Endometriosis (say "en-doh-mee-tree-OH-sus") is a problem many women have during their childbearing years. It means that a type of tissue that lines your uterus is also growing outside your uterus. This does not always cause symptoms. And it usually isn't dangerous. But it can cause pain and other problems.
The clumps of tissue that grow outside your uterus are called implants. They usually grow on the ovaries, the fallopian tubes, the outer wall of the uterus, the intestines, or other organs in the belly. In rare cases they spread to areas beyond the belly.
Your uterus is lined with a type of tissue called endometrium (say "en-doh-MEE-tree-um"). Each month, your body releases hormones that cause the endometrium to thicken and get ready for an egg. If you get pregnant, the fertilized egg attaches to the endometrium and starts to grow. If you do not get pregnant, the endometrium breaks down, and your body sheds it as blood. This is your menstrual period.
When you have endometriosis, the implants of tissue outside your uterus act just like the tissue lining your uterus. During your menstrual cycle, they get thicker, then break down and bleed. But the implants are outside your uterus, so the blood cannot flow out of your body. The implants can get irritated and painful. Sometimes they form scar tissue or fluid-filled sacs (cysts). Scar tissue may make it hard to get pregnant.
Experts don't know what causes endometrial tissue to grow outside your uterus. But they do know that the female hormone estrogen makes the problem worse. Women have high levels of estrogen during their childbearing years. It is during these years—usually from their teens into their 40s—that women have endometriosis. Estrogen levels drop when menstrual periods stop (menopause). Symptoms usually go away then.
The most common symptoms are:
Endometriosis varies from woman to woman. Some women don't know that they have it until they go to see a doctor because they can't get pregnant or have a procedure for another problem. Some have mild cramping that they think is normal for them. In other women, the pain and bleeding are so bad that they aren't able to work or go to school.
Many different problems can cause painful or heavy periods. To find out if you have endometriosis, your doctor will:
If it seems like you have endometriosis, your doctor may suggest that you try medicine for a few months. If you get better using medicine, you probably have endometriosis.
The only way to be sure you have endometriosis is to have a type of surgery called laparoscopy (say "lap-uh-ROSS-kuh-pee"). During this surgery, the doctor puts a thin, lighted tube through a small cut in your belly. This lets the doctor see what is inside your belly. If the doctor finds implants, scar tissue, or cysts, he or she can remove them during the same surgery.
There is no cure for endometriosis, but there are good treatments. You may need to try several treatments to find what works best for you. With any treatment, there is a chance that your symptoms could come back.
Treatment choices depend on whether you want to control pain or you want to get pregnant. For pain and bleeding, you can try medicines or surgery. If you want to get pregnant, you may need surgery to remove the implants.
Treatments for endometriosis include:
As a last resort for severe pain, some women have their uterus and ovaries removed (hysterectomy and oophorectomy). If you have your ovaries taken out, your estrogen level will drop and your symptoms will probably go away. But you may have symptoms of menopause, and you will not be able to get pregnant.
If you are getting close to menopause, you may want to try to manage your symptoms with medicines rather than surgery. Endometriosis usually stops causing problems when you stop having periods.
Learning about endometriosis:
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|Hysterectomy and Oophorectomy: Should I Use Estrogen Therapy (ET)?|
The exact cause of endometriosis is not known. Possible causes include the following:
Some women with endometriosis don't have symptoms. Other women have symptoms that range from mild to severe. Symptoms may include:
Symptoms are often most severe just before and during your menstrual period. They get better as your period is ending. Some women, especially teens, have pain all the time.
Endometriosis is usually a long-lasting (chronic) disease. When you have endometriosis, the type of tissue that lines your uterus is also growing outside your uterus. The clumps of tissue (called implants) may have grown on your ovaries or fallopian tubes, the outer wall of the uterus, the intestines, or other organs in the belly. In rare cases they spread to areas beyond the belly.
