The tissue that lines the uterus is called the endometrium. Normally, if a woman doesn’t get pregnant, this tissue is shed each month during her period. In endometriosis, tissue that looks and acts like endometrial tissue implants outside the uterus.

Each month, this misplaced tissue responds to the hormonal changes of the menstrual cycle. It builds up, breaks down, and bleeds. But, the blood has nowhere to go. This causes surrounding tissue to become inflamed or swollen. It can also cause scar tissue, chronic pain, and heavy periods.

Endometriosis is a main cause of infertility in women. This can happen if the tissue implants in the ovaries or fallopian tubes.  Tissue can also implant on other organs in the pelvis.

The cause of endometriosis is not clear. It may be that during a woman’s period, some of the tissue backs up through the fallopian tubes into the abdomen. Another theory suggests genes are to blame. Current research is also looking at the role of the immune system.

What are the risk factors for endometriosis? 

While any woman may develop endometriosis, the following women seem to be at an increased risk for the disease:

• Women who have a mother, sister, or daughter with the disease
• Women who gave birth for the first time after age 30
• White women
• Women with an abnormal uterus

What are the symptoms of endometriosis?

While each woman may experience symptoms differently, these are the most common symptoms:

• Pain, cramps which may be felt in the abdomen or lower back during your period
• Pain during sex
• Abnormal or heavy menstrual flow
• Infertility
• Fatigue
• Painful urination during your periods
• Painful bowel movements during your periods
• Other gastrointestinal problems, such as diarrhea, constipation, and/or nausea

The amount of pain a woman has isn’t always related to the severity of the disease. Some women with severe disease may have no pain. Other women with a milder form of the disease may have severe pain or other symptoms.

How is endometriosis diagnosed? 

First, your doctor will review your medical history. You will also have a physical exam and a pelvic exam.

A laparoscopy is done to diagnose endometriosis. This uses a thin tube with a lens and a light at the end. It’s inserted into an incision in the abdominal wall to see into the pelvic area. The health care provider can often find the locations, extent, and size of the misplaced tissue.

Other tests may include:

• Biopsy. For this test, a small tissue sample is removed from the body and examined.
• Ultrasound. This imaging test uses high-frequency sound waves to create an image of the organs.
• Computed tomography (CT scan). For this imaging test, X-rays and a computer are used to make images (often called slices). It can find problems that may not show up on an ordinary X-ray.
• Magnetic resonance imaging (MRI). This imaging test provides a two-dimensional view of organs or tissue.

How is endometriosis treated? 

Your health care provider will consider your age, overall health, symptoms and other factors when advising what treatment is best for you. Whether you hope to become pregnant will also play a role in your options.

Treatment options include medicine, surgery, or both. If symptoms are mild, you may only need pain medicine. In other cases, hormone-based medicine, such as birth control pills, will stop ovulation and slow endometriosis.

Several options can be used to remove the implants. Doctors may be able to remove abnormal tissue growths using a laparoscope. In other cases, open surgery is needed. Surgery to remove the uterus is also an option.

What are the complications of endometriosis? 

Endometriosis can make it very hard or impossible for a woman to get pregnant. Sometimes surgery can help. But, in a few cases, women may remain infertile.

Living with endometriosis

Simple steps that can help ease the pain of endometriosis include:

• Rest, relaxation, and meditation
• Warm baths
• Prevent constipation
• Regular exercise
• Use of hot water bottle or heating pad on your abdomen

Key points

• Endometriosis is common in women of during the years they can have children.
• It causes tissue that looks and acts like endometrial tissue to implant outside the uterus.
• Treatment  may include medicine, surgery, or both.
• It can make it very hard or impossible for a woman to get pregnant.

Next steps

Tips to help you get the most from a visit to your health care provider:

• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your provider tells you.
• At the visit, write down the names of new medicines, treatments, or tests, and any new instructions your provider gives you.
• If you have a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your provider if you have questions.

Sarah Bush Lincoln Women’s Healthcare is always accepting new patients. For more information on the clinic, or to make an appointment, click here.