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Definition

Endometriosis is when endometrial-like tissue is found outside the womb, such as in the organs in the belly or pelvis. Normally, it is only found inside the womb where hormones cause it to thicken to get the body ready for a fertilized egg. It leaves the body during menstruation when a woman does not become pregnant.

Tissue that forms outside of the womb cannot pass during menstruation. This causes swelling and scarring.

Endometriosis
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Causes

The cause is not known. It may be due to:

  • Menstrual tissue that backs up through the fallopian tubes and spills into the belly
  • An immune system that lets the tissue implant on other organs
  • A lymphatic system that carries cells from the womb
  • Surgery when cells are picked up and moved by mistake

Risk Factors

This problem is more common in women of reproductive age. It is also more common in women who are white. Other things that may raise the risk are:

  • Menstruating before the age of 10 years old
  • Having a cycle of less than 28 days
  • Having a flow of more than 5 to 6 days
  • Having an abnormal reproductive tract
  • Not having children

Symptoms

Some people do not have problems. Others may have mild to severe problems, such as:

  • Cramping and pelvic pain before and during menstrual bleeding
  • Pain during sex and bleeding after
  • Pain during bowel movements or urination
  • Irregular menstrual cycles
  • Pain in the lower back, belly, or pelvis

Diagnosis

You will be asked about your symptoms and health history. A pelvic exam will be done.

Images will be taken of the pelvis. This can be done with an ultrasound taken from the outside of the belly. It may also be done with a probe placed in vagina.

Laparoscopy is needed to confirm the diagnosis. A small cut is made in the belly. A telescope is passed through it. It lets the doctor to look for signs of tissue outside the womb. A biopsy may be taken. It will be tested for signs of endometriosis.

Treatment

Treatment depends on how severe the problems are. The goals are to ease pain and slow tissue growth. Options may be:

Medicine

Medicine may be given to ease pain and swelling. It may be over-the-counter pain medicine, such as nonsteroidal anti-inflammatory drugs (NSAIDs). Women with severe problems may need prescription pain medicine.

Hormonal Therapy

Hormone therapy may be given to women who are not trying to become pregnant. Birth control pills may be used to ease pain and shrink the size and number of growths. These problems often return when the pills are stopped, so they are often taken all the time. An intrauterine device may be used in those who are not helped by birth control pills. Hormone therapy may also be used after surgery to lower the chance of growths coming back.

Surgery

Surgery may be done to remove growths in women who want to have children in the future. This is often done with laparoscopic surgery.

Women with severe symptoms may need a hysterectomy to remove the uterus and ovaries. Pregnancy will not be possible.

Prevention

There are no guidelines to prevent endometriosis.

RESOURCES

Endometriosis Association  http://www.endometriosisassn.org 

The American College of Obstetricians and Gynecologists  http://www.acog.org 

CANADIAN RESOURCES

The Society of Obstetricians and Gynaecologists of Canada  http://www.sogc.org 

Women's Health Matters  http://www.womenshealthmatters.ca 

References

American College of Obstetricians and Gynecologists (ACOG). Practice bulletin no. 114: management of endometriosis. Obstet Gynecol. 2010 Jul;116(1):223-36, reaffirmed 2018.

Endometriosis. ACOG website. Available at: https://www.acog.org/Patients/FAQs/Endometriosis. Updated January 2019. Accessed January 14, 2020.

Endometriosis. EBSCO DynaMed website. Available at:  https://www.dynamed.com/condition/endometriosis  . Updated August 30, 2019. Accessed January 14, 2020.

Endometriosis. Office on Women's Health—US Health and Human Services website. Available at: https://www.womenshealth.gov/a-z-topics/endometriosis. Updated April 1, 2019. Accessed January 14, 2020.

Levine EM, et al: Deep Infiltrating Endometriosis: Making the Diagnosis. J Diagn Med Sonogr 2019;35(4):1-3.

Practice bulletin no. 114: management of endometriosis. Obstet Gynecol. 2010;116(1):223-236. Reaffirmed 2016.

2/12/2018 DynaMed Systematic Literature Surveillance  https://www.dynamed.com/topics/dmp~AN~T115220/Endometriosis  : Guerriero S, Saba L, et al. Transvaginal ultrasound (TVS) versus magnetic resonance (MR) for diagnosing deep infiltrating endometriosis: a systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2017 Nov 20.

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