The uterus (womb) is between the bladder and rectum. The inner layer of the uterus is the endometrium. In the disorder endometriosis, the kind of tissue that usually lines the inside of the uterus is present in other places. The most common places are ovaries, fallopian tubes, and lining of the pelvis (peritoneum), especially behind the uterus.
Hormones that affect the uterine lining also affect the extra tissue. Each month, during a period, this extra lining also bleeds, which causes pain. This blood can’t go anywhere, so cysts and scar tissue form.
About 5% to 15% of women of childbearing age get endometriosis. It can be managed but not prevented.
The cause is unknown. It may run in families. Scar tissue from endometriosis around pelvic organs can cause pain and infertility by blocking fallopian tubes. This scar tissue can sometimes block the intestines (bowel) or ureters (tubes that connect kidneys and bladder).
Endometriosis may cause no symptoms and be found only because of abdominal or pelvic surgery for something else. Symptoms include abdominal (belly) cramps during periods that are worse than normal, dull constant pain in the lower abdomen and back, pain during sex or bowel movements, a period more than once a month, heavier periods that last longer than usual, and trouble getting pregnant.
The health care provider will do a pelvic examination and a pregnancy test. The health care provider may also do blood and urine tests to see if infection may be causing symptoms. Ultrasound, CT, or MRI may also be done to show organs inside the body. However, laparoscopy is the only way to have a definite diagnosis. In this operation, a telescope-like tool is put through a small cut into the abdomen to see the extra tissue. Laparoscopy can also be used as treatment. Biopsy samples (small pieces of tissue) may be taken for the diagnosis.
The treatment chosen depends on symptoms, the woman’s age, and if children are wanted.
Medicines work well. Pills for pain include nonsteroidal antiinflammatory drugs (NSAIDs) such as ibuprofen. Birth control pills or other hormones can help relieve symptoms.
In laparoscopic surgery, another treatment, the health care provider can remove some endometriosis tissue by cauterizing (burning) or using a laser. Endometriosis can return, but this surgery may reduce pain and help chances of getting pregnant.
Surgery to remove the uterus and ovaries (total hysterectomy) is done only if the woman is older and doesn’t want to have more children.
Problems can continue until menopause (change of life) and estrogen levels fall. At that time, lower levels of this hormone won’t stimulate endometriosis.
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