Matthew Wosnitzer, MD, is board-certified in urology. He is an attending physician at Yale New Haven Health System, Northeast Medical Group and teaches at the Frank Netter School of Medicine.
Endometriosis is a chronic condition where tissue similar to the endometrium (the inner lining of the uterus) grows outside the uterus. The condition can cause many symptoms, including painful and heavy periods and bowel problems. It may also interfere with fertility. Treatments usually include pain medication, hormone therapy, and surgery.
Endometriosis is caused by the formation of endometrial-like tissue in the ovaries, fallopian tubes, pelvis, bladder, rectum, intestines, and/or vagina. Often, the out of place endometrial-like cycles between proliferating and breaking down during phases of the menstrual cycle, leading to periodic cramps, swelling, and bleeding. It’s now known what predisposes a woman to develop endometriosis, and it is believed to be associated with environmental and hereditary factors.
Endometriosis is considered as a possible cause of episodic cramping, pain, swelling, and/or bleeding, especially when the symptoms are more severe or widespread than expected with menstruation. A pelvic examination or imaging tests like a pelvic ultrasound or computerized tomography (CT) scan can identify endometrial-like tissue outside the uterus, but often, a surgical biopsy is necessary to definitively identify the condition.
Endometriosis does tend to run in families, but the exact hereditary pattern and the specific genes that could be responsible for the condition are not known. It is believed that a hereditary predisposition could make you more prone to endometriosis and that certain factors—being underweight and having a history of abdominal surgery—may increase the risk.
Endometriosis can interfere with fertility, and the condition increases the risk of miscarriage and pregnancy complications. However, you can get pregnant and have a healthy pregnancy when you have endometriosis. Lifestyle strategies like a healthy diet are important. And often, hormonal treatment, intrauterine insemination, or in vitro fertilization are used to facilitate pregnancy.
Endometriosis does not cause visible changes in a woman’s appearance, and it doesn’t cause a change in the appearance of menstrual bleeding. However, when viewed with diagnostic medical imaging tests, the endometrial-like tissue often appears as cystic lesions. And, when viewed directly during surgery, endometriosis has a characteristic appearance of bluish, black, reddish, or white lesions that look “burned.”
Painful menstrual cramps are described as dysmenorrhea. Painful menstrual cramps can occur at any age and may vary in intensity throughout a woman’s lifetime. Dysmenorrhea can be managed with medication. It is not always associated with a medical problem, but sometimes dysmenorrhea can signal an issue like endometriosis, fibroids, cysts, or an infection.
Endometrial cell transport is one of the processes by which retrograde menstruation is believed to lead to endometriosis. When the endometrial tissue flows into the fallopian tubes and/or ovaries, some of the endometrial cells may remain there, where they can adhere and continue to grow.
Endometrial tissue normally lines the uterus. It is composed of connective tissue, red blood cells, and glands. Normally, endometrial tissue supports and nourishes pregnancy. This tissue responds to hormonal changes, proliferating during pregnancy and during certain phases of the menstrual cycle, and breaking down during other phases. When endometrial tissue breaks down, menstruation occurs.
Hormone therapy such as Depo-Provera can be used to help reduce pain and overgrowth of endometrial tissue in women who have endometriosis. These treatments, which are usually contraceptives, can improve symptoms and may help the overall outcome of the condition. Contraceptive hormonal treatments are not used as a treatment for endometriosis while you are trying to get pregnant.
A hysterectomy is a surgical operation in which a woman’s uterus (also referred to as the womb) is removed. This procedure can be done for the treatment of a variety of conditions, including cancer, prolapsed uterus, and endometriosis. A hysterectomy causes medical menopause. A woman can no longer become pregnant after a hysterectomy and may need to take medical treatment to manage the symptoms of menopause.
A laparoscopy is a minimally invasive procedure in which a camera-equipped surgical device is inserted into a small surgical incision. This type of procedure can be used for diagnostic purposes and for a surgical operation. Healing and recovery are often faster after a laparoscopic procedure than after an open operation with a larger incision, but a laparoscopic procedure does pose a risk of surgical complications.
Sometimes, a small amount of menstrual blood and tissue flows up and into the fallopian tubes and ovaries, instead of out of the body through the vagina. This can happen due to the partial blockage of the fallopian tubes. Typically, most of the retrograde menstrual tissue eventually flows out of the vagina. Experts suggest that retrograde flow could be an underlying cause of endometriosis.
Gruber TM, Mechsner S. Pathogenesis of endometriosis: the origin of pain and subfertility. Cells. 2021;10(6). doi:10.3390/cells10061381
Jerman LF, Hey-Cunningham AJ. The role of the lymphatic system in endometriosis: a comprehensive review of the literature. Biol Reprod. 2015 Mar;92(3):64. doi: 10.1095/biolreprod.114.124313.
Pattanasri M, Ades A, Nanayakkara P. Correlation between ultrasound findings and laparoscopy in prediction of deep infiltrating endometriosis (DIE). Aust N Z J Obstet Gynaecol. 2020 Sep 7. doi: 10.1111/ajo.13242.
By clicking “Accept All Cookies”, you agree to the storing of cookies on your device to enhance site navigation, analyze site usage, and assist in our marketing efforts.