Endometriosis is one of the most common causes of chronic pelvic pain and infertility in women, affecting 5.5 million American women and girls alone. It occurs when endometrial tissue, the tissue that lines the inside of the uterus and is shed every month during menstruation, is found elsewhere in the body, usually in the pelvic area. The most common locations include the ovaries, fallopian tubes, pelvic sidewall, and non-reproductive organs such as the bladder, bowels, or colon. Endometrial tissue can also be found on scars, such as from a caesarian section or laparoscopy, and in very rare cases on organs or structures outside the pelvic area. The places where these cells attach are called implants or lesions.

Endometrial cells found outside the uterus respond to the hormones that regulate the menstrual cycle in the same way endometrial cells found within the uterus respond. Each month the tissue builds up, breaks down, and sheds. Unlike normal endometrial tissue however, the tissue at these implants has no way to leave the body. The implants may swell and bleed, leading to painful inflammation and the development of scar tissue around the cells, which can form adhesions that cover and bind the abdominal organs and can interfere with organ function and anatomy.

Symptoms of Endometriosis

Endometriosis is a progressive condition and symptoms often worsen with time, but the rate of progression varies from woman to woman and some women experience no symptoms at all. Symptoms sometimes appear at menarche (first menstruation) and sometimes later in life. The most common symptom is pelvic pain usually, although not necessarily, associated with the menstrual cycle. Often the pain is worst shortly before the menstrual period begins and eases up as it progresses. As the condition advances, pain may become increasingly chronic and in the very advanced stages the buildup of scar tissue and development of adhesions might result in a condition called a “frozen pelvis,” in which several or all of the organs of the pelvis are bound together abnormally. Endometriosis is also a common cause of infertility because scar tissue can build up and block the fallopian tubes, preventing ovulation, or interfere in other ways with normal reproductive function. An estimated 30 to 40 percent of women with the condition are infertile. The tenderness and inflammation often associated with the condition can also cause pain during intercourse and painful urination or bowel movements during menstruation. Other gastrointestinal complaints are also common side effects.

Causes of Endometriosis

The exact cause of endometriosis is unknown and may involve a combination of several factors, including heredity. The retrograde menstruation theory suggests that during menstruation some of the menstrual tissue can back up through the fallopian tubes and implant in the abdomen. Some experts believe that all women experience some menstrual tissue backup during their cycles and that a hormonal imbalance or immune system problem allows this tissue to grow in the women who develop endometriosis. The possibility of surgical transplantation in some cases is considered viable and there is some evidence of a connection between exposure to the chemical dioxin, a toxic chemical byproduct of pesticide manufacturing, bleached pulp and paper products, and medical and municipal waste incineration, and the development of endometriosis.

Diagnosing Endometriosis

The condition can be difficult to diagnose. Ultrasounds, MRIs, CT scans, and similar technologies do not provide conclusive results. The only definitive way to diagnose it is to perform a laparoscopy or laparotomy (abdominal surgery) and take a biopsy of the tissue. Unfortunately, this is an expensive and invasive procedure and is suggested only in severe cases or when certain types of treatment are being considered. If you suspect you might have endometriosis, a thorough discussion of your menstrual history and symptoms with a qualified gynecologist is the best way to determine what steps should be taken for diagnosis or treatment.

Treating Endometriosis

There is currently no known absolute cure for endometriosis, but treatment can ease the symptoms. For women who suffer primarily from menstrual pain, taking pain medication such as aspirin, ibuprofen, or naproxen can ease symptoms, as can application of heat to the affected areas with a heating pad, warm bath, etc. Endometriosis is exacerbated by the hormone estrogen and there are hormonal therapies available to reduce the symptoms, including some types of birth control pills. Some women have also found relief through alternative treatments such as homeopathy, acupuncture, and massage. Be sure to research alternative therapies thoroughly and discuss them with your doctor before undertaking any treatment or regime.

Many women have also reported that dietary changes and regular exercise have helped ease their symptoms. Regular exercise improves blood flow, increases levels of endorphins (chemicals naturally produced by the body that relieve pain symptoms), and reduces pain. Proper nutrition at the very least ensures a higher overall level of health, and there is some evidence that, for example, regular consumption of omega 3 fatty acids such as those found in fish can relieve menstrual symptoms. In advanced cases, abdominal surgery can remove misplaced endometrial tissue and scar tissue buildup, easing symptoms. Although women were once told that hysterectomy (removal of the uterus) was the definitive cure for the condition, it is now known that it can recur even after hysterectomy. Contrary to popular belief, endometriosis also cannot be cured by pregnancy.