Endometriosis is a condition in some women that occurs when the cells that normally line the inside of the uterus (endometrial cells) are found in other parts of the body. These cells are typically found in areas around the uterus in the pelvic organs—the ovaries, fallopian tubes and the lining of the abdomen (peritoneum), but they can be found in other parts of the body such as the bowel and/or bladder. Since they are the same type of cells that are usually just on the inside of the uterus, they respond to estrogen and grow a little each month and sometimes bleed slightly. The small amount of growth and bleeding each month causes endometriosis.
Women who have endometriosis may experience significant endometriosis symptoms including pain, infertility or both. It is unclear however, why many women may have no endometriosis symptoms at all and find out they have endometriosis because they develop a cyst on their ovary or they have surgery for another reason.
There are a wide range of endometriosis symptoms. Usually these symptoms occur at regular times that are often before, during or after monthly periods.
Endometriosis symptoms may include:
Painful menstrual cramps
Pelvic pain that can radiate to the back, down the legs or into the vagina or rectum.
Bloating, constipation and/or diarrhea
Pain with urination
Pain with a bowel movement
Pain during or after sexual intercourse
An experienced gynecologist may suspect endometriosis based on a woman’s symptoms and the findings during a pelvic exam. Currently, the only way to diagnose endometriosis is through laparoscopy—a minor surgical procedure that is done under general anesthesia (while the patient is asleep). Using the laparoscope (which is equipped with a tiny camera on the end), the surgeon can look inside the pelvic cavity and other areas to see if endometrial cells/lesions are present.
There is no cure for endometriosis nor one perfect endometriosis treatment. Most women will need to try many different endometriosis treatments that can include medications, behavioral therapy and surgery. Endometriosis treatment requires trial and error to find the best combination for any one person.
If endometriosis is seen at the time of diagnosis, it is removed by cautery (electrical energy), laser (intense light energy) or excision (surgical removal). In general, surgery of this type will lessen pelvic pain associated with endometriosis and will enhance fertility.
Often non-steroidal anti-inflammatory drugs such as aspirin, ibuprofen (Motrin® or Advil®) or naproxen (Aleve®) are prescribed first for endometriosis treatment. An evaluation at a Pain Treatment Program can often be very helpful to manage pain. Some women find that alternative therapies such as acupuncture, physical therapy or bio-feedback can be helpful.
Other treatment options include hormonal therapies. Birth control pills which contain estrogen and progestins (progesterone hormone) are usually prescribed first. Combinations of estrogen and progestin may also be prescribed as a patch (an adhesive bandage) or a ring which is inserted into the vagina. Other options for endometriosis treatment include progestin alone, Gonadotropin-Releasing Hormone Agonists (drugs which lower estrogen) or Danazol(a male hormone-like pill).
Not being able to conceive is common but not a universal problem among all women with endometriosis. Some women will be able to become pregnant without endometriosis treatment. Since all hormonal treatments prevent pregnancy, medical treatments for endometriosis are not used in women who are attempting to conceive.
Treatment options to improve fertility outcomes include:
Laparoscopic surgery has been shown to improve fertility, and thus is considered a treatment of choice for women with endometriosis symptoms who wish to start a family or have more children.
Intrauterine inseminations (IUI), fertility drugs in the form of pills or injections or in vitro fertilization (IVF). IVF is a procedure in which a woman takes fertility drugs to make multiple eggs. The eggs are removed from her ovaries and then fertilized with her partner's sperm in the laboratory. The fertilized eggs (embryos) grow in the IVF Lab for 3-5 days until the embryo(s) are ready to be implanted into the uterus.