What is endometriosis?

The inside of the uterus is lined with a tissue called the endometrium. The endometrium is the lining that is shed during a woman's period (menstruation). But, sometimes endometrial tissue grows outside the uterus... usually on the ovaries, fallopian tubes, the outer surface of the uterus, the bladder, the rectum, and/or the lining of the pelvic cavity. In rare cases, it may also be found in other parts of the body. Endometrial tissue that grows in the ovaries may cause a cyst.

The endometrial lining that builds up outside the uterus responds to hormonal changes in your body, just like the lining inside your uterus. Wherever the endometrial lining is located, it acts as it normally would during a menstrual cycle: it thickens, breaks down, and bleeds each month. Because the lining located outside the uterus has nowhere to exit your body, it becomes trapped and the surrounding tissue can become irritated. The bleeding of this tissue each month can also cause scar tissue (called adhesions) to form. Adhesions can cause pain and can even bind organs together.

What are the symptoms of endometriosis?

Endometriosis can be mild, moderate, or severe. Some women have no symptoms at all. But the main symptom of endometriosis is pelvic pain. Pain may occur with sex, during bowel movements or urination, or right before or during your menstrual cycle. Pain can also occur when inserting or removing tampons. Heavy periods or bleeding or spotting in between periods can also occur. Endometriosis may also cause infertility.

How is endometriosis diagnosed?

If you have symptoms of endometriosis, your doctor will do a pelvic exam to manually feel for any abnormalities, such as cysts on your reproductive organs or scars behind your uterus.

An ultrasound can be performed to provide a video image of your reproductive organs. The imaging won't definitely tell your doctor whether or not you have endometriosis, but it is a useful tool for identifying cysts associated with endometriosis.

The most accurate way of diagnosing endometriosis is by looking directly inside the body. This can be done by laparoscopy. For laparoscopy, the doctor makes a small cut near your navel. A thin, lighted laparoscope (a long tube with a light on the end) is inserted into your abdomen. The laparoscope allows the doctor to view the pelvic organs.

How is endometriosis treated?

Endometriosis cannot be cured, but symptoms can usually be relieved. Treatments may relieve pain and infertility for a while, but symptoms may return after treatment. Treatment depends on the extent of the disease, your symptoms, and whether you want to have children.

• Medications:  Anti-inflammatory drugs such as Ibuprofen or Naproxen may help relieve menstrual cramping.
• Hormones:  The birth control pill, IUD's containing hormone, Depo-Provera injections, GnRH (Gonadotropin-releasing hormone), and Progestion may be used to relieve pain. These hormones help slow the growth of the endometrial tissue and prevent growth of new adhesions, but they will not make endometriosis go away.
• Surgery:  Surgery may be done to remove endometriosis and the scarred tissue around it. In severe cases of endometriosis, surgery is often the best choice of treatment. Surgery is most often done by laparoscopy. Endometriosis can be burned away or removed during this procedure. However, with some cases, a procedure called laparotomy may be needed. Your doctor will discuss with you the method that will be best for you. After surgery, you may have relief from pain, but symptoms may return. Many patients are treated with medications even after surgery to control the symptoms of endometriosis. If pain is severe and does not go away after treatment, your doctor may recommend a hysterectomy (a surgery to remove your uterus).

In summary:

Endometriosis can cause pain and infertility, but it often can be treated successfully. You may need more than one kind of treatment. You can work with your doctor to decide which treatment is right for you.