Definition

Normally, endometrial tissue is found only inside the uterus. The uterus is the reproductive organ where a fetus develops. Hormones cause the tissue to form there, preparing the body for a fertilized egg. If you do not become pregnant, the tissue leaves the body during menstruation.

In endometriosis, endometrial-like tissue is found outside the uterus. For example, it may be found on organs in the abdomen or pelvis. In these places, the tissue still responds to hormones. It swells, breaks down, and bleeds. But it is unable to leave when you menstruate. Surrounding tissue becomes inflamed. There is often scarring.

Endometriosis

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Causes

Possible causes include:

• Menstrual tissue backs up through the fallopian tubes and spills into the abdomen
• Immune system may allow the tissue to implant on other organ surfaces and develop into endometriosis
• Lymph system may carry endometrial cells from the uterus
• Certain cells left behind on abdominal organs during embryonic development can turn into endometrial tissue

Hormones and growth factors cause the disease to progress.

Risk Factors

Factors that may increase your risk of endometriosis include:

• Family history—a mother or sister with endometriosis
• Early onset of menstruation
• Not having children—Pregnancy slows or stops the disease from progressing. The condition usually resolves at menopause. The symptoms may return with hormone replacement therapy.
• Prolonged menstrual bleeding—more than 7-8 days
• Abnormal development of the uterus, with a blocked segment

Symptoms

Symptoms range from mild to severe. There may be many large growths with little pain. Or, there may be small areas with intense pain.

Symptoms include:

• Cramping and pelvic pain—especially just before and during menstrual bleeding
• Pain during sex— dyspareunia
• Heavy periods
• Low back pain
• Pain during bowel movements or urination
• Infertility
• Miscarriage

Diagnosis

You will be asked about your symptoms and medical history. A pelvic exam will be done. These are best done early in the menstrual period.

Imaging tests will be done. This can be done with:

• Abdominal ultrasound
• Transvaginal ultrasound
• MRI scan

Diagnosis is usually confirmed with a laparoscopy. This test allows the doctor to see if there are patches of endometrial tissue and scar tissue.

Treatment

The goals of treatment are to:

• Control pain
• Slow endometrial growth
• Restore or preserve fertility

Treatment options depend on:

• Severity of symptoms
• Size, number, and location of growths
• Degree of scarring
• Extent of the disease
• Age and whether a baby is wanted in the future

Treatment includes:

Prevention

There are no current guidelines to prevent endometriosis.