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Endometriosis

What is endometriosis?
What are the most common places in the body where…
What are the effects of endometriosis?
Who is at risk of endometriosis?
What are the symptoms of endometriosis?
How is endometriosis diagnosed?
How is endometriosis treated?
What medications are used to treat endometriosis?
What hormones are used most often for treatment?
What types of surgery are used to treat endometriosis?
What can I expect after surgery?
What is endometriosis?

  • Endometrium: Tissue that forms the lining of the uterus
  • Endometrium grows in places in the body other than the uterus.

What are the most common places in the body where…

  • Ovaries
  • Fallopian tubes
  • Surface of the uterus
  • Cul-de-sac (the space behind the uterus)
  • Bowel
  • Bladder and ureters
  • Rectum
  • Lungs: rarely
  • Other parts of the body as well

What are the effects of endometriosis?

  • Abnormal bleeding
    • Endometrial tissue outside the uterus responds to changes in hormones.
    • It breaks down and bleeds like the lining of the uterus during the menstrual cycle.
  • Adhesions
    • The breakdown and bleeding of this tissue each month can cause scar tissue, called adhesions, to form.
    • Adhesions can cause pain.
    • Sometimes, adhesions bind organs together.
  • Infertility
    • Endometriosis may lead to infertility.

Who is at risk of endometriosis?

  • Age
    • Most common in women in their 30s and 40s,
    • It can occur any time in women who menstruate.
  • Children
    • Endometriosis occurs more often in women who have never had children.
  • Family History
    • Women with a mother, sister, or daughter who have had endometriosis

What are the symptoms of endometriosis?

  • Pelvic pain.
    • Pain may occur with sex,
    • During bowel movements or urination,
    • Just before or during the menstrual cycle.
    • Pain severity does not correlate with condition severity
    • Some women with slight pain may have a severe case.
    • Others who have a lot of pain may have a mild case.
  • Menstrual bleeding may occur more than once a month.
  • Many women with endometriosis have no symptoms.
    • They may first find out that they have endometriosis if they are not able to get pregnant.
    • In women who can get pregnant, many often find that symptoms are relieved while they are pregnant.

How is endometriosis diagnosed?

  • Physical exam, including a pelvic exam.
  • Laparoscopy
    • Looking directly inside the body.
    • The only sure way to tell if endometriosis is present
  • Biopsy
    • Sometimes a small amount of tissue is removed during the procedure and studied in a lab.

How is endometriosis treated?

  • Options
    • Medication
    • Surgery
    • Both
  • Treatment choice depends on
    • Extent of the disease
    • Your symptoms
    • Whether you want to have children.
  • Treatment Efficacy
    • Treatments may relieve pain and infertility for a time
    • Symptoms may come back after treatment.

What medications are used to treat endometriosis?

  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
    • May be used to relieve pain.
  • Hormones
    • May help slow the growth of the endometrial tissue
    • And prevent the growth of new adhesions
    • But will not make them go away.

What hormones are used most often for treatment?

  • Oral contraceptives
    • Birth control pills contain hormones
      • Help keep the menstrual period
        • Regular
        • Lighter
        • Shorter
      • Can relieve pain.
  • Gonadotropin-releasing hormone (GnRH) drugs
    • Decrease estrogen levels
      • By stopping its production by the ovaries.
    • Causes a short-term condition that is much like menopause.
    • Given as a shot, an implant, or nasal spray.
    • Efficacy
      • In most cases, endometriosis shrinks and pain is relieved
    • Side effects
      • Hot flushes
      • Headaches
      • Vaginal dryness
      • Decrease in bone density
    • Duration
      • Treatment with GnRH most often lasts at least 3 months.
    • Bone Loss
      • Long-term use can result in bone loss.
      • Prevention
        • Your doctor may prescribe certain hormones or medications to take along with GnRH treatment.
      • In many cases, this therapy also may reduce other side effects.
    • After stopping GnRH treatment, you should have periods again in about 6–10 weeks.
  • Progestin
    • Progestin works against the effects of estrogen on the tissue.
    • Although you will no longer have a monthly menstrual period when taking progestin, you may have irregular vaginal bleeding.
    • Progestin is taken as a pill or injection.

What types of surgery are used to treat endometriosis?

  • Often is done by laparoscopy.
  • During laparoscopy, endometriosis can be removed or burned away.
  • Not all cases can be handled with laparoscopy.
  • Sometimes a procedure called a laparotomy may be needed.

What can I expect after surgery?

  • You may have relief from pain.
  • However, symptoms return within 1 year in about one half of women who have had surgery.
  • Many patients are treated with both surgery and medications to help extend the symptom-free period.
  • If pain is severe and does not go away after treatment, a hysterectomy (surgery to remove your uterus) may be an option.
  • Endometriosis is less likely to come back if your ovaries also are removed.
  • After this procedure, a woman will no longer have periods or be able to get pregnant.
  • There is a small chance that your symptoms will come back even if your uterus and ovaries are removed.