Diagnosing and treating endometriosis

By Kenneth L. Noller, MD

March 03, 2008 02:07 pm

— Endometriosis is a condition that can cause mild to severe pelvic pain before and during menstruation and can lead to infertility in women. It occurs most often in women in their 30s and 40s, and up to 50% of childbearing-age women may be affected. If your mother, sister, or daughter has endometriosis, you are at increased risk.
Endometrial cells line the inside of the uterus and respond to the hormones that control the menstrual cycle. Each month, the hormone estrogen signals the endometrial cells to build up the lining of the uterus to prepare to support a fertilized egg. If no egg implants, the lining stops growing and menstruation begins.
In most women, a small amount of blood and endometrial cells flow back through the fallopian tubes and into the abdomen during menstruation. Endometrial cells can also travel through blood and lymph vessels. Endometriosis occurs if the endometrial cells attach to other places such as the ovaries, fallopian tubes, rectum, intestines, bladder, ureters, and the surface of the uterus. The endometrial cells outside the uterus may bleed before and during menstruation and may allow scar tissue to develop.
Women with endometriosis may experience pain during sex, bowel movements, or urination; before or during menstruation; or may have menstrual bleeding that occurs more than once a month. However, some women will have no symptoms and may first be diagnosed when they have trouble getting pregnant.
Endometriosis can sometimes be detected by performing a pelvic examination. This also helps to rule out other causes of pelvic pain. Other times, the diagnosis can only be made by surgery. Laparascopy is the most common surgical procedure used. A lighted scope is inserted through a small incision in the abdomen and allows your doctor to view your pelvic organs. If endometriosis is found during the procedure, it can often be removed at the time of the exam.
Endometriosis can also be treated with medication. Your doctor may prescribe medications such as ibuprofen or naproxen to relieve pain. Hormonal medi-cations, such as birth control pills, may be prescribed to control the menstrual cycle and reduce endometriosis by regulating levels of estrogen or progesterone. Other hormonal methods may be used, but they may be associated with an increased risk of side effects, such as hot flashes, loss of bone density, bloating, headaches, vaginal dryness, mood changes, sexual problems, and weight gain.
Surgery to remove excess endometrial cells and scar tissue may be necessary in severe cases. While surgery and treatment may help on a short-term basis, about half of women who have surgery will experience symptoms again within a year. Endometriosis is an ongoing problem, though many women’s symptoms improve after menopause.
For more information, the ACOG Patient Education Pamphlet “Endometriosis” is available in English and Spanish at www.acog.org/publications/
patient_education.