Endometriosis Endometriosis is a condition where tissue similar to the lining of your uterus grows on other parts of your body. When this tissue grows in the wrong places, it can cause you to experience uncomfortable symptoms that can impact your daily life. Some people with endometriosis also have issues getting pregnant.
Causes of Endometriosis The causes of endometriosis are still unknown. One theory suggests that during menstruation, some of the tissue backs up through the fallopian tubes into the abdomen, a sort of "reverse menstruation," where it attaches and grows. Another theory suggests that endometrial tissue may travel and implant via blood or lymphatic channels, similar to the way cancer cells spread. A third theory suggests that cells in any location may transform into endometrial cells. Endometriosis can also occur as a result of direct transplantation—in the abdominal wall after a cesarean section, for example. Additionally, it appears that certain families may have predisposing genetic factors to the disease. A few places you can develop endometriosis include the:
Outside and back of your uterus.
Fallopian tubes.
Ovaries.
Vagina.
Peritoneum (the lining of your abdomen and pelvis).
Bladder and ureters.
Intestines.
Rectum.
Diaphragm (a muscle near the bottom of your chest that plays an important role in breathing).
Endometriosis Symptoms The following are the most common symptoms for endometriosis, but each woman may experience symptoms differently or some may not exhibit any symptoms at all. Symptoms of endometriosis may include:
Pain, especially excessive menstrual cramps that may be felt in the abdomen or lower back
Pain during intercourse
Abnormal or heavy menstrual flow
Infertility
Painful urination during menstrual periods
Painful bowel movements during menstrual periods
Other gastrointestinal problems, such as diarrhea, constipation and/or nausea
Relationship of Endometriosis to Infertility Endometriosis is considered one of the three major causes of female infertility. According to the American Society for Reproductive Medicine, endometriosis can be found in 24 to 50 percent of women who experience infertility. In mild to moderate cases, the infertility may be temporary. In these cases, surgery to remove adhesions, cysts and scar tissue can restore fertility. In other cases — a very small percentage — women may remain infertile. How endometriosis affects fertility is not clearly understood. It is thought that scar tissue from endometriosis can impair the release of the egg from the ovary and subsequent pickup by the fallopian tube. Other mechanisms thought to affect fertility include changes in the pelvic environment that results in impaired implantation of the fertilized egg.
What is the treatment for endometriosis? Your healthcare provider will help create your treatment plan for endometriosis based on a few factors, including:
The severity of your endometriosis.
Your plans for future pregnancies.
Your age.
The severity of your symptoms (often pain).
In many cases, your treatment plan will focus primarily on managing your pain and improving fertility issues (if you are planning on a future pregnancy). This can be done through medications and surgery. Medications are often used to help control the symptoms of endometriosis. These can include pain medications and hormone therapies. Hormonal options for suppressing endometriosis can include:
Birth control: There are multiple forms of hormonal suppression options including combination options using estrogen and progesterone or progesterone-only options. These come in multiple forms including oral birth control pills, patch, vaginal ring, birth control shot, Nexplanon implant or IUD. This hormonal treatment often helps people have lighter, less painful periods. These are not options for patients attempting pregnancy.
Gonadotropin-releasing hormone (GnRH) medications: This medication is actually used to stop the hormones that cause your menstrual cycle. This basically puts your reproductive system on hold as a
way to relieve your pain. GnRH medications can be taken as an oral pill (by mouth), a shot or a nasal spray.
Danazol (Danocrine®): This is another form of hormonal medication that stops the production of the hormones that cause you to have a period. While taking this medication for endometriosis symptoms, you may have the occasional menstrual period, or they might stop entirely.
With all of these medications, it’s important to note that your symptoms can come back if you stop taking the medication. These medications aren’t recommended during pregnancy or if you are actively attempting to achieve pregnancy. Talk to your healthcare provider about the pros and cons of each medication before starting. Medications for endometriosis pain relief can include:
Over-the-counter pain relief.
Non-steroidal anti-inflammatory drugs (NSAIDs).
In some cases, your provider might recommend surgery as a way to confirm and treat endometriosis. There are always risks to a surgical procedure. However, surgery for endometriosis can be an effective way to relieve pain and, in some cases, improve your fertility. Endometriosis is considered a chronic disease. Many people experience relief from endometriosis pain after surgery, but the symptoms may return within a few years. The severity of your endometriosis could play a part in how quickly — if at all — it comes back after surgery. Your provider might suggest combining a surgical procedure with medications for the best outcome. Your provider may recommend pelvic floor physical therapy with or without medications for central nerve pain. Surgical options to treat endometriosis include:
Laparoscopy: In this procedure, your surgeon will make a very small cut in your abdomen (< 1 centimeter) and insert a thin tube-like tool called a laparoscope into your body. This tool can be used to see inside your body and identify endometriosis with a high-definition camera. Additional 5millimeter instruments can then be used to excise and remove lesions.
Hysterectomy: In severe cases, your surgeon may suggest removing your uterus based on the amount of endometriosis and scar tissue present, if you have other uterine conditions like adenomyosis and your desire for future fertility. If you have a hysterectomy, areas of endometriosis should still be excised to optimize your pain relief.
If you have endometriosis and are trying to achieve pregnancy, in vitro fertilization (IVF) may help you achieve this goal.