11/5/2018 Endometriosis: Symptoms, causes, and treatments

What's to know about

endometriosis?
By Lori Smith BSN MSN CRNP | Last updated Thu 4 January 2018

Reviewed by Debra Rose Wilson, PhD, MSN, RN, IBCLC, AHN-BC, CHT

What is endometriosis? Symptoms Treatment Diagnosis Diet Causes Risk factors

Endometriosis is an incurable but manageable gynecological

condition.
It occurs when endometrial implants, comprised of tissue normally found within the uterus,
are present in other areas of the body.

As the tissue continues to thicken, break down, respond to menstrual cycle hormones, and
bleed during the menstrual cycle, endometriosis forms deep inside the body.

Scar tissue and adhesions form, and this can cause organ fusion and anatomical changes.

Endometriosis is thought to affect around 11 percent of women in the United States aged
between 15 and 44 years.

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11/5/2018 Endometriosis: Symptoms, causes, and treatments

Fast facts on endometriosis

Here are some key points about endometriosis. More information is in the main article.

• Endometriosis affects between 6 and 10 percent of women of reproductive age

worldwide.

• The condition appears to be present in a developing fetus, but estrogen levels

during puberty are thought to trigger the symptoms.

• Symptoms are generally present during the reproductive years.

• Most women go undiagnosed, and in the U.S. it can take around 10 years to receive
a diagnosis.

• Allergies, asthma, chemical sensitivities, autoimmune diseases, chronic fatigue

syndrome, fibromyalgia, breast cancer, and ovarian cancer are linked to women and
families with endometriosis.

What is endometriosis?
Endometrial tissue consists of gland, blood
cells, and connective tissue. It normally grows
in the uterus, to prepare the lining of the
womb for ovulation.

Endometrial implants are buildups of

endometrial tissue that grow in locations
outside the uterus.
Endometriosis sees the endometrial implant tissue, normally found,
When they grow outside the uterus, this is in the uterus build up in other parts of the body.
called endometriosis.

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11/5/2018 Endometriosis: Symptoms, causes, and treatments

They can develop anywhere in the body, but they usually occur in the pelvic area.

They may affect:

the ovaries

the fallopian tubes

the peritoneum

the lymph nodes

Normally, this tissue is expelled during menstruation, but displaced tissue cannot do this.

This leads to physical symptoms, such as pain. As the lesions grow larger, they can affect
bodily functions. For example, the fallopian tubes may be blocked.

The pain and other symptoms can affect different areas of life, including the ability to work,
medical care costs, and difficulty maintaining relationships.

Symptoms
Other medical conditions such as pelvic
inflammatory disease (PID), ovarian cysts, and
irritable bowel syndrome (IBS) can mimic the
symptoms of endometriosis.

Symptoms of endometriosis include:

Severe menstrual cramps, unrelieved with

NSAIDS

Long-term lower-back and pelvic pain

Endometriosis can lead to painful cramps in the pelvis.

Periods lasting longer than 7 days

Heavy menstrual bleeding where the pad or tampon needs changing every 1 to 2 hours

Bowel and urinary problems including pain, diarrhea, constipation, and bloating

Bloody stool or urine

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11/5/2018 Endometriosis: Symptoms, causes, and treatments

Nausea and vomiting

Fatigue

Pain during intercourse

Spotting or bleeding between periods

Pain is the most common indication of endometriosis, but the severity of the pain does not
always correlate with the extent of the disease.

Pain often resolves following menopause, when the body stops producing estrogen
production. However, if hormone therapy is used during menopause, symptoms may persist.

Pregnancy may provide temporary relief from symptoms.

Complications

Complications include:

infertility, which can affect 50 percent of those with the condition.

increased risk of developing ovarian cancer or endometriosis-associated adenocarcinoma

ovarian cysts

inflammation

scar tissue and adhesion development

intestinal and bladder complications

It is important to see a health care provider about symptoms, to avoid future complications.

Treatment
Surgery is possible, but it is normally considered only if other treatments are not effective.

Other options include:

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11/5/2018 Endometriosis: Symptoms, causes, and treatments

Pain medications: Either over-the-counter

(OTC) nonsteroidal anti-inflammatory drugs
(NSAIDs) such as ibuprofen (Advil, Motrin IB,
others) or prescription drugs for the
treatment of painful menses.

Hormones: Treatment may be with hormonal

therapies such as hormonal birth control,
Gonadotropin-releasing hormone (Gn-RH)
A hysterectomy, or the removal of the uterus, will be considered
agonists and antagonists, when all other avenues of treatment have been exhausted.

Medroxyprogesterone (Depo-Provera) or
Danazol. Placement of an intrauterine device (IUD) may also be recommended.

Surgery: Initial surgery will seek to remove the areas of endometriosis, but a hysterectomy
with removal of both ovaries may be necessary.

