Endometriosis occurs in about 1 in 10 women of reproductive age – that’s more than 6 million women in the United States. The diagnosis of endometriosis is most common when a woman reaches her 30s and 40s.
Endometriosis is a condition in which the tissue that lines the uterus or womb is present on other organs. Endometriosis is usually found in the lower abdomen or pelvis, but it can appear anywhere in the body.
The most common symptom of endometriosis is lower abdominal or pelvic pain, especially with menstruation (dysmenorrhea). Some women also experience pain with sexual intercourse (dyspareunia). Other symptoms may include changes in bowel and bladder symptoms (such as pain with bowel movements, bloating, constipation, blood in the urine, or pain with urination), and possibly abnormal vaginal bleeding. Clinical diagnosis of endometriosis can be made on the basis of symptoms but definitive diagnosis requires laparoscopy (a surgery with general anesthesia in which a doctor looks inside the abdomen with a camera, usually through the belly button). A tissue sample (biopsy) from a suspected endometriosis lesion at time of surgery can confirm the diagnosis. A patient can initiate medical treatment on the basis of clinical diagnosis alone.
When a woman with endometriosis has her period, she has bleeding not only from the cells and tissue inside the uterus, but also from the cells and tissue outside the uterus. The endometriosis lesions cause inflammation and irritation, creating pain. However, some women with endometriosis do not have any pain.
The exact cause of endometriosis is not known, but there are several theories that offer possible explanations. When a woman has her period, some of the blood and tissue from her uterus travels out through the fallopian tubes and into the pelvis and very rarely other areas of the body. This is called retrograde menstruation. Nearly all women have some degree of retrograde menstruation, so abnormalities of the endometrial tissue in the uterus, a receptive environment in the pelvis, and alterations in the local immune system likely contribute to the development of endometriosis. Other theories exist to explain endometriosis lesions in rare locations outside of the pelvis, and researchers are actively exploring other causes.
Almost 40% of women with infertility have endometriosis. Inflammation from endometriosis may negatively impact the function of the ovary, egg, fallopian tubes or uterus. In addition, scar tissue that is often present in patients with endometriosis can cause blockage or distortion of the fallopian tubes so they are unable to pick up and transport the egg after ovulation.
Treatment for endometriosis depends on the extent of the disease, the degree of symptoms, and the desire for future children. Endometriosis may be treated with medication, surgery, or both. The first line therapy for endometriosis is with medications, particularly when pain is the primary problem. As endometriosis lesions are sensitive to ovarian hormones, medical therapies aim to lower estrogen levels and/or shrink the lesions with a form of progesterone called a progestin. If medical therapy fails or in certain cases to treat infertility, surgery can be used to remove or burn as much of the endometriosis as possible without injuring other internal organs.
No, a hysterectomy is not necessary. However, if a woman with endometriosis is not interested in becoming pregnant, she and her doctor may decide to remove the uterus and possibly the ovaries if other treatments are ineffective.
No, endometriosis is not a type of cancer. Some research suggests that women with endometriosis may be at a slightly higher risk of developing certain cancers. If you are concerned about your risk of gynecologic cancer, please talk to your healthcare provider.