Overview

Endometriosis is a gynecological condition affecting 11% of women in America. Females of most ages can experience symptoms of this illness. It particularly impacts those in their 30s to 40s and can cause infertility.

Knowing the causes and symptoms can help in effective treatment. There are several options for treating endometriosis. These include hormone therapy, pain management, and surgery.

Endometriosis is a disorder causing abnormal growth of endometrial tissue. Instead of being contained within the uterus, tissue also grows on:

• Ovary (left or right)
• Fallopian Tubes
• Abdominal Cavity (Peritoneum)
• The area behind the uterus (Cul-de-sac)
• Outside of the uterus the outer parts of the bladder, rectum, intestines, and ureters

When endometriosis occurs, the extra tissue acts like the lining inside the uterus. It reacts to the hormones of a woman’s menstrual cycle, such as estrogen.

Bleeding will occur, followed by swelling, irritation, and inflammation. Frequently causing intense pain, this process can also lead to scar tissue buildup. Scarring in the reproductive organs makes it more difficult for pregnancy to occur.

Stages of Endometriosis

There are four stages of endometriosis. The American Society of Reproductive Management establishes staging.

These stages indicate the number and depth of endometrial lesions. It is not a measurement of pain or symptoms.

1. Stage I: Minimal (superficial implants)
2. Stage II: Mild (some more and deeper implants)
3. Stage III: Moderate (deep implants, small cysts, some filmy adhesions)
4. Stage IV: Severe (many deep implants, large cysts, many dense adhesions)

Causes of Endometriosis

Unlike other illnesses, there is no known cause. Researchers in the field are hopeful to one day have definitive answers.

For now, there are several theories as to what causes endometriosis:

• Early start of menstruation (before age 11)
• Extended years and intensity of menstruation
• Familial history (possible genetic factors)
• Backup of menstrual flow (leading to a buildup of tissue)
• Unusually high estrogen hormone levels
• Malfunction in the immune system
• Complications from abdominal surgery (i.e., c-section)
• Drinking large amounts of alcohol or caffeine

Symptoms

Endometriosis has many symptoms. The most common and challenging symptom is ongoing pain of varying intensities. The degree of pain does not always indicate the severity of the condition.

Some people with endometriosis may have no pain but experience other complications. Patients experiencing these symptoms should seek medical attention for an accurate diagnosis.

Symptoms can include:

• Cramps (more intense and painful version of menstrual cramping)
• Lower back and pelvic pain (long-lasting)
• More than a week-long menstrual period (with spotting or bleeding between periods)
• Menstrual bleeding (heavier than what is considered normal)
• Intestinal dysfunction (such as constipation, diarrhea, and bloating)
• Painful urination
• Bloody urine or bowel movement
• Frequently feeling nauseous or vomiting
• Chronic fatigue
• Painful intercourse
• Infertility or difficulties becoming pregnant

Treatments for Endometriosis

Endometriosis has no known cure. Yet, there are many options available in the treatment of this condition.

Diagnosis

The first step is getting a diagnosis. Patients should discuss symptoms with a trusted doctor. Then one or more of the following procedures will help determine what is happening:

• Pelvic exam
• Ultrasound
• MRI
• Laparoscopy

Treatment Options

Once diagnosed, a patient and doctor will consider the best course of treatment. To do this, they will weigh factors, starting with the patient’s age and whether they want children. They will also consider the severity of the symptoms and stage of the disease.

Knowing the answers to these questions helps doctors as they recommend treatment. Options include:

• Hormone replacement therapy: Through this method, the hormones that have malfunctioned are either replaced or corrected. This can alter the misfiring of the menstrual cycle. It can also trick the brain into no longer perceiving endometriosis-related pain.
• Pain management medication: An NSAID is the most common pain medication. Nonsteroidal anti-inflammatory drugs are often an over-the-counter option. It is unknown how effective they are in treating endometrial pain.
• Surgical options: Doctors may determine that a surgical response is best for the patient. Surgeries can include laparoscopy, a laparotomy, or surgery that severs pelvic nerves.

Medications

Endometriosis treatment often includes a combination of different medications. Some will regulate hormones, and others will treat pain.

Here are some of the medications used in the treatment of this condition:

• Orilissa (elagolix)
• Lupron (GnRH)
• Oral contraceptives
• Depo-Provera (progestin)
• Progesterone
• Mirena (IUD)
• Danocrine (Danazol)
• NSAIDs (anti-inflammatory medicines)
• Norethindrone