Endometriosis is a condition in which tissue from the membrane normally lining the uterus — the endometrium — grows outside the uterus, typically on the ovaries, fallopian tubes, intestines or other areas in the pelvis. This tissue acts just like the endometrium in accumulating blood in the monthly menses period, but it has no place to shed the blood at the end of the cycle. The accumulation of tissue and blood can cause inflammation and scarring, which can lead to other conditions, particularly pelvic pain and infertility. Blood trapped in the ovaries also can develop into benign cysts called endometrioma.
Endometriosis affects more than one million women in North America and at this time, the exact cause of condition is unknown. Endometriosis is typically seen during the reproductive years. It occurs in roughly 5-10% of women. Between 25 and 50 percent of infertile women are estimated to have endometriosis.
Symptoms of endometriosis typically worsen over time. The severity of symptoms may vary and some women with the condition may not experience any symptoms at all. Symptoms may stop after menopause or during pregnancy, though will begin in women after they have a baby and begin menstruating again.
Common symptoms may include:
- Pelvic pain and cramping before and during periods
- Lower back and stomach pain during periods
- Excessive bleeding during periods
- Pelvic pain during intercourse
It is important to note that these symptoms can occur with other conditions. If you’re experiencing any of these symptoms, see your doctor to determine the cause.
There is currently no cure for endometriosis. In many cases, menopause will stop the process. In patients in the reproductive years, the goal of endometriosis treatment is to provide pain relief, to restrict progression of the process, and to restore or preserve fertility where needed.
Treatment may depend on the severity of your condition, your age and whether or not you are planning to have children, and whether you have any other associated conditions. Treatments include:
- Hormonal therapies to slow the growth of endometriosis. These include birth control pills, progestins, Danazol and the newer drugs known as aromatase inhibitors, which act by interrupting local estrogen formation within the endometrial growths.
- Over-the-counter pain relievers to manage pelvic pain and menstrual cramping.
- Surgery for some women who are trying to get pregnant and for those who suffer from severe pelvic pain. With the use of cystectomy and ablative surgery, pregnancy rates are approximately 40%.
- Conservative surgery removes endometrial growths, scar tissue and adhesions without removing reproductive organs.
- In the most severe cases, a hysterectomy — with or without the removal of the ovaries — is performed. This is typically a last resort, particularly for women who are still in their reproductive years.
While surgery can be very effective in treating endometriosis, the recurrence rate of the condition after surgery is an estimated 40 percent.
Women who are experiencing infertility due to endometriosis may also benefit from treatment from an infertility specialist.