Fertility treatment: Pregnancy may be recommended via in-vitro fertilization (IVF).

Managing symptoms at home

Complementary and alternative treatments may include acupuncture, chiropractic, and herbal
medicine, but there is little evidence to show that these are effective.

Avoiding caffeine may help to reduce pain, as caffeine can worsen symptoms.

Exercise, such as walking, may reduce pain and slow the progress of the condition by
reducing estrogen levels.

It is important to monitor symptoms, because of the long-term complications of endometriosis.

Intolerable pain or unexpected bleeding should be reported to a doctor.

Although there is currently no cure for endometriosis, most women are able to relieve the
pain of symptoms and will still be able to have children.

Diagnosis
Diagnosis can be challenging because there is no single test for evaluation.
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11/5/2018 Endometriosis: Symptoms, causes, and treatments

The only way to truly confirm the condition is by undergoing a surgical laparoscopy.

A surgical laparoscopy is a minimally invasive procedure in which a thin, lighted tube with a
miniature camera attached, called a laparoscope, is inserted through a small incision in the
pelvic area.

A diagnosis can be categorized as follows:

Stage 1: Lesions are minimal and isolated

Stage 2: Lesions are mild. There may be several and adhesions are possible.

Stage 3: Lesions are moderate, deep or superficial with clear adhesions

Stage 4: Lesions are multiple and severe, both superficial and deep, with prominent
adhesions.

It can take many years to receive a diagnosis.

Other possible diagnostic strategies include a pelvic exam, radiologic imaging with ultrasound
or magnetic resonance imaging (MRI), and the use of certain medications including birth
control or gonadotropin releasing hormone (GnRH) agonists.

Diet
Dietary steps have been suggested for managing the pain and effects of endometriosis.

A 2004 study suggests that a brown seaweed called bladderwrack may have an estrogen-
reducing effect in women. This can reduce the growth rate of endometriosis.

One author presented a case study using a diet low in short-chain-fermentable carbohydrates
to reduce the symptoms of endometriosis. This diet has been shown to work on IBS and since
it is often found with endometriosis, then perhaps the diet would be effective for those with
only endometriosis.

More research is needed, but there is little harm in trying this approach.

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11/5/2018 Endometriosis: Symptoms, causes, and treatments

Dietary choices have also been linked to the development of endometriosis. A study carried
out in 2011 suggested that fruit intake increased the risk of endometriosis and a higher total
fat intake decreased the risk.

Dairy products were also shown to reduce the risk of endometriosis, although these results
were not statistically significant.

Eating yogurt, sauerkraut, and pickles or finding a good source of probiotics may help reduce
gastrointestinal symptoms and cause increased digestive activity.

Avoiding caffeine may help to reduce pain, as caffeine can worsen symptoms.

Causes
The exact cause of endometriosis is not currently fully understood.

Possible explanations include:

Problems with menstrual flow: Menstrual blood enters the fallopian tubes and the pelvis
instead of leaving the body in the usual way.

Embryonic cell growth: At times, embryonic cells lining the abdomen and pelvis develop into
endometrial tissue within those cavities.

Fetal development: Data show that endometriosis can be present in a developing fetus, but
pubertal estrogen levels are thought to trigger the symptoms.

Surgical scar: Endometrial cells can move during a procedure such as a hysterectomy or c-
section.

Endometrial cell transport: The lymphatic system transports endometrial cells to various
parts of the body.

Genetics: There may be an inherited component. A woman with a close family member who
has endometriosis is more likely to develop endometriosis herself.

Hormones: Endometriosis is stimulated by the hormone estrogen.

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Immune system: Problems with the immune system can prevent the destruction of
extrauterine endometrial tissue.

Risk factors
Anyone can develop endometriosis, but some risk factors increase the risk.

These include:

Age: It is most common in women aged 30 to 40 years

Nulliparity: Never giving birth

Genetics: One or more relatives having the condition

Medical history: Having a pelvic infection, uterine abnormalities, or a condition that

prevents expulsion of menstrual blood.

Menstrual history: Menses lasting more than 7 days or menstrual cycles of less than 27
days.

Caffeine, alcohol consumption, and lack of exercise: These can raise levels of estrogen.

Some health conditions have been linked to endometriosis. These include allergies, asthma,
and some chemical sensitivities, some autoimmune diseases, chronic fatigue syndrome, and
ovarian and breast cancer.

Researchers have found links between endometriosis and exposure to certain chemicals,
including phthalates.

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Additional information
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11/5/2018 Endometriosis: Symptoms, causes, and treatments

Article last updated by Yvette Brazier on Thu 4 January 2018.

Visit our Endometriosis category page for the latest news on this subject, or sign up to our newsletter to
receive the latest updates on Endometriosis.

All references are available in the References tab.

References

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