What is Endometriosis?
Endometriosis is defined by the deposition of endometrial glands and stroma (tissue normally found inside the uterine cavity) outside of the uterus, most commonly behind the uterus in the pelvis. The most common mechanism for the formation of endometriosis is the backflow of endometrium at the time of a patient’s menstrual cycle, which either implant and grow in the pelvis or induces other pelvic tissues to differentiate into endometrial tissue.
Endometriosis is a common disorder often resulting in painful menstrual periods, pelvic pain at other times in the cycle, as well as infertility. Roughly 10% of all women develop endometriosis, most commonly in their late twenties. This condition is highly associated with both chronic pelvic pain as well as infertility, affecting a large percentage of women who undergo laparoscopy for either pelvic pain or unexplained infertility.
Symptoms
The primary symptom of endometriosis is pelvic pain, often associated with your menstrual period. Although many women experience cramping during their menstrual period, women with endometriosis typically describe menstrual pain that's far worse than usual. They also tend to report that the pain has increased over time.
Common signs and symptoms of endometriosis may include:
- Painful periods (dysmenorrhea). Pelvic pain and cramping may begin before and extend several days into your period. You may also experience lower back and abdominal pain.
- Pain with intercourse. Pain during or after sex is common with endometriosis.
- Pain with bowel movements or urination. You're most likely to experience these symptoms during your period.
- Excessive bleeding. You may experience occasional heavy periods (menorrhagia) or bleeding between periods (menometrorrhagia).
- Infertility. Endometriosis is first diagnosed in some women who are seeking treatment for infertility.
- Other symptoms. You may also experience fatigue, diarrhea, constipation, bloating, or nausea, especially during menstrual periods.
Diagnosis
Diagnosing endometriosis can be challenging, and sometimes requires laparoscopy. Laparoscopy is a procedure in which a scope is placed into the abdomen generally through the umbilicus (belly button), to look for and biopsy the endometrial lesions on the ovaries, behind the uterus, on the bladder, or elsewhere in the pelvis or abdomen.
An ultrasound may show the classic echogenic ovarian cysts or endometriomas that are common in advanced cases of endometriosis, but in more mild cases of endometriosis, there generally are no obvious signs on ultrasound. But mild endometriosis is less likely to be causal in chronic pelvic pain or infertility.
Tests to check for physical clues of endometriosis include:
Treatment
Your doctor may recommend that you take an over-the-counter pain reliever, such as ibuprofen (Advil, Motrin, etc.), to help ease painful menstrual cramps. However, if you find that taking the maximum dose doesn't provide full relief, you may need to try another treatment approach to manage your signs and symptoms.
Treatment options include:
