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