Endometriosis

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. This is called Endometriosis. The most common areas for this abnormal growth of endometrium are the reproductive organs (ovaries, fallopian tubes, and uterus). Endometrium may also grow on the intestines, bladder, rectum, and the lining of the pelvic area and abdomen.

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 bloodshed from the tissue has no way to leave the body.  When the tissue bleeds, cysts, scar tissue, and adhesions form.  Adhesions or scars on the ovaries or tubes can cause infertility.  In very rare cases, endometriosis becomes cancerous.

What are the symptoms?

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

• Pelvic, back, or back side pain before or during the menstrual period
• Very painful menstrual cramping
• Pain during sex
• Abnormal or heavy menstrual flow
• Painful bowel movements, diarrhea, constipation, or other intestinal problems during menstrual periods
• Painful urination or feeling the need to urinate often during menstrual periods
• Trouble becoming pregnant

How is it diagnosed?

You will have a pelvic exam to check for cysts or nodules or any abnormal tenderness or thickening in your pelvic area. You may have blood tests.

You may need a procedure called a laparoscopy for diagnosis. 

Other tests you may have include:

• Ultrasound scan
• CT (computed tomography)
• MRI (Magnetic resonance imaging)
• Blood tests

How is it treated?

There are many ways to lessen the symptoms and problems caused by endometriosis. The treatment depends on the severity of the symptoms, the location and degree of endometriosis, your age and your plans for having children.

If the only symptom is mild premenstrual pain, you may just need to take a pain-relief medicine such as aspirin, acetaminophen or ibuprofen. If these nonprescription medicines do not relieve the pain, your provider may prescribe stronger pain medicine.

If you have a laparoscopy, your provider may use a cautery to remove abnormal tissue, especially if you have a mild case of endometriosis.

Your provider may prescribe medicine, such as birth control pills, to control your hormones.  The purpose of these medications is to control the hormone stimulation of the endometriosis areas. 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. The most effective drug treatment allows your body to heal the endometriosis as much as possible by stopping your menstrual periods for about 6 months.

Sometimes surgery may be necessary, for example, if you have large pieces of endometrial tissue in your pelvis. In many cases it is very helpful to take medicines and have surgery to remove or burn off the areas of endometrial tissue. 

In severe cases, possible treatment is surgery to remove the organs containing the growths.

How long will symptoms last?

Endometriosis is a disease that can get more severe as you grow older until menopause.  The condition usually goes away after menopause. 

Current treatments offer some relief from the symptoms but not a cure. 

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 3 months. Record all symptoms, including any time lost from work, school or leisure 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
• Use a hot water bottle or heating pad on your abdomen
• Avoid constipation by increasing the fiber in your diet
• Do relaxation exercises
• Take pain medicine as recommended by your provider.