| Basic Information |
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| Description |
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A disorder in which tissue resembling the inner lining of the uterus (endometrium) appears
at unusual locations in the lower abdomen. This tissue may be found on the ovary surfaces;
behind the uterus, low in the pelvic cavity; on the intestinal wall; and rarely, at other sites far
away. The 4 stages (classification) of endometriosis (minimal, mild, moderate or severe) are
used to describe the anatomic location and the severity of the disorder. Endometriosis can
affect females between puberty and menopause, but is most common between ages 20 and
30.
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| Frequent Signs and Symptoms |
The following symptoms may begin abruptly or develop over many years:
- Increased pelvic pain during menstrual periods, especially the last days, or the pelvic
pain may occur at anytime.
- Pain with sexual intercourse.
- Premenstrual spotting.
- Blood in the urine.
- Back pain.
- Pain with intestinal contractions.
- Blood in the stool (sometimes).
- Infertility.
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| Causes |
Unknown, but the following theory is most accepted among medical professionals:
- Normally during ovulation, the uterus lining thickens to prepare for implantation of a
fertilized egg. If this does not occur, the lining tissue peels away from the uterus and
is expelled in the menstrual flow.
- In some cases, this material builds up and passes backward out of the fallopian tubes
into the pelvic cavity. Here it floats freely and attaches itself to other tissues.
- The transplanted tissue reacts each month as if it were still in the uterus, thickening
and peeling away. New bits of peeled-off tissue create new implants. The growing
endometrial tissue between pelvic organs may cause them to adhere together,
producing pain and other symptoms.
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| Risk Increases With |
- Women who don't become pregnant or delay childbirth.
- Family history of endometriosis.
- Cervical stenosis (narrowing or closing).
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| Preventive Measure |
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There are no known preventive steps. Early diagnosis and appropriate treatment help
prevent the spread of the endometriosis.
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| Expected Outcome |
- Without treatment, endometriosis becomes increasingly severe. It subsides after menopause
when estrogen production decreases.
- Symptoms can be relieved with medication, and the disorder is sometimes curable with
surgery.
- Women with severe disease have less success with treatment.
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| Possible Complications |
- Sterility (from tissue implants constricting the fallopian tubes).
- Bowel or bladder problems.
- Adhesions of pelvic organs.
- Recurrence of endometriosis after surgery.
- Implants on the ovary can lead to large cysts and pelvic masses called endometriomas.
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| Treatment/Post Procedure Care |
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| General Measures |
- Diagnosing the disorder may take time, requiring repeated examinations or surgical
diagnostic procedures, such as laparoscopy. A laparoscope (telescope instrument with fiber
optic light) is inserted into the abdomen through a small incision and visual examination of
many abdominal organs is possible.
- Treatment after diagnosis will vary depending on the stage of the disease and the patient's
age and desire to have children.
- If you want children, consider pregnancy as soon as possible. Pregnancy may offer some
relief from the disorder. Delaying pregnancy may result in infertility.
- Use sanitary napkins instead of tampons. Tampons may make backward menstrual flow
more likely.
- Use heat to relieve pain. Place a heating pad or hot-water bottle on your abdomen or back,
or take warm baths to relax muscles and relieve discomfort. For some women, cold therapy
is more helpful. Place an ice pack on the lower abdomen.
- Laser surgery or electrocoagulation may be used to remove the abnormal growths.
- Surgery to remove implants, or a hysterectomy to remove the uterus, fallopian tubes and
ovaries in women who don't want to become pregnant.
- Additional information or help in finding a support group is available from the Endometriosis
Association, 8585 N. 76th Place, Milwaukee, W153223, (800) 992-ENDO;
http://www.ivg.com/endoassn.html
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| Medication |
- You may use nonprescription drugs, such as nonsteroidal anti-inflammatory drugs
(NSAIDs), to relieve minor pain.
- Stronger pain relievers may be prescribed.
- Oral contraceptives, progestogens, danazol, gonadotropin-releasing hormones (Gn-RH) are
commonly used drugs for treating endometriosis by suppressing ovarian function.
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| Activity |
- Exercise, such as walking, helps in relieving pain and reduces estrogen levels which may
slow the growth of endometriosis.
- Some activity restrictions may apply following surgical therapies.
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| Diet |
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Some diet changes may help. Avoid caffeine. It seems to aggravate pain in some women.
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| Notify Your Healthcare Provider If |
- You or a family member has symptoms of endometriosis.
- The following occur during treatment:
- Intolerable pain.
- Unusual or excessive vaginal bleeding.
- New, unexplained symptoms develop. Drugs used in treatment may produce side effects.
- Symptoms recur after treatment.
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