Endometriosis

Overview

What is endometriosis?

The word "endometriosis" (say: "end-oh-me-tree-oh-sis") means a problem with the lining of the uterus. The lining is called the endometrium or endometrial tissue. Normally, every month when you have your period, the lining comes out in your menstrual flow.

Endometrial tissue is usually only inside your uterus. However, if you have endometriosis, tissue from the lining of the uterus may move through the fallopian tubes and get on your ovaries, in your pelvis, on your bladder or in other areas. When you have your period, this tissue swells and bleeds, just like the lining of your uterus. This is often painful, and scar tissue can form in your pelvic area.

Symptoms

What are the symptoms of endometriosis?

There’s no easy way to tell you have this problem. If you have severe cramping and pain during sex or at the beginning of your period, or low back pain or rectal pain, you may have endometriosis. If you have these kinds of pain, your doctor still may not be sure if endometriosis is the cause. Many other health problems can cause pain like this.

Diagnosis & Tests

How does my doctor know I have it?

Your doctor will do a physical exam and listen as you describe your symptoms. Your doctor may suspect that endometriosis is causing your symptoms, but the only way for your doctor to be sure is to do a laparoscopy (say: "lap-ah-ross-ca-pee"). This is a way for the doctor to look inside your uterus by making a small cut in your skin and putting a thin tube inside your abdomen. The doctor can then use a tiny camera to see if there are spots of endometriosis. If your doctor decides to perform this procedure, you will be given medicine so you won’t feel any pain.

Treatment

Can anything treat endometriosis?

A number of medicines might help with your pain. You can try over-the-counter medicines such as acetaminophen (one brand name: Tylenol) or ibuprofen (brand names: Advil, Motrin).

Sometimes it helps to take birth control pills to regulate your hormones. Another medicine that might help is a long-acting progestin (this is a hormone that comes in a shot; it’s also used for birth control).

Other medicines are danazol or a monthly shot of a hormone called a GnRH analog. Danazol and GnRH analog stop your periods. They may cause side effects like the ones women have at menopause. These include hot flashes and vaginal dryness. Danazol might cause acne and unwanted facial hair. Sometimes the side effects of the GnRH analog go away if you also take an estrogen pill every day.

Aromatase inhibitors, such as exemestane and letrozole, are a new form of treatment for endometriosis. This treatment is still considered experimental, but it has shown promise in some small studies. If you take an aromatase inhibitor, you will probably take it in addition to one of the medicines listed above.

How long does treatment last?

Birth control pills, danazol and GnRH analogs are taken for 6 to 9 months. During that time, your pain should get better. After you stop taking the medicine, the pain may come back.

What about surgery?

Surgery is also used to treat endometriosis. During surgery (or sometimes during diagnostic laparoscopy), the doctor removes the endometrial tissue from the wrong places. If you have a severe case of endometriosis, your doctor may recommend a hysterectomy. In this type of surgery, the uterus—and sometimes the ovaries—are removed completely.

What happens during and after menopause?

For many women, endometriosis goes away at menopause, when periods stop. Until menopause, medicine and surgery may be able to help with symptoms of endometriosis.

Complications

Is endometriosis harmful to me?

Some studies have found that endometriosis may put you at a higher risk of getting ovarian cancer. It also might make it harder to get pregnant.

What about pregnancy?

Some women who have endometriosis have trouble getting pregnant. For some women, this means that it may take a little longer to get pregnant. Some other women may need surgery and/or other fertility treatments to help them get pregnant. If you have endometriosis and you plan to become pregnant, your doctor may advise you not to wait. Endometriosis can get worse as you get older, so your chances of getting pregnant may go down with time.

Usually, endometriosis symptoms go away while you’re pregnant.

It’s important not to get pregnant while you’re taking prescription medicine to treat endometriosis. And if you want to get pregnant after the treatment is over, these medicines don’t improve your chances of getting pregnant. If you don’t want to get pregnant after the treatment, you should keep using birth control.

Other Organizations

Questions to Ask Your Doctor

  • Do you suspect that endometriosis may be the cause of my pelvic pain?

  • Do I need diagnostic laparoscopy? What does this procedure entail?

  • What do the results of the laparoscopy indicate? Do I have endometriosis? Do I have scar tissue?

  • What are my treatment options? Should I take birth control pills or another type of medicine?

  • I’m trying to get pregnant. How does endometriosis affect my ability to conceive?

  • What can we do to improve my ability to conceive?

Citations

  • Diagnosis and Treatment of Endometriosis by C Wellbery, MD( 10/15/99, http://www.aafp.org/afp/991015ap/1753.html)