Endometriosis Causes, Symptoms & Treatments

Endometriosis is a medical condition that occurs when the lining of the uterus, called the endometrium, grows in other places, such as the fallopian tubes, ovaries or along the pelvis. When that lining breaks down, like the regular lining in the uterus that produces the menstruation, it has nowhere to go. This causes cysts, heavy periods, severe cramps and even infertility. 

About 5 million women in the United States have endometriosis, but the true number of cases may be much higher, because not all women with the condition have symptoms, according to the National Institute of Child Health and Human Development (NICHD).

The endometrial tissue may also grow in the vagina, cervix, bowel or bladder, and in rare cases it may spread to other parts of the body, such as the lungs.

                                                                       

     

Causes

·         The endometrium is the inner layer of uterine tissue that is shed during menstruation.

·         The thickness of the endometrial layer is related to the egg-producing (ovulatory) cycle and the hormonal levels that regulate this cycle.

·         The endometrium is at its thinnest immediately following menstruation and thickens during the first two weeks of the menstrual cyle.

·         Once the release of the egg (ovulation) has occurred, the endometrial tissue becomes rich in glands.

·         The whole process prepares the uterus for the attachment of a fertilized egg. If implantation does not occur, the endometrial layer is shed, and bleeding, known as menstruation (a period), begins.

·         Endometriosis occurs when growth of this endometrial tissue develops outside the uterus. This growth usually occurs within the pelvic region on the ovaries and other pelvic structures, such as the bladder and colon, but it may also occur within the abdominal cavity.

Symptoms

The most common symptom of endometriosis is cramping during menstruation, which can get worse over time, and can be debilitating. The pain is due to internal bleeding from the lining being shed inside the body — in a place where it doesn’t belong — and can also lead to scar tissue formation, blocked fallopian tubes, and bowel problems, according to the Office on Women's Health.

Although many women experience some pain during their periods, women with endometriosis often say their menstrual pain is much worse than usual, and increases over time, according to the Mayo Clinic.

Treatment

Treatment for endometriosis can involve pain medication (for the severe cramping), hormone therapy to slow growth of the endometrial tissue and surgery to remove the tissue, according to the NICHD. A number of factors go into determining a woman's treatment, including her age, the severity of her symptoms, and whether the patient wants to become pregnant.

For women who are not trying to become pregnant, hormonal birth control pills are usually the first step in treatment.

For women who are trying to become pregnant, treatment may involve gonadotropin-releasing hormone (GnRH) agonist, which stops ovulation, according to the Office on Women's Health. This treatment is usually recommended for only six months at a time, and pregnancy is possible once treatment is stopped, according to the NICHD.

For women whose symptoms are not relieved by medication, surgery is another treatment option. Laparoscopy and laparotomy are common forms of surgery used to treat endometriosis. They require going in through the abdominal region to remove the endometrial tissue. 

Most women experience relief from pain after surgery, but the pain may come back within two years, according to ACOG. Birth-control pills and other medications may be used along with surgery to help extend the pain-free period, ACOG says.