What is endometriosis?

The word “endometriosis” means a problem with the lining of the uterus. The lining is called the endometrium or endometrial tissue. It is a disorder that occurs when your uterine lining grows outside of your uterus. These areas of growth often are called patches, lesions, or nodules.

Symptoms of endometriosis

There are no exact signs of endometriosis. Many of its symptoms are similar to those of other health problems. Contact your doctor if you have:

  • heavy menstrual bleeding
  • severe cramping or pain before and/or during your period
  • frequent spotting or bleeding between periods
  • pain while going to the bathroom during your period
  • pain with sex
  • pain in your stomach, low back, or rectum
  • problems with fertility
  • unexplained tiredness or lack of energy
  • digestive or gastrointestinal issues or symptoms.

The location and size of patches do not relate to the amount of pain you may have.

What causes endometriosis?

Doctors and researchers do not know the cause of endometriosis. Genetics plays a part, as it can run in your family. Retrograde menstrual flow is another possible cause. This is when some of the tissue that is shed during your period flows up instead of out. It ends up in your fallopian tubes and other parts of your pelvis.

Other factors include how your body responds to estrogen and progesterone. If your body resists progesterone, it can have a hard time shedding the uterine lining. Some people have flawed immune systems. This means their bodies don’t destroy all of the lining. It results in leftover lining that attaches outside your uterus.

How is endometriosis diagnosed?

Visit your doctor or gynecologist if you have symptoms. They will do physical and pelvic exams. They also will review your symptoms, health history, and family history.

The only way to confirm a diagnosis is to have surgery. Laparoscopy is the most common procedure. This allows the doctor to look inside your uterus. They will make a small cut in your skin and put a thin tube inside your abdomen. The doctor uses a small, lighted camera to see if there are patches of endometriosis. They may take a sample of tissue to biopsy. For this procedure, the doctor gives you medicine so you don’t feel pain.

Can endometriosis be prevented or avoided?

You cannot prevent or avoid endometriosis. Some women have an increased risk of getting the condition. Factors that increase your risk include:

  • family history
  • early start of menstruation (before the age of 11)
  • short menstrual cycles (27 days or less)
  • long, heavy periods (7 days or more).

Factors that may help decrease your risk include:

  • late start of menstruation
  • low body fat
  • regular exercise (4 or more hours each week)
  • pregnancy.

Endometriosis treatment

Several types of medicine can help treat endometriosis.

  • Over-the-counter medicine can relieve pain and inflammation.
  • Birth control pills can regulate your hormones and reduce heavy bleeding.
  • Progestin is a hormone that can manage symptoms over time. You can take this in the form of a shot or pill.
  • Danazol and GnRH analog are hormone shots that stop your periods. These have side effects similar to menopause, such as hot flashes and vaginal dryness. Danazol may cause acne or unwanted facial hair. A daily estrogen pill can reduce the side effects of GnRH analog.
  • Aromatase inhibitors, such as exemestane and letrozole, are a new form of treatment for endometriosis. They have shown promise in some small studies. They often are used in addition to one of the other medicines listed above.

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

Your doctor may recommend a procedure. It could be surgery or a diagnostic laparoscopy. In this procedure, the doctor removes the endometrial tissue that has grown outside of your uterus. Another procedure is a hysterectomy. Severe cases may require this type of surgery. The doctor would remove your uterus, and sometimes ovaries.

Living with endometriosis

Endometriosis can make it harder to get pregnant. You may need surgery and/or fertility treatments to help. Talk to your doctor if you plan to become pregnant. They may advise you to start now. The condition can get worse with age, so your chances of getting pregnant lessen over time. Usually, symptoms go away while you’re pregnant. Do not take prescription medicine when you’re trying to get pregnant.

Some studies have found that endometriosis may put you at a higher risk of getting ovarian cancer. Often, the condition goes away or becomes milder with menopause. Until menopause, medicine and/or surgery may be able to help with symptoms.

Questions to ask your doctor

  • What are the benefits and risks of surgery?
  • What can I do to improve my chances of getting pregnant?