Gynecologic Problems
FAQ013, October 2018



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Endometriosis

What is endometriosis?

Endometriosis is a condition in which the type of tissue that forms the lining of the uterus (the endometrium) is found outside the uterus.

How common is endometriosis?

Endometriosis occurs in about 1 in 10 women of reproductive age. It is most often diagnosed in women in their 30s and 40s.

Where does endometriosis occur?

Areas of endometrial tissue (often called implants) most often occur in the following places:

  • Peritoneum
  • Ovaries
  • Fallopian tubes
  • Outer surfaces of the uterus, bladder, ureters, intestines, and rectum
  • Cul-de-sac (the space behind the uterus)

How does endometriosis cause problems?

Endometriosis implants respond to changes in estrogen, a female hormone. The implants may grow and bleed like the uterine lining does during the menstrual cycle. Surrounding tissue can become irritated, inflamed, and swollen. The breakdown and bleeding of this tissue each month also can cause scar tissue, called adhesions, to form. Sometimes adhesions can cause organs to stick together. The bleeding, inflammation, and scarring can cause pain, especially before and during menstruation.

What is the link between infertility and endometriosis?

Almost 40% of women with infertility have endometriosis. Inflammation from endometriosis may damage the sperm or egg or interfere with their movement through the fallopian tubes and uterus. In severe cases of endometriosis, the fallopian tubes may be blocked by adhesions or scar tissue.

What are the symptoms of endometriosis?

The most common symptom of endometriosis is chronic (long-term) pelvic pain, especially just before and during the menstrual period. Pain also may occur during sexual intercourse. If endometriosis is present on the bowel, pain during bowel movements can occur. If it affects the bladder, pain may be felt during urination. Heavy menstrual bleeding is another symptom of endometriosis. Many women with endometriosis have no symptoms.

How is endometriosis diagnosed?

A health care professional first may do a physical exam, including a pelvic exam. However, the only way to tell for sure that you have endometriosis is through a surgical procedure called laparoscopy. Sometimes a small amount of tissue is removed during the procedure. This is called a biopsy.

How is endometriosis treated?

Treatment for endometriosis depends on the extent of the disease, your symptoms, and whether you want to have children. Endometriosis may be treated with medication, surgery, or both. When pain is the primary problem, medication usually is tried first.

What medications are used to treat endometriosis?

Medications that are used to treat endometriosis include pain relievers, such as nonsteroidal anti-inflammatory drugs (NSAIDs), and hormonal medications, including birth control pills, progestin-only medications, and gonadotropin-releasing hormone agonists. Hormonal medications help slow the growth of the endometrial tissue and may keep new adhesions from forming. These drugs typically do not get rid of endometriosis tissue that is already there.

How can surgery treat endometriosis?

Surgery can be done to relieve pain and improve fertility. During surgery, endometriosis implants can be removed.

Does surgery cure endometriosis?

After surgery, most women have relief from pain. But there is a chance the pain will come back. About 40–80% of women have pain again within 2 years of surgery. This may be due to endometriosis that was not visible or could not be removed at the time of surgery. The more severe the disease, the more likely it is to return. Taking birth control pills or other medications after having surgery may help extend the pain-free period.

What if I still have severe pain that does not go away even after I have had treatment?

If pain is severe and does not go away after treatment, a hysterectomy may be a "last resort" option. Endometriosis is less likely to come back if your ovaries also are removed. If you keep your ovaries, endometriosis is less likely to come back if endometriosis implants are removed at the same time you have the hysterectomy.

Glossary

Adhesions: Scars that can make tissue surfaces stick together.

Biopsy: A minor surgical procedure to remove a small piece of tissue. This tissue is examined under a microscope in a laboratory.

Bladder: A hollow, muscular organ in which urine is stored.

Endometriosis: A condition in which tissue that lines the uterus is found outside of the uterus, usually on the ovaries, fallopian tubes, and other pelvic structures.

Endometrium: The lining of the uterus.

Estrogen: A female hormone produced in the ovaries.

Fallopian Tubes: Tubes through which an egg travels from the ovary to the uterus.

Gonadotropin-Releasing Hormone Agonists: Medical therapy used to block the effects of certain hormones.

Hormone: A substance made in the body that controls the functions of cells or organs.

Hysterectomy: Surgery to remove the uterus.

Infertility: The inability to get pregnant after 1 year of having regular sexual intercourse without the use of birth control.

Inflammation: Pain, swelling, redness, and irritation of tissues in the body.

Laparoscopy: A surgical procedure in which a thin, lighted telescope called a laparoscope is inserted through a small incision (cut) in the abdomen. The laparoscope is used to view the pelvic organs. Other instruments can be used with it to perform surgery.

Ovaries: Organs in women that contain the eggs necessary to get pregnant and make important hormones, such as estrogen, progesterone, and testosterone.

Pelvic Exam: A physical examination of a woman’s pelvic organs.

Peritoneum: The membrane that lines the abdominal cavity and surrounds the internal organs.

Progestin: A synthetic form of progesterone that is similar to the hormone made naturally by the body.

Rectum: The last part of the digestive tract.

Ureters: A pair of tubes, each leading from one of the kidneys to the bladder.

Uterus: A muscular organ located in the female pelvis. During pregnancy this organ holds and nourishes the fetus.

If you have further questions, contact your obstetrician–gynecologist.

FAQ013: This information was designed as an educational aid to patients and sets forth current information and opinions related to women’s health. It is not intended as a statement of the standard of care, nor does it comprise all proper treatments or methods of care. It is not a substitute for a treating clinician’s independent professional judgment. Please check for updates at www.acog.org to ensure accuracy.

Copyright October 2018 by the American College of Obstetricians and Gynecologists

American College of Obstetricians and Gynecologists
409 12th Street SW, Washington, DC  20024-2188