Endometriosis occurs when cells in inner lining of the uterus begin to grow outside of the uterus. It generally appears in the reproductive years and occurs in approximately 6–10% of women.
Endometrial cells shed each month during menstruation. If endometrial cells attach themselves to tissue outside the uterus instead of being shed through menstruation, they are called endometriosis implants. These implants are most commonly found on the ovaries, fallopian tubes, outer surfaces of the uterus or intestines, and on the surface lining of the pelvic cavity. They can also be found in the vagina, cervix, and bladder, less commonly outside the pelvis, on the liver, in old surgery scars, and rarely, around the lungs or brain.
While they may cause problems, endometrial implants are not cancerous. The primary symptom of endometriosis is pelvic pain, often associated with your menstrual period. Women with endometriosis typically describe menstrual pain that's far worse than usual. Other symptoms include pain with intercourse, painful bowel movements or pain while urinating, excessive bleeding or bleeding in between periods, fatigue, diarrhea, constipation, bloating or nausea.
However, the severity of discomfort isn't always a reliable indicator of the severity of the condition. Some women with mild endometriosis have extensive pain, while others with advanced endometriosis may have little pain or even no pain at all.
Factors that place you at greater risk of developing endometriosis are:
- Never giving birth
- Having one or more relatives (mother, aunt or sister) with endometriosis
- Menstrual cycles shorter than 27 days with bleeding lasting longer than eight days
- Any medical condition that prevents the normal passage of menstrual flow
- A history of pelvic infection
Infertility is the primary complication of endometriosis and approximately one-third to one-half of women who have endometriosis will have difficulty getting pregnant.
Endometriosis may obstruct an egg from passing through the fallopian tube and keep the egg and sperm from uniting. Women with endometriosis are often advised not to delay trying to conceive. The longer you have endometriosis, the greater your chance of becoming infertile.
To diagnose endometriosis and other conditions that can cause pelvic pain, your doctor will ask you to describe your symptoms, including the location of your pain and when it occurs. Tests may also include a routine pelvic exam, vaginal ultrasounds, and laparoscopy.
Treatment will depend on the severity of your signs and symptoms and whether you hope to become pregnant. Generally, doctors recommend trying conservative treatment approaches first, like over-the-counter pain relievers or hormonal therapy before considering surgery.
If you suffer from severe pain or are trying to become pregnant, surgery to remove endometrial lesions may increase your chances of fertility and minimize pain. In rare, serious cases, you and your doctor may consider radical hysterectomy (removal of the uterus, cervix and the ovaries) to alleviate severe pain associated with endometriosis.