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About Endometriosis -- Pelvic Pain Caused by Endometriosis

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Updated June 21, 2014

What Endometriosis Is:

Endometriosis is a type of women's pelvic pain; it can affect 5% to 10% of females. In women with endometriosis, uterine tissue (endometrium) grows outside the uterus. This tissue may be found in the pelvic cavity, around the ovaries, behind the uterus or even in the bladder or bowel. This "extra" tissue causes an inflammatory response that can cause scarring and adhesions to form in the pelvic cavity. Endometriosis is one of the most common types of chronic pelvic pain in women.

Endometriosis Symptoms:

The most common endometriosis symptom is dysmenorrhea, or a painful menstrual period. Endometriosis pain is usually located in the pelvic region, though it can occur in the lower back as well. Endometriosis pain may occur before, during or after menstruation. Endometriosis may also cause pain during sexual intercourse, bowel movements and urination. Other symptoms of endometriosis include bowel disorders and fatigue. Some cases of endometriosis can cause infertility.

Diagnosing Endometriosis:

If your doctor suspects you have endometriosis, he may do any of the following diagnostic tests.
  • A pelvic exam, much like you would have at your usual gynecologist checkup.

  • A transvaginal ultrasound -- An ultrasound provides a picture of what is happening in and around your uterus, and can help locate nodules and cysts.

  • An MRI, if a clearer picture of the tissues in and around the pelvic cavity is needed.

  • A laparoscopy -- During a laparoscopy, your doctor inserts a small camera through a tiny incision in your abdomen to examine structures in the pelvis. He can also take a sample of tissue for a biopsy.

Treating Endometriosis:

Typical treatments for endometriosis include:
  • Painkillers: Over-the-counter or prescription NSAIDs can control pain in mild cases.

  • Hormone treatments: Progesterone, oral contraceptives and gonadotropin agonist drugs (which keep the ovaries from producing estrogen) can control mild endometriosis pain. They may be combined with NSAIDs.

  • Laparoscopic surgery: For severe endometriosis pain