"en-doh-mee-tree-OH-sus") is a problem many women have during their
childbearing years. It means that a type of tissue that lines your uterus is
also growing outside your uterus. This does not always cause symptoms. And it
usually isn't dangerous. But it can cause pain and other problems.
The clumps of tissue that grow outside your uterus are called implants.
They usually grow on the ovaries, the fallopian tubes, the outer wall of the
uterus, the intestines, or other organs in the belly. In rare cases they
spread to areas beyond the belly.
is lined with a type of tissue called
endometrium (say "en-doh-MEE-tree-um"). Each month, your body releases
hormones that cause the endometrium to thicken and get ready for an egg. If you
get pregnant, the fertilized egg attaches to the endometrium and starts to
grow. If you do not get pregnant, the endometrium breaks down, and your body
sheds it as blood. This is your
When you have
endometriosis, the implants of tissue outside your uterus act just like the
tissue lining your uterus. During your menstrual cycle, they get thicker, then
break down and bleed. But the implants are outside your uterus, so the blood
cannot flow out of your body. The implants can get irritated and painful.
Sometimes they form scar tissue or fluid-filled sacs (cysts). Scar tissue may
make it hard to get pregnant.
Experts don't know
what causes endometrial tissue to grow outside your uterus. But they do know
that the female hormone
estrogen makes the problem worse. Women have high
levels of estrogen during their childbearing years. It is during these
years—usually from their teens into their 40s—that women have endometriosis.
Estrogen levels drop when menstrual periods stop (menopause). Symptoms usually
go away then.
The most common symptoms
Endometriosis varies from woman to woman. Some women don't know that they have it until they go to see a doctor because they can't
get pregnant or have a procedure for another problem. Some have mild cramping that they think is normal for them. In
other women, the pain and bleeding are so bad that they aren't able to work or
go to school.
problems can cause painful or heavy periods. To find out if you have
endometriosis, your doctor will:
If it seems like you have endometriosis, your doctor may
suggest that you try medicine for a few months. If you get better using
medicine, you probably have endometriosis.
To find out if you
have a cyst on an ovary, you might have an imaging test like an
MRI, or a
CT scan. These tests show pictures of what is inside
The only way to be sure you have endometriosis is to
have a type of surgery called
laparoscopy (say "lap-uh-ROSS-kuh-pee"). During this
surgery, the doctor puts a thin, lighted tube through a small cut in your
belly. This lets the doctor see what is inside your belly. If the doctor finds
implants, scar tissue, or cysts, he or she can remove them during the same
There is no cure for
endometriosis, but there are good treatments. You may need to try several
treatments to find what works best for you. With any treatment, there is a
chance that your symptoms could come back.
depend on whether you want to control pain or you want to get pregnant. For
pain and bleeding, you can try medicines or surgery. If you want to get
pregnant, you may need surgery to remove the implants.
for endometriosis include:
As a last resort for severe pain, some women have their
uterus and ovaries removed (hysterectomy and oophorectomy). If you
have your ovaries taken out, your estrogen level will drop and your symptoms
will probably go away. But you may have symptoms of menopause, and you will not
be able to get pregnant.
If you are getting close to
menopause, you may want to try to manage your symptoms
with medicines rather than surgery. Endometriosis usually stops causing
problems when you stop having periods.
Learning about endometriosis:
Health Tools help you make wise health decisions or take action to improve your health.
The exact cause of
endometriosis is not known. Possible causes include the following:
Some women with
endometriosis don't have symptoms. Other women have
symptoms that range from mild to severe. Symptoms may include:
are often most severe just before and during your
menstrual period. They get better as your period
Some women, especially teens, have pain all the time.
other conditions can cause symptoms that are similar
to endometriosis. These conditions include painful periods,
Endometriosis is usually a long-lasting (chronic)
disease. When you have
endometriosis, the type of tissue that lines your uterus is
also growing outside your uterus. The clumps of tissue (called implants) may have grown on your ovaries or
fallopian tubes, the outer wall of the
uterus, the intestines, or other organs in the belly. In rare cases they
spread to areas beyond the belly.
