Endometriosis occurs in about 1 in 10 women of reproductive age – that’s more than 6 million women in the United States. It is most often diagnosed in women in their 30s and 40s.
Endometriosis is a condition in which the tissue that makes up the uterine lining (the lining of the womb) is present on other organs inside your body. Endometriosis is usually found in the lower abdomen, or pelvis, but can appear anywhere in the body.
The most common symptom of endometriosis is pelvic or lower abdominal pain, especially with menstruation. Some women also experience pain with sexual intercourse. Other symptoms may include 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 where a doctor looks in the abdomen with a camera usually through the belly button). A tissue sample from a suspected endometriosis lesion will likely be taken (a biopsy). Medical treatment can be initiated 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 can also have bleeding from the cells and tissue outside the uterus. The endometriosis lesions cause inflammation and irritation, creating pain.
The exact cause of endometriosis is not known. The most likely causes include an abnormality of the endometrial tissue in the uterus, a receptive environment in the pelvis, and alterations in the local immune system. 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. With endometriosis, the tissue from the uterus implants in the abdomen and is not cleared out by the immune cells. This is just one possible explanation and researchers are exploring other causes.
Almost 40% of women with infertility have endometriosis. Inflammation from endometriosis may negatively affect the function of the ovary, egg, fallopian tubes or uterus. Endometriosis can also cause blockage or distortion of the fallopian tubes so they are unable to pick up the egg after ovulation.
Treatment for endometriosis depends on the extent of the disease, your symptoms, and whether you want to have 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.
No. Endometriosis is not a type of cancer. Some research suggests that some 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.