Endometriosis

What is endometriosis?

Endometriosis is an abnormal growth of the uterine lining tissue outside of the uterus. The uterus (womb) is the organ at the top of the vagina. Babies grow in the uterus, and menstrual blood comes from the uterus. The tissue that lines the inside of the uterus is called the endometrium. In some women, for reasons we don't fully understand, some of this tissue can get out of the uterus and grow in other places inside the body. This condition is called endometriosis.

The abnormal endometrial tissue most often grows around the ovaries, fallopian tubes, and the outside surface of the uterus. However, in some women it may also grow on the bowel, bladder, rectum, and lining of the abdomen. Very rarely, it may grow in other places.

The misplaced tissue responds to the hormones of the menstrual cycle. It bleeds each month just like the lining of the uterus. However, when the tissue is not in the uterus, the blood has no way to leave the body. It can cause pain, cysts, and scar tissue. Scar tissue that causes organs, such as the ovaries or tubes, to stick together can cause infertility.

How does it occur?

Doctors don't know why some women have endometriosis. There are many theories, but none of them explains all cases. Some of the common theories are:

• Some of the endometrial tissue flows backward through the fallopian tubes into the abdomen and pelvis, where it attaches and grows.
• Endometrial cells spread to other parts of the body through the lymph system or blood vessels.
• Some endometrial tissue in the uterus backs up in all women. Your immune system is supposed to destroy the misplaced endometrial tissue. Women who have endometriosis may have an immune system that cannot destroy all of the misplaced tissue.
• Normal tissue from parts of your body may have changed over time into areas of endometriosis. Some women may inherit a tendency to have endometriosis.

What are the symptoms?

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

• pelvic, back, or backside pain that starts just before or during the menstrual period
• very painful menstrual cramps
• pain during sex (often in the pelvis)
• abnormal or heavy menstrual flow
• painful bowel movements, diarrhea, constipation, or other bowel problems during menstrual periods
• painful urination or feeling the need to urinate often during menstrual periods
• trouble getting pregnant

How is it diagnosed?

Your healthcare provider will ask about your symptoms. You will have a pelvic exam.

You may need a procedure called a laparoscopy for diagnosis. For this procedure, you are given an anesthetic so you will not feel any pain. Then a small cut is made near the belly button. Your abdomen is filled with a gas. Your healthcare provider puts a thin tube with a lens and a light through the cut and into your abdomen to look at the organs and pelvic cavity. With the scope your provider can see abnormal growths of endometriosis. Sometimes a small piece of tissue is removed to help make a diagnosis. This is called a biopsy.

Other tests you may have are:

• ultrasound scan
• CT (computed tomography)
• MRI (magnetic resonance imaging)
• hysterosalpingogram (X ray dye test to see if your tubes are blocked)
• blood tests

How is it treated?

There are many ways to lessen the symptoms caused by endometriosis. The type of treatment chosen depends on:

• how bad your symptoms are
• where the abnormal tissue is and how much you have
• your age
• your plans for having children.

If the only symptom is mild premenstrual pain, you may just need to take a mild pain-relief medicine such as aspirin, acetaminophen, ibuprofen, or naproxen. Fish oil supplements may also help with pain relief for some women. If symptoms are still a problem, then your healthcare provider may suggest hormone medicine. Hormones will help shrink the endometriosis and may stop the buildup of cysts, scar tissue, and swelling. There are different forms of hormone medicine that might be used. Medicines that have female hormones are:

• birth control pills for 6 months to control or block the hormones that make the endometrial tissue grow
• monthly progesterone shots (Depo-Provera)
• an intrauterine device (IUD) that contains a progesterone hormone

The most effective drug treatments use a different type of hormone medicine to keep your ovaries from making female hormones for about 6 months. This stops the stimulation of the endometrial tissue and allows your body to heal the endometriosis as much as possible. Some of the medicines that might be used in this way are:

• leuprolide acetate (monthly shot into muscle)
• nafarelin (nasal spray used 2 times a day)
• goserelin (implanted under the skin every 4 weeks)

While you are taking this type of hormone medicine, you will probably have symptoms that are similar to menopause, such as hot flashes and vaginal dryness. While you are taking this type of hormone medicine, you should also take calcium to keep your bones strong.

You may need surgery to remove or burn off endometrial tissue. It may help to first take medicines to shrink the endometriosis tissue and then have surgery. Different surgical treatments can be used to treat endometriosis, such as:

• laparoscopy with a laser or electrocautery (burning with an electric wire)
• open surgery, which involves a larger cut in your belly.

In the most severe cases, your healthcare provider may recommend surgery to remove the organs that have growths. The fallopian tubes, uterus, or the ovaries may be removed. If your uterus is removed (a hysterectomy), you will not be able to get pregnant. However, some women still have symptoms even after their uterus is removed.

How long will the effects last?

Endometriosis can get worse as you get older until you reach menopause. It usually goes away after menopause. Symptoms can also get better with a pregnancy.

Current treatments offer some relief from symptoms but not a cure. Endometriosis may come back or get worse after hormone therapy or surgery.

Adhesions or scars on the ovaries or tubes can make it hard for you to get pregnant. However, there are treatments and procedures that can help you get pregnant.

Very rarely, endometriosis becomes cancerous.

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 the numbers on your calendar for 3 months. Record all symptoms and any time lost from work, school, or other activities. Report the symptoms to your healthcare provider. Take your calendar with you to your appointment. If you have not yet been diagnosed with endometriosis, your provider may not suspect endometriosis without this information.

To help ease your pain:

• Take warm baths.
• Rest.
• Wear loose clothing.
• Put a covered hot water bottle or heating pad on your belly.
• Eat more fiber to help constipation.
• Do relaxation exercises.
• Take pain medicine as recommended by your provider.

Some women report that massage therapy or acupuncture helps symptoms, but this has not been proven.

Call your healthcare provider if you have new or worsening:

• pelvic or back pain
• abdominal cramps
• painful bowel movements, diarrhea, constipation, or other bowel problems
• painful urination or feeling the need to urinate often

For more information, contact the Endometriosis Association. This organization is a support group run by women with endometriosis.

• Endometriosis Association International Headquarters
  Phone: (414) 355-2200
  Web site: http://www.endometriosisassn.org

How can I help prevent endometriosis?

Doctors do not know how to prevent endometriosis.

Disclaimer: This content is reviewed periodically and is subject to change as new health information becomes available. The information provided is intended to be informative and educational and is not a replacement for professional medical evaluation, advice, diagnosis or treatment by a healthcare professional.

HIA File wome5231.htm Release 13/2010