Endometriosis is a condition where endometrial tissue, which normally lines the uterus, is found in the abdominal cavity, on the ovaries and sometimes in the large bowel, bladder or vagina. The tissue responds to normal hormonal stimulation, enlarging before each menstrual period and breaking down and bleeding at the end of each cycle. This tissue can cause severe pain during menstruation or intercourse and may also result in infertility. Most cases are treated with medications, especially if one wants to become pregnant in the future. Surgery can be performed to remove endometrial tissue to prevent infertility.
Endometrial tissue grows inappropriately in the abdominal cavity and ovaries.
What it is: Endometriosis occurs during menstruation when endometrial cells (which originate and belong in the uterus) travel back through the Fallopian tubes into other areas of the pelvis and even into the bloodstream or lymph glands. Endometrial tissue then grows improperly in other parts of the body besides the uterus, including the abdominal cavity, umbilicus, ovaries, lung, bladder, vagina or small or large bowel. How and why endometrial tissue is found in other parts of a woman’s body is not understood. Endometriosis can develop after years of painless menstruation. Endometriosis does not always cause infertility but has been linked to it. Women who develop endometriosis may have an above average amount of menstrual back-flow. Although researchers are unsure what causes endometriosis, it affects 10%-15% of menstruating women between ages 25 and 44. It is most common in women with a family history of the disease, those who delay childbearing and women of Asian descent.
Side effects: The severity of symptoms does not always reflect the degree of endometriosis present. Only about 50% of women with endometriosis ever experience symptoms, and many women with severe endometriosis have little pain. The most common symptom is an aching pain beginning several days before the menstrual period and increasing in severity until the period ends. Some women, however, are only in pain during ovulation, midway through the menstrual cycle. Depending on where the endometriosis is located, it can cause infertility, painful sexual intercourse and bleeding while passing stool or urinating.
Diagnosis and treatment: Endometriosis can be diagnosed during a laparoscopy, a procedure where the physician inserts a long, thin tube into the abdominal cavity (while the patient is anesthetized) and looks for the misplaced tissue. During this procedure, often the tissue can be lysed or detached and no further surgery is needed. Treatment aims to relieve symptoms and to maintain the woman’s fertility. Surgery is recommended when pain is severe despite drug therapy or when large cysts or sacs containing endometrial tissue develop on the ovaries or elsewhere. If the patient is under 35, surgery can restore or maintain fertility 25%-50% of the time. If the patient is over 35, removal of the uterus and ovaries may be recommended.
Endometriosis can also be treated with medications that stop ovulation and lower hormone levels over three to nine months. (Medications used include gonadotropin-releasing hormones, progestins, danazol and birth control pills.) When normal menstrual cycle stimulation of the misplaced tissue is stopped, symptoms gradually disappear. However, some of these drugs have bothersome side effects and may be expensive. Furthermore, once a woman quits taking the medications, endometriosis often returns. Continued use of birth control pills can slow the worsening of endometriosis. However, this is only a viable option for women not trying to become pregnant right away. For treatment of pain with or without hormone suppression, nonsteroidal anti-inflammatory drugs sometimes help.
Patients taking medication to treat endometriosis should be encouraged to consult their pharmacists if they have any questions.