With each menstrual cycle, the implants go through the
same growing, breaking down, and bleeding that the uterine lining (endometrium)
goes through. This is why endometriosis pain may
start as mild discomfort a few days before the menstrual period and then usually
is gone by the time the period ends. But if an implant grows in a sensitive
area, it can cause constant pain or pain during certain activities, such as
sex, exercise, or bowel movements.
Some women have no symptoms or problems. Others have mild to severe
infertility. There is no way to predict whether
endometriosis will get worse, will improve, or will stay the same until
Between 20% and 40%
of women who are infertile have endometriosis (some have more than one possible
cause of infertility).1 Experts don't fully
understand how endometriosis causes infertility. It could be that:2
A common complication of
endometriosis is the development of a cyst on an ovary. This blood-filled
growth is called an
ovarian endometrioma or an endometrial cyst.
Endometriomas can be as small as 1 mm or
more than 8 cm across. The symptoms of an ovarian cyst may be the same as those of endometriosis.
Also, ovarian cancer risk is higher in women with
endometriosis.3 This type of ovarian cancer is most
commonly seen in women older than 60.
of endometriosis is higher if:
Call a doctor immediately if you develop sudden, severe pelvic
Call a doctor to schedule an appointment
If you have mild pain during your period but
have no other symptoms or concerns, you can wait through several menstrual
cycles. Then at your next routine visit with your doctor, you can discuss your pain.
Home treatment may be all that you need to relieve
Health professionals who can evaluate
endometriosis and help you manage the pain
If your case is complicated or your main problem is
infertility, you may be referred to:
For diagnosis with
laparoscopy or for surgical treatment, you may be
referred to a
To prepare for your appointment, see the topic Making the Most of Your Appointment.
To see whether your symptoms are
endometriosis, your doctor first
If your exam, symptoms, and risk factors strongly suggest
that you have endometriosis, your doctor may suggest that you
a nonsteroidal anti-inflammatory drug (NSAID) and/or
hormone therapy before you have other tests. If treatment improves your
symptoms after a few months, the diagnosis of endometriosis is more certain.
a surgical procedure used to diagnose and treat endometriosis.
If your doctor recommends a laparoscopy, it will
be used to look for and possibly remove implants and scar tissue. But laparoscopy is not always needed. It is usually done when infertility
requires rapid treatment and probable surgery or when treatment has not
relieved pain or infertility.
If your doctor feels an abnormal mass during the pelvic exam, you may have a cyst on the ovary (ovarian endometrioma) or another problem. You may
transvaginal ultrasound, a CT scan, or an MRI.
There is no cure for
endometriosis, but treatment can help with pain and
infertility. Treatment depends on how severe your symptoms are and whether you
want to get pregnant. If you have pain only, hormone therapy to lower
your body's estrogen levels will shrink the implants and may reduce
pain. If you want to become pregnant, having surgery, infertility treatment, or both may
Not all women with
endometriosis have pain. And endometriosis doesn't always get worse over time.
During pregnancy, it usually improves, as it does after menopause.
If you have mild pain, have no plans for a future pregnancy, or are near
menopause (around age 50), you may not feel a need for treatment. The decision
is up to you.
have pain or bleeding but aren't planning to get pregnant soon,
birth control hormones (patch, pills, or ring) or
anti-inflammatories (NSAIDs) may be all that you need
to control pain. Birth control hormones are likely to keep endometriosis from
getting worse.4 If you have severe symptoms or
if birth control hormones and NSAIDs don't work, you might try a stronger
Besides medicine, you can try other things at home to help with the pain. For example, you can apply heat to your belly, or you can exercise regularly.
If hormone therapy doesn't work or if growths are
affecting other organs,
surgery is the next step. It removes endometrial growths and scar tissue.
This can usually be done through one or more small incisions,
Laparoscopy can improve pain and your chance for pregnancy. This is especially true for women
with mild to moderate endometriosis.5
In severe cases, removing the uterus and ovaries
(hysterectomy and oophorectomy) is an option. This surgery causes early
menopause. It is only used when you have no pregnancy
plans and have had little relief from other treatments.