With each menstrual cycle, the implants go through the same growing, breaking down, and bleeding that the uterine lining (endometrium) goes through. This is why endometriosis pain may start as mild discomfort a few days before the menstrual period and then usually is gone by the time the period ends. But if an implant grows in a sensitive area, it can cause constant pain or pain during certain activities, such as sex, exercise, or bowel movements.
Some women have no symptoms or problems. Others have mild to severe symptoms or infertility. There is no way to predict whether endometriosis will get worse, will improve, or will stay the same until menopause.
Between 20% and 40% of women who are infertile have endometriosis (some have more than one possible cause of infertility).1 Experts don't fully understand how endometriosis causes infertility. It could be that:2
A common complication of endometriosis is the development of a cyst on an ovary. This blood-filled growth is called an ovarian endometrioma or an endometrial cyst. Endometriomas can be as small as 1 mm or more than 8 cm across. The symptoms of an ovarian cyst may be the same as those of endometriosis.
Your risk of endometriosis is higher if:
Call a doctor immediately if you develop sudden, severe pelvic pain.
Call a doctor to schedule an appointment if:
If you have mild pain during your period but have no other symptoms or concerns, you can wait through several menstrual cycles. Then at your next routine visit with your doctor, you can discuss your pain. Home treatment may be all that you need to relieve mild pain.
Health professionals who can evaluate endometriosis and help you manage the pain include:
If your case is complicated or your main problem is infertility, you may be referred to:
To prepare for your appointment, see the topic Making the Most of Your Appointment.
To see whether your symptoms are caused by endometriosis, your doctor first will:
If your exam, symptoms, and risk factors strongly suggest that you have endometriosis, your doctor may suggest that you first try a nonsteroidal anti-inflammatory drug (NSAID) and/or hormone therapy before you have other tests. If treatment improves your symptoms after a few months, the diagnosis of endometriosis is more certain.
Laparoscopy is a surgical procedure used to diagnose and treat endometriosis. If your doctor recommends a laparoscopy, it will be used to look for and possibly remove implants and scar tissue. But laparoscopy is not always needed. It is usually done when infertility requires rapid treatment and probable surgery or when treatment has not relieved pain or infertility.
There is no cure for endometriosis, but treatment can help with pain and infertility. Treatment depends on how severe your symptoms are and whether you want to get pregnant. If you have pain only, hormone therapy to lower your body's estrogen levels will shrink the implants and may reduce pain. If you want to become pregnant, having surgery, infertility treatment, or both may help.
Not all women with endometriosis have pain. And endometriosis doesn't always get worse over time. During pregnancy, it usually improves, as it does after menopause. If you have mild pain, have no plans for a future pregnancy, or are near menopause (around age 50), you may not feel a need for treatment. The decision is up to you.
If you have pain or bleeding but aren't planning to get pregnant soon, birth control hormones (patch, pills, or ring) or anti-inflammatories (NSAIDs) may be all that you need to control pain. Birth control hormones are likely to keep endometriosis from getting worse.4 If you have severe symptoms or if birth control hormones and NSAIDs don't work, you might try a stronger hormone therapy.
Besides medicine, you can try other things at home to help with the pain. For example, you can apply heat to your belly, or you can exercise regularly.
If hormone therapy doesn't work or if growths are affecting other organs, surgery is the next step. It removes endometrial growths and scar tissue. This can usually be done through one or more small incisions, using laparoscopy.
Laparoscopy can improve pain and your chance for pregnancy. This is especially true for women with mild to moderate endometriosis.5
In severe cases, removing the uterus and ovaries (hysterectomy and oophorectomy) is an option. This surgery causes early menopause. It is only used when you have no pregnancy plans and have had little relief from other treatments.
Endometriosis cannot be prevented. This is in part because the cause is poorly understood. But long-term use of birth control hormones (patch, pills, or ring) may prevent endometriosis from becoming worse.
Home treatment may ease the pain of endometriosis. You can try the following things along with your other treatments.
Medicines can be used to reduce pain and bleeding and, in some cases, to shrink endometriosis growths. For women who are not trying to get pregnant, birth control hormones and anti-inflammatories (NSAIDs) are usually recommended first. They are least likely to cause serious side effects and can be a long-term treatment option.1 But if infertility from endometriosis is your main problem, medicines are generally not used.
All hormone therapies for endometriosis can cause side effects and pose certain health risks. Some cause especially unpleasant side effects. Before starting a medicine or hormone therapy, review its possible side effects. If they sound less difficult than your endometriosis symptoms, discuss the therapy with your doctor.
Although surgery doesn't cure endometriosis, it does offer short-term results for most women and long-term relief for a few.
Surgery may be recommended when:
Some studies suggest that using hormone therapy after surgery can make the pain-free period longer by preventing the growth of new or returning endometriosis.4
To help the stress and pain of endometriosis, you can consider other treatments. Researchers have not yet looked at these therapies for endometriosis. But these treatments have proven benefits for treating other conditions:
|American Congress of Obstetricians and Gynecologists (ACOG)|
|409 12th Street SW|
|P.O. Box 96920|
|Washington, DC 20090-6920|
American Congress of Obstetricians and Gynecologists (ACOG) is a nonprofit organization of professionals who provide health care for women, including teens. The ACOG Resource Center publishes manuals and patient education materials. The Web publications section of the site has patient education pamphlets on many women's health topics, including reproductive health, breast-feeding, violence, and quitting smoking.
|American Society for Reproductive Medicine|
|1209 Montgomery Highway|
|Birmingham, AL 35216-2809|
This organization provides literature and information on infertility.
|8585 North 76th Place|
|Milwaukee, WI 53223|
The Endometriosis Association is a self-help organization that provides information and support to women and girls with endometriosis, educates the public as well as the medical community about the disease, and conducts and promotes research related to endometriosis.
|National Institute of Child Health and Human Development|
|P.O. Box 3006|
|Rockville, MD 20847|
The National Institute of Child Health and Human Development (NICHD) is part of the U.S. National Institutes of Health. The NICHD conducts and supports research related to the health of children, adults, and families. NICHD has information on its Web site about many health topics. And you can send specific requests to information specialists.
- Fritz MA, Speroff L (2011). Endometriosis. In Clinical Gynecologic Endocrinology and Infertility, 8th ed., pp. 1221–1248. Philadelphia: Lippincott Williams and Wilkins.
- Barbieri RL (2010). Endometriosis. In EG Nabel, ed., ACP Medicine, section 16, chap. 10. Hamilton, ON: BC Decker.
- Sarajari S, et al. (2007). Endometriosis. In AH DeCherney et al., eds., Current Diagnosis and Treatment Obstetrics and Gynecology, 10th ed., pp. 712–719. New York: McGraw-Hill Medical Publishing Division.
- Ferrrero S, et al. (2010). Endometriosis, search date December 2009. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
- American Society for Reproductive Medicine (2006). Endometriosis and infertility. Fertility and Sterility, 86(Suppl 4): S156–S160.
- Li D, et al. (2003). Exposure to non-steroidal anti-inflammatory drugs during pregnancy and risk of miscarriage: Population-based cohort study. BMJ, 327(7411): 368–372.
- American College of Obstetricians and Gynecologists (2010). Management of endometriosis. ACOG Practice Bulletin No. 114. Obstetrics and Gynecology, 116(1): 225–236.
- American College of Obstetricians and Gynecologists (2010). Noncontraceptive uses of hormonal contraceptives. ACOG Practice Bulletin No. 110. Obstetrics and Gynecology, 115(1): 206–218.
Other Works Consulted
- American Society for Reproductive Medicine (2008). Treatment of pelvic pain associated with endometriosis. Fertility and Sterility, 90(Suppl 3): S260–S269.
|Primary Medical Reviewer||Adam Husney, MD - Family Medicine|
|Specialist Medical Reviewer||Kirtly Jones, MD - Obstetrics and Gynecology|
|Last Revised||July 7, 2011|
Last Revised: July 7, 2011
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