy (removal of the
uterus). Parts or all of the ovaries may also be removed in these
cases. Even with removal of the uterus and ovaries, endometriosis
returns in about 15% of women.
Getting
Pregnant With Endometriosis
Laparoscopic
surgery to remove growths can help affected women get pregnant.
Treatments like in vitro fertilization can also help overcome
infertility associated with endometriosis.
Coping
With Endometriosis
While
endometriosis can’t be prevented, some lifestyle measures can help
manage the condition and improve endometriosis symptoms. Exercise may
help relieve pain through the production of endorphins. Some women find
that techniques like yoga, massage, acupuncture, and meditation are
helpful in managing symptoms.
Is
There a Cure for Endometriosis?
Endometriosis
symptoms go away with menopause for most women. Many women find that
endometriosis symptoms are relieved during pregnancy. And in about
one-third of cases, the symptoms disappear on their own.
Endometriosis
Symptoms, Stages, Treatment
This tool does not provide medical
advice.
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