If you are having trouble
becoming pregnant even after surgery, you can consider trying
fertility drugs with
in vitro fertilization. To learn more, see the
cannot be prevented. This is in part because the cause is poorly understood.
But long-term use of
birth control hormones (patch, pills, or ring) may prevent endometriosis from
Home treatment may ease the pain of
endometriosis. You can try the following things along with your other treatments.
Medicines can be used to reduce pain and bleeding and, in some cases, to shrink endometriosis growths. For women who are not trying to get pregnant, birth control hormones and
anti-inflammatories (NSAIDs) are usually recommended first. They are least
likely to cause serious side effects and can be a long-term treatment
option.1 But if infertility from endometriosis is your main problem, medicines are generally not
All hormone therapies for endometriosis can
cause side effects and pose certain health risks. Some cause especially
unpleasant side effects. Before starting a medicine or hormone therapy, review
its possible side effects. If they sound less difficult than your endometriosis
symptoms, discuss the therapy with your doctor.
risk is higher in women who have endometriosis.
Using birth control hormones for 5 or more years lowers this risk.8
Although surgery doesn't cure
endometriosis, it does offer short-term results for
most women and long-term relief for a few.
Surgery may be recommended when:
Some studies suggest
that using hormone therapy after surgery can make the pain-free period longer
by preventing the growth of new or returning endometriosis.4
To help the stress
and pain of
endometriosis, you can consider other treatments. Researchers have not yet looked at these therapies
for endometriosis. But these treatments have proven benefits for
treating other conditions:
American Congress of Obstetricians and Gynecologists
(ACOG) is a nonprofit organization of professionals who provide health care for
women, including teens. The ACOG Resource Center publishes manuals and patient
education materials. The Web publications section of the site has patient
education pamphlets on many women's health topics, including reproductive
health, breast-feeding, violence, and quitting smoking.
This organization provides literature and information on
The Endometriosis Association is a self-help organization that
provides information and support to women and girls with endometriosis,
educates the public as well as the medical community about the disease, and
conducts and promotes research related to endometriosis.
The National Institute of Child Health and Human
Development (NICHD) is part of the U.S. National Institutes of Health. The
NICHD conducts and supports research related to the health of children, adults,
and families. NICHD has information on its Web site about many health topics.
And you can send specific requests to information specialists.
CitationsFritz MA, Speroff L (2011). Endometriosis. In Clinical Gynecologic Endocrinology and Infertility, 8th ed., pp. 1221–1248. Philadelphia: Lippincott Williams and Wilkins.Barbieri RL (2010). Endometriosis. In EG Nabel, ed., ACP Medicine, section 16, chap. 10. Hamilton, ON: BC Decker.Sarajari S, et al. (2007). Endometriosis. In AH DeCherney et al., eds., Current Diagnosis and Treatment Obstetrics and Gynecology, 10th ed., pp. 712–719. New York: McGraw-Hill Medical Publishing Division.Ferrrero S, et al. (2010). Endometriosis, search date December 2009. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.American Society for Reproductive Medicine (2012). Endometriosis and infertility: A committee opinion. Fertility and Sterility, 98(3): 591–598.Li D, et al. (2003). Exposure to non-steroidal anti-inflammatory drugs during pregnancy and risk of miscarriage: Population-based cohort study. BMJ, 327(7411): 368–372.American College of Obstetricians and Gynecologists (2010). Management of Endometriosis. ACOG Practice Bulletin No. 114. Obstetrics and Gynecology, 116(1): 225–236.American College of Obstetricians and Gynecologists (2010 reaffiremed 2012). Noncontraceptive uses of hormonal contraceptives. ACOG Practice Bulletin No. 110. Obstetrics and Gynecology, 115(1): 206–218.Other Works ConsultedAmerican Society for Reproductive Medicine (2008). Treatment of pelvic pain associated with endometriosis. Fertility and Sterility, 90(Suppl 3): S260–S269.
July 7, 2011
Adam Husney, MD - Family Medicine & Kirtly Jones, MD - Obstetrics and Gynecology
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