ENDOMETRIOSIS

General Information

DEFINITION--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.

BODY PARTS INVOLVED--Uterus; ovaries; fallopian tubes; outer layer of the intestines.

SEX OR AGE MOST AFFECTED--Females between puberty and menopause.

SIGNS & SYMPTOMS--

The following symptoms may begin abruptly or develop over many years:

• Increased pelvic pain during menstrual periods.
• Pain with sexual intercourse.
• Blood in the urine.
• Back pain.
• Pain with intestinal contractions.
• Blood in the stool (sometimes).

CAUSES--Unknown, but the following theory is most accepted among doctors: 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.

RISK INCREASES WITH

• Adult women who don't become pregnant.
• Family history of endometriosis.

HOW TO PREVENT--Having children while you are young.

What To Expect

DIAGNOSTIC MEASURES--

• Your own observation of symptoms.
• Medical history and exam by a doctor.
• Laboratory blood studies.
• Surgical diagnostic procedures, such as laparoscopy (See Glossary).
• X-rays of the lower intestines (barium enema).

APPROPRIATE HEALTH CARE

• Self-care after diagnosis.
• Doctor's treatment. Diagnosing the disorder may be difficult, requiring repeated examinations or surgical diagnostic procedures.
• Surgery to remove implants, or a hysterectomy (see in Surgery section) to remove the uterus, fallopian tubes and ovaries in women who don't want to become pregnant.

POSSIBLE COMPLICATIONS

• Sterility from tissue implants that constrict the fallopian tubes.
• Disabling, but never life-threatening, pain.
• Adhesions of pelvic organs.

PROBABLE OUTCOME--Without treatment, endometriosis becomes increasingly severe. It subsides after menopause when estrogen production decreases. Symptoms can be relieved with medication, and it is sometimes curable with surgery.

How To Treat

GENERAL MEASURES--

• If you want children, consider pregnancy as soon as possible. Delaying pregnancy may cause 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 hot baths to relax muscles and relieve discomfort.
• See Resources for Additional Information.

MEDICATION--

• You may use non-prescription drugs, such as acetaminophen, to relieve minor pain.
• Your doctor may prescribe: danazol, gonadotropin-releasing hormones, oral contraceptives or progestogens that are commonly used drugs for treating endometriosis by suppressing ovarian function.

ACTIVITY--No restrictions.

DIET--No special diet.

Call Your Doctor If

• You have symptoms of endometriosis.
• The following occurs 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.