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About Endometriosis

In this section, you or a loved one can find out more about medical treatments and practical information about endometriosis. Read on to find answers to some of your questions as well as links to other information. Being informed is an important first step toward becoming an active decision-maker in your care plan.

What Is Endometriosis?

Endometriosis is an estrogen-dependent condition in which tissue that normally grows on the inside of the uterus grows outside of it instead, often causing inflammation, significant pain, and sometimes infertility. This tissue growth usually affects the ovaries, bowel, or pelvic lining, but it can reach beyond the pelvic region as well.

Normally, endometrial tissue in the uterus thickens, breaks down and is expelled as bleeding during the menstrual cycle. In endometriosis, the tissue continues to thicken and break down as it normally would, but it can't be expelled. Instead, it irritates nearby tissues, causing scar tissue, cysts, and adhesions (places where abnormal tissues grow so that they stick to each other).

What Causes Endometriosis?

It isn't known for certain what causes endometriosis, but one theory is so-called retrograde menstruation, in which menstrual blood containing tissue from the uterine lining (called endometrial tissue) flows back into the pelvis instead of out of the body. The displaced tissues then adhere to the pelvic walls and organs, where they continue to grow, thicken, and bleed during each menstrual cycle. Other theories are that the endometrial cells develop outside the uterus from unspecialized cells capable of renewing themselves (so-called stem cells).

Some scientists think endometriosis may be an immune system disorder, meaning that the body fails to recognize and destroy endometrial cells that are growing outside of the uterus.

What Are the Effects of Endometriosis?

In endometriosis, the primary symptom is pelvic pain, especially during menstruation, but it can also occur between menstrual periods. Other symptoms can include:

  • Pain during intercourse 
  • Pain with bowel movements or urination, especially during menstruation
  • Infertility 
  • Excessive bleeding during periods
Which Body Parts Are Affected?

The pelvis near the uterus is the part of the body most commonly affected by endometriosis, although women may also notice pain or other symptoms, especially those related to urination or bowel movements.

Are There Other Complications?

The severity of endometriosis symptoms can differ widely from woman to woman. Many different factors can affect an individual's health and the course of the disease, but some of the more troublesome complications include the following:

  • Infertility: Endometriosis can make it difficult for a woman to get pregnant, often because the fallopian tube (the tube that runs between the ovary where new eggs develop and the uterus) becomes obstructed, preventing the sperm from reaching the egg. Women with endometriosis are often advised not to delay pregnancy, because endometriosis can worsen over time. In vitro fertilization may make it easier for some women with endometriosis to become pregnant. 
  • Increased cancer risk: Women with endometriosis get ovarian cancer at higher rates than average (although the incidence is still small).
Lifestyle Options

For most women, regardless of having endometriosis or not, exercise, healthy eating, and good sleep habits are recommended. A healthy lifestyle can lead to enhanced quality of life for most people. Talk to your doctor before making any lifestyle changes.

Exercise

Getting regular exercise may help improve symptoms of endometriosis as well as increase general well-being.

Diet

Good nutrition is important for all women. Some people believe that maintaining a healthy weight and following a diet that helps keep hormones in balance can help with endometriosis. Additionally, a diet that is rich in fiber can help prevent painful straining during bowel movements.

Natural pain relief

Warm baths and heating pads can help relax uterine and pelvic muscles, relieving cramps.

Medical Treatment

Interventions for endometriosis can differ widely from woman to woman. Therefore, treatment plans are usually tailored to each woman's circumstances. Women should work closely with their medical professionals to create individualized treatment plans.

Medication

The first treatments that a doctor may prescribe for a woman with endometriosis are oral contraceptives and/or pain medications, such as anti-inflammatory drugs (NSAIDs, for example, ibuprofen) to relieve pain. These medications are usually effective for the management of menstrual pain, but may not be effective for non-menstrual pain. In addition, these medications may lose their effectiveness over time. The second medical treatments include drugs that help control the effects of estrogen (estrogen is the hormone from the ovary that fuels growth and activity of endometriosis tissue) such as progestins, or that lower or stop estrogen production, so called gonadotropin hormone agonists.

Surgery

Women with endometriosis who want to become pregnant or who suffer from pain may choose to have a surgery called laparoscopy to remove as much of the endometriosis tissue as possible without removing the uterus and ovaries. After such surgery, however, endometriosis and pain return. Hysterectomy, or removal of the entire uterus, is the last treatment option for severe endometriosis pain, but removing the ovaries is necessary to stop completely the growth of the abnormal tissues that cause endometrial pain. Hysterectomy is a major surgery that ends one's ability to have children and brings on menopause (if the ovaries are removed).

Additional Therapies

Physical therapy can be helpful in some forms of chronic pelvic pain associated with endometriosis. Also, because living with chronic pelvic pain can be stressful and upsetting, studies have shown that in many cases, it may be helpful to work with a trained counselor, psychologist, or psychiatrist. Your doctor can provide more information about various treatments for chronic pelvic pain.

Please be sure to consult with your physician.

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