Endometriosis

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KEY POINTS

• Endometriosis is when tissue that forms the lining of the uterus grows outside of the uterus, the muscular organ at the top of the vagina. It can cause irritation, swelling, pain, and scar tissue.
• Treatment may include pain medication, hormone therapy, or surgery including removal of the uterus and ovaries.
• Ask your healthcare provider how to take care of yourself at home including what symptoms or problems you should watch for and what to do if you have them.

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What is endometriosis?

Endometriosis is when tissue that forms the lining of the uterus grows outside of the uterus. The uterus is the muscular organ at the top of the vagina. Babies grow in the uterus, and menstrual blood comes from the uterus.

The tissue most often grows around the ovaries, fallopian tubes, outside surface of the uterus, and lining of the pelvis. It may also grow in other areas, such as the bladder, rectum, or intestines. The tissue responds to the hormones of your menstrual cycle. It bleeds each month just like the lining of the uterus. However, when the tissue is not in the uterus, the blood has no way to leave the body. It can cause irritation, swelling, pain, and scar tissue. The scar tissue may cause organs to stick together.

Endometriosis can get worse as you get older until you reach menopause. It usually goes away after menopause. Symptoms can also get better with a pregnancy, but this improvement may not last. Endometriosis can make it hard to get pregnant.

What is the cause?

The exact cause of endometriosis is not known. It may be due to a problem with your immune system. The immune system is your body’s defense against infection. You are more likely to have endometriosis if you:

• Have a family member with endometriosis
• Started having menstrual periods before age 12
• Have periods that last 7 or more days
• Have periods more than once every 28 days
• Have never given birth
• Have had pelvic infections

What are the symptoms?

Some women have no symptoms. When you have symptoms, they may include:

• Pelvic or back pain that starts just before or during your menstrual period
• Very painful menstrual cramps
• Pelvic pain during sex
• Abnormal or heavy menstrual flow
• Diarrhea, constipation, or painful bowel movements during menstrual periods
• Painful urination or feeling the need to urinate often during menstrual periods
• Trouble getting pregnant

How is it diagnosed?

Your healthcare provider will ask about your symptoms and medical history and examine you, including a pelvic exam. Tests may include:

• Blood tests
• Ultrasound, which uses sound waves to show pictures of the pelvic organs
• CT scan, which uses X-rays and a computer to show detailed pictures of the pelvic organs
• MRI, which uses a strong magnetic field and radio waves to show detailed pictures of the pelvic organs
• Hysterosalpingogram, which uses X-rays and a dye put into your vagina to show the uterus and fallopian tubes
• Laparoscopy, which uses a small lighted tube put into the belly through a small cut to look for misplaced tissue. A biopsy may be taken to help make a diagnosis. A biopsy is the removal of a small sample of tissue for testing.

How is it treated?

Treatment depends on:

• How bad your symptoms are
• Where the abnormal tissue is and how much you have
• Your age
• Your plans for having children

Possible treatments include:

Pain-relief medicine

Your provider may suggest that you take nonprescription pain medicine, such as acetaminophen, ibuprofen, or naproxen. Read the label and take as directed. Unless recommended by your healthcare provider, you should not take these medicines for more than 10 days.

• Nonsteroidal anti-inflammatory medicines (NSAIDs), such as ibuprofen, naproxen, and aspirin, may cause stomach bleeding and other problems. These risks increase with age.
• Acetaminophen may cause liver damage or other problems. Unless recommended by your provider, don't take more than 3000 milligrams (mg) in 24 hours. To make sure you don’t take too much, check other medicines you take to see if they also contain acetaminophen. Ask your provider if you need to avoid drinking alcohol while taking this medicine.

Hormone medicine

Hormones can help shrink the misplaced tissue and help relieve pain and swelling. Different forms of hormone medicine can be used, such as birth control pills, hormone shots, or an intrauterine device (IUD) that contains a hormone

Surgery

You may need surgery to remove the tissue. Your provider may recommend different types of surgery, depending on your symptoms:

• Laparoscopy, which uses tools put through a small cut in the belly to destroy or remove the tissue
• Open surgery, which involves a larger cut in your belly to remove the misplaced tissue
• Hysterectomy, which removes organs that have growths, such as the fallopian tubes, uterus, or the ovaries. If your uterus is removed, you will no longer be able to get pregnant or have children.

Endometriosis may come back or get worse after hormone therapy or surgery. In severe cases, removal of the uterus and ovaries may be recommended.

How can I take care of myself?

Follow the full course of treatment prescribed by your healthcare provider. In addition:

• Keep track of your symptoms in a diary or on the calendar. Let your provider know what seems to help.
• Put a heating pad set on low, or a covered hot water bottle, on your lower belly.
• Soak in a warm (not hot) tub.
• Don’t wear tight underwear or clothing that puts pressure on your belly.
• Eat high-fiber foods to help you move your bowels without straining.
• Take care of your health. Try to get at least 7 to 9 hours of sleep each night. If you smoke, try to quit. If you want to drink alcohol, ask your healthcare provider how much is safe for you to drink. Learn ways to manage stress. Exercise according to your healthcare provider's instructions.
• You may want to try massage by a trained massage therapist, or acupuncture, which uses special needles to stimulate the release of your body's natural painkillers.

Ask your provider:

• How and when you will get your test results
• How long it will take to recover
• If there are activities you should avoid and when you can return to your normal activities
• How to take care of yourself at home
• What symptoms or problems you should watch for and what to do if you have them

Make sure you know when you should come back for a checkup. Keep all appointments for provider visits or tests.

You can get more information from:

• Endometriosis Association International Headquarters
  414-355-2200
  http://www.endometriosisassn.org