Endometriosis: What You Need to Know

Endometriosis is derived from the word “endometrium”, which is the tissue that lines the uterus. Patients with endometriosis have endometrial-type tissue outside of the uterus.

A woman’s uterus is lined with endometrial tissue. This lining is called the endometrium. Your body grows a new endometrium with each menstrual cycle to prepare for a fertilized egg. Endometriosis is a condition in which endometrial tissue grows outside the uterus.

• Endometriosis affects an estimated 2 to 10 percent of American women between the ages of 25 and 40
• Women with endometriosis are more likely to have infertility or difficulty getting pregnant
• Symptoms of endometriosis may include: excessive menstrual cramps, abnormal or heavy menstrual flow and pain during intercourse.
• Laparoscopy, a minimally invasive surgical procedure, can be used to definitively diagnose and treat endometriosis.

Endometriosis most often occurs on or around reproductive organs in the pelvis or abdomen, including:

• Fallopian tubes
• Ligaments around the uterus
• Lining of the pelvic cavity
• Ovaries
• Outside surface of the uterus
• Space between the uterus and rectum or bladder

More rarely, it can also grow on and around the:

• Bladder
• Cervix
• Intestines
• Rectum
• Stomach (abdomen)
• Vagina or vulva

Endometrial tissue growing in these areas does not shed during a menstrual cycle like healthy endometrial tissue inside the uterus does. The buildup of abnormal tissue outside the uterus can lead to inflammation, scarring and painful cysts. It can also lead to buildup of fibrous tissues between reproductive organs that causes them to “stick” together.

Causes of Endometriosis

Doctors do not know exactly what causes endometriosis, but there are a few theories of what might cause it:

• Blood or lymph system transport: Endometrial tissues are transported to other areas of the body through the blood or lymphatic systems, similar to the way cancer cells can spread through the body.
• Direct transplantation: Endometrial cells may attach to the walls of the abdomen or other areas of the body after a surgery, such as a C-section or hysterectomy.
• Genetics: Endometriosis seems to affect some families more often than others, so there may be a genetic link to the condition.
• Reverse menstruation: Endometrial tissue goes into the fallopian tubes and the abdomen instead of exiting the body during a woman’s period.
• Transformation: Other cells in the body may become endometrial cells and start growing outside the endometrium.

Symptoms of Endometriosis

The most common signs of endometriosis are pain and infertility. Endometriosis pain typically presents as:

• Painful menstrual cramps that may go into the abdomen (stomach) or lower back
• Pain during or after sex

Other Symptoms may include:

• Diarrhea or constipation during a menstrual period
• Fatigue or low energy
• Heavy or irregular periods
• Pain with urination or bowel movements during a menstrual period
• Spotting or bleeding between menstrual periods

Risk Factors

Each person’s experience with endometriosis is different. Women with endometriosis may have some of these symptoms, all of these symptoms or none of them. Having severe pain or other symptoms is not necessarily a sign of more severe endometriosis.

Research shows that there are some things that put a person at higher risk of developing endometriosis, including having:

• A mother, sister or daughter who has endometriosis
• An abnormal uterus, which is diagnosed by a doctor
• Early menstruation (before age 11)
• Shorter menstrual periods (less than 27 days on average)
• Heavy menstrual periods lasting more than seven days

Some things that can lower the risk of endometriosis include:

• Pregnancy and breastfeeding
• Having your first period after age 14
• Eating fruits, especially citrus fruits

Endometriosis Prevention

Endometriosis is an idiopathic condition, meaning there is no known cause. There are also no specific ways to prevent endometriosis. However, being aware of the symptoms and whether you could be at higher risk can help you know when to discuss it with a doctor.

Endometriosis and Infertility

Endometriosis is one of the most common conditions linked to female infertility. The American Society for Reproductive Medicine found that 24% to 50% of women with infertility have endometriosis. Mild to moderate cases of endometriosis may only cause temporary infertility. Surgery to remove the endometrial tissue can help a woman become pregnant.

Doctors don’t know exactly how endometriosis affects fertility. Scar tissue from endometriosis may affect the release of eggs from the ovaries or block the path of the egg through the fallopian tube so it cannot get to the uterus. Endometriosis may also damage sperm or fertilized eggs before they implant in the uterus.

Many women with endometriosis or endometriosis-related infertility can still get pregnant and carry a successful pregnancy. There are treatment options, including In-Vitro Fertilization (IVF), that may help women become pregnant. Talk to your doctor about your fertility goals when discussing your endometriosis treatment plan.