Endometriosis is a condition that causes pelvic pain in women of childbearing age.
It is a benign condition, meaning that it is not a type of cancer. Endometriosis occurs when the cells from inside the uterus grow outside of the uterus. These cells can become attached to other areas inside the pelvis or abdomen, such as the fallopian tubes, ovaries, or intestines.
These cells then release substances that irritate the surrounding tissues, sometimes causing them to bleed. The body recognizes that these cells do not belong outside of the uterus and releases inflammatory proteins that travel to the endometriosis, causing swelling, pain, and scarring.
Endometriosis can cause severe pelvic pain, especially around the time of a woman’s period. It can also affect her ability to become pregnant and may cause pain with urination, bowel movements, or intercourse.
The causes of endometriosis are not known, but having a close relative with it may increase your chances of also having it.
What are the risk factors for endometriosis?
Endometriosis occurs in women of childbearing age and affects women of all races. Other risk factors for endometriosis include:
- Never having been pregnant
- Menstrual cycles that started at a young age or periods that are close together
- Developmental abnormalities of the uterus and cervix
- Any condition that prevents the normal passage of menstrual flow out of the body
Endometriosis Symptoms and Diagnosis
Pelvic pain is the most common symptom of endometriosis but may also include:
- Painful menstrual periods
- Pain during or after intercourse
- Painful bowel movements or urination, especially during menstrual periods
Your doctor may suspect that you have endometriosis based on your symptoms and a physical exam.
Examination is the most important part of the initial diagnosis for endometriosis. If pain is reproduced during a pelvic and rectovaginal exam, there is a high chance that surgery will help the condition.
Diagnostic tests, such as an ultrasound, MRI or endorectal ultrasound, may be helpful for surgical planning, especially if nodularity are present during your exam.
The only way your doctor will know for sure that you have endometriosis is to do surgery to look at the inside of your abdomen or pelvic area. This is done most often through a minimally invasive surgical procedure called laparoscopy. During this procedure, doctors obtain biopsies and send them to a pathologist for final diagnosis.
Endometriosis Treatment Options
Your doctor will discuss treatment options for endometriosis, such as medication or surgery.
Medical management for endometriosis
Your doctor may prescribe the following treatments to control your symptoms:
- Over-the-counter pain medication such as NSAIDS (ibuprofen)
- Birth control such as pills, the ring, patch or shot
- Insertion of an intrauterine device (IUD)
Medical management is typically the first step of treatment. If there is no improvement in symptoms, surgery to evaluate and treat endometriosis may be needed.
Surgery for endometriosis
Surgery should be performed by a gynecologist who has done training specifically in treatment of pelvic pain and endometriosis.
Surgical options include removal of the endometriosis called excision, burning of the endometriosis called cauterization, or removal of the organs such as the ovaries or uterus with endometriosis. The diagnosis of endometriosis can only be made by taking a biopsy of the endometriosis.
- Laparoscopic excision of endometriosis allows for organ preservation
- Ablation or cauterization of endometriosis may be helpful to remove mild or superficial disease
- Hysterectomy with or without removal of ovaries is the definitive treatment in patients with extensive disease