Endometriosis is a common condition in which tissue similar to the lining of the uterus grows outside the womb, causing pelvic pain and fertility problems.
Some women with endometriosis have no symptoms. When symptoms occur, pelvic pain is a common occurrence.
- Pain can be severe and disabling in some cases
- Usually occurs just before or during menstrual periods
- May occur between menstrual periods and worsen during a period
- Pain with periods may worsen over time
- Pain may occur during or after sex
- Pain may occur with bowel movements or while urinating, especially during a period
- Pain may also occur in the lower back or in the abdomen
Explanations for the pain due to endometriosis include:
- Endometriosis growths swell and bleed in areas of the body where there is no room to grow and where blood cannot easily get out of the body
- As the growths expand, they can grow into the ovaries, where trapped blood can form cysts
- Scar tissue forms which can cause pain
- Endometriosis growths may also cause problems in the intestines and bladder, which can lead to pain
Other symptoms of endometriosis may include:
- Heavy menstrual bleeding
- Irregular bleeding/spotting between periods
- Ovarian cysts called endometriomas (cysts containing endometriosis tissue)
What Causes Endometriosis?
The cause of endometriosis is unknown but several theories as to why the condition occurs include:
- Metaplasia is when one type of tissue changes to another normal type of tissue. One theory is that endometrial tissue may change and replace other types of tissues outside the uterus.
- First-degree relatives of women who have endometriosis are more likely to develop the disease, so there may be a genetic predisposition to develop the condition.
- Lymphatic or vascular distribution of endometrial cells in which endometrial fragments travel through blood vessels or the lymphatic system to other parts of the body may explain how endometriosis cells end up in distant sites, such as the lung, brain, skin, or eye.
- Immune system dysfunction may play a role.
- Retrograde menstruation is an older theory that theorizes that menstrual tissue flows backwards through the fallopian tubes (called “retrograde flow”) and deposits on the pelvic organs where it grows. However, researchers have found 90% of women have retrograde flow and do not have endometriosis, so it is believed this is not a trigger for endometriosis.
- A controversial theory is that environmental factors may contribute to the development of endometriosis, such as the effects of toxins in the environment on reproductive hormones and immune system function.
How is Endometriosis Diagnosed?
Endometriosis can be difficult to diagnose, and there is no one simple test that is used. A complication of obtaining a diagnosis is that many women are brought up to believe pelvic pain symptoms are normal, and birth control hormones or pregnancy can temporarily relieve symptoms even without a diagnosis.
The only way to definitively diagnose endometriosis is with an invasive laparoscopic procedure and a biopsy of the tissue. This procedure may also be used to remove endometriosis at the same time.
Endometriomas (ovarian cysts containing endometriosis tissue) may be seen with ultrasound.
A common problem among patients with endometriosis is having a healthcare provider take the pain seriously so it is important for women to find a doctor experienced in treating endometriosis.
What Is the Treatment for Endometriosis?
Endometriosis symptoms usually go away when a woman goes through menopause.
Medications used to treat endometriosis include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain
- Hormonal birth control
- Pills, patches, and vaginal rings to reduce or prevent menstrual bleeding
- Progestin-containing intrauterine device (IUD) to help treat pain
- Gonadotropin-releasing hormone (GnRH) analogs and GnRH antagonists
- Nafarelin (Synarel)
- Leuprolide (Lupron)
- Goserelin (Zoladex)
- Elagolix (Orilissa)
- Aromatase inhibitors
- Muscle relaxers to treat pain symptoms
- Tricyclic antidepressants to treat pain symptoms
- Desipramine (Norpramin)
- Amitriptyline (Elavil)
- Anti-convulsant medications to treat pain symptoms
- Dosages are lower than those given to prevent seizures
Interventional therapies used to treat endometriosis pain include:
- Nerve blockade
- Anesthetic muscle injections with or without corticosteroids to block trigger points
- Physical therapy to help control and relax pelvic muscles
- Behavioral therapy to help manage stress and pain
Surgery for endometriosis is used both to diagnose endometriosis and also to remove it. It may be performed before medications are tried since it’s used diagnostically. It may also be considered if medications do not work to relieve pain.
- Endometriosis surgery is often done laparoscopically, and the goal is to remove endometriosis and scar tissue.
- It is not a permanent cure and endometriosis tissue frequently grows back and pain returns without post-surgical treatment such as hormonal birth control
- Surgery for endometrioma (ovarian cysts containing endometriosis tissue) is usually only done if the cyst is larger than 4 to 5 cm, symptomatic, or growing
- Removal of the uterus (hysterectomy), ovaries (oophorectomy), or ovaries and fallopian tubes (salpingo-oophorectomy) is the only potential cure for endometriosis and may be recommended for patients who:
- Have tried other treatments and still have severe symptoms
- Do not wish to become pregnant in the future
- Want a permanent treatment
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