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Disease: Endometriosis Endometriosis
Category: Gynecological diseases

Disease Definition:

This condition is a disorder of the female reproductive system, in which the endometrium that usually lines the uterus grows in other places as well. Usually, the growth is on the fallopian tubes, ovaries or the tissue lining the pelvis.


The endometrial tissue, when located elsewhere in the body, continues to act as it normally would during menstrual cycle; it thickens, breaks down and bleeds each month. However, this blood becomes trapped and the surrounding tissue becomes irritated because there’s nowhere for the blood from this displaced tissue to exit the body.


The trapped blood could lead to cysts, scar tissue and adhesions, which are abnormal tissue that bind organs together, a process that could cause pelvic pain, particularly during period. Fertility problems may also be caused by endometriosis.

Work Group:

Symptoms, Causes


Endometriosis, usually ranging from mild to moderate to severe, tends to get worse over time when left untreated. In some cases, endometriosis has no signs and symptoms and it could only be discovered when bits of endometrial tissue (implants) are found outside the uterus during a tubal ligation, or some other unrelated operation. However, in other cases, women with endometriosis could experience one or more of the following signs and symptoms:


Excessive bleeding:

In this case a woman may experience occasional heavy periods known as menorrhagia or she may experience bleeding between periods, known as menometrorrhagia.


Painful periods (dysmenorrhea):

Before the period, pelvic pain and cramping could begin and extend several days into the period, including lower back and abdominal pain. Severity of pain isn’t necessarily a reliable indicator of the extent of the condition. Although some women with severe scarring may have little pain or even no pain at all, however, some women with mild endometriosis could have intense pain.


Pelvic pain at other times:

A woman could either experience pelvic pain during ovulation or a sharp pain deep in the pelvis during intercourse or pain during bowel movements or urination.



When women are seeking treatment for infertility, the first diagnosis could be endometriosis. Sometimes, endometriosis could be mistaken for other conditions that can cause pelvic pain, including ovarian cysts or pelvic inflammatory disease (PID). Endometriosis could also be confused with irritable bowel syndrome (IBS), which is a condition that causes constipation, bouts of diarrhea and abdominal cramping. The diagnosis of endometriosis could be difficult when IBS accompanies it.


In case a woman experiences signs and symptoms that indicate endometriosis, she should see a doctor. However, it could be difficult to pinpoint the cause of chronic or severe pelvic pain. Additionally, she could avoid unnecessary complications and pain when the problem is discovered early.


The roles of hormones and immune system in this condition are being studied, but the exact cause of endometriosis is still not known. Some people believe that menstrual blood that contains endometrial cells flows back through the fallopian tubes, takes root and grows.
Other people believe that the bloodstream carries endometrial cells to other sites in the body.


Yet another group of people believe that a predisposition toward endometriosis could be carried in the genes of certain families. The development of endometriosis could also be contributed to a faulty immune response.


Some researchers believe that the cells that are responsible for the growth of the women’s reproductive organs at the embryo stage retain their ability to become endometrial cells. Later in life, genetic and environmental influences allow these cells to give rise to endometrial tissue outside the uterus.



About one-third to one-half of the women with endometriosis have difficulty getting pregnant, so impaired fertility is the main complication of endometriosis.


Pregnancy occurs when an ovary releases an egg that travels through the fallopian tube, becomes fertilized by a sperm cell and attaches itself to the uterine wall in order to begin development. However, endometriosis produces adhesions that trap the egg near the ovary, inhibit the mobility of the fallopian tube and impair its ability to pick up the egg. But mostly, this disease interferes with conception in more complex ways.


All these complications put aside, some women suffering from this condition are still able to conceive. Most women with mild to moderate endometriosis can become pregnant, but it may take them a little longer. However, most women don’t have any signs or symptoms of endometriosis during pregnancy.


Because endometriosis tends to get worse with time, women are advised not to delay having children. The longer someone has endometriosis, the greater her chance of becoming infertile.


Despite the fact that cancerous changes could occur in endometrial implants, but the rate of cancer in this tissue isn’t higher than that in other tissues. If a woman has endometriosis, it doesn’t mean that her risks of getting ovarian cancer or uterine cancer are higher.


Medications or surgery are the two methods used in treating endometriosis. The severity of a woman's signs and symptoms and whether she hopes to become pregnant or not will determine the treatment method. But in most cases, conservative treatment is recommended first, and surgery is left as a last resort.



In order to help ease painful menstrual cramps, a woman may be recommended some over-the-counter pain relievers, such as ibuprofen. However, she may need to try another treatment in order to manage her signs and symptoms in case taking the maximum dose of the pain reliever doesn’t provide her full relief.



In order to reduce or eliminate the pain of endometriosis, supplemental hormones may be used. These supplemental hormones are effective because the rise and fall of hormones during a woman’s menstrual cycle causes endometrial implants to thicken, break down and bleed. A woman should consider questioning the diagnosis of endometriosis or its relationship to her symptoms in case hormonal therapy has little to no effect on her symptoms. Some of the hormonal therapies that are used in treating endometriosis are:


Hormonal contraceptives:

In order to control the hormones responsible for the buildup of endometrial tissue each month, birth control pills, patches or vaginal ring could be used. When using a hormonal contraceptive, most women have lighter and shorter menstrual flow. The pain of mild to moderate endometriosis could be reduced or even eliminated when using hormonal contraceptives, particularly continuous cycle regimens.



Danazol is a drug that blocks the production of ovarian-stimulating hormones and prevents menstruation and the symptoms of endometriosis. It also suppresses the growth of endometrium. However, because this drug can cause some unwanted side effects including facial hair and acne, it may not be a first choice drug.


Gonadotropin-releasing hormone (Gn-RH) agonists and antagonists:

The production of ovarian-stimulating hormones is blocked by these drugs, a thing that prevents menstruating and lowers the estrogen levels dramatically, causing endometrial implants to shrink. Endometriosis can be forced to remission during the time of treatment with Gn-RH agonists and antagonists, and in some cases for months or years afterward. Because these drugs create an artificial menopause that in some cases lead to troublesome side effects including hot flashes and vaginal dryness, a low dose of estrogen could be taken along with these drugs in order to decrease their side effects.


Aromatase inhibitors:

These drugs, which are used in treating breast cancer, could also be used to treat endometriosis. They work by blocking the production of estrogen from endometrial implants themselves,and they block the conversion of hormones such as androstenedione and testosterone into estrogen. This blockage deprives endometriosis of the estrogen it needs to grow. Some of the early studies have suggested that aromatase inhibitors could be better tolerated than other hormonal approaches and are as good as them.



This injectable drug relieves the signs and symptoms of endometriosis by stopping menstruation and the growth of endometrial implants. Weight gain, decreased bone production and depressed mood are some of the side effects of this drug.


It is quite possible that a woman may experience a recurrence of symptoms after stopping hormonal treatment because these therapies are not a permanent fix for endometriosis.



In case someone has endometriosis, surgery to remove implants could increase their chances of becoming pregnant. They may also benefit from surgery in case they have severe pain from endometriosis.


The endometrial growths, scar tissue and adhesions are removed in conservative surgery without removing the reproductive organs. This procedure could be done laparoscopically, or in more extensive cases, via traditional abdominal surgery. During a laparoscopic surgery, a laparoscope, which is a slender viewing instrument, is inserted through a small incision near the navel. Guided by the laparoscope, the doctor inserts other instruments, such as a laser, small surgical instruments or a cautery, an instrument that destroys tissue with heat, through another small incision to remove endometrial implants.


In some cases, assisted reproductive technologies to help the woman become pregnant are preferable to conservative surgery, and these approaches are often suggested when conservative surgery is not effective.



In some severe cases of endometriosis; the best treatment may be a total hysterectomy and the removal of both ovaries.
Although hysterectomy alone could also be effective, however, removing the ovaries ensures that endometriosis will not return. Both of these surgeries are considered last resort, particularly for women who are still in their reproductive years because after a hysterectomy she won't be able to get pregnant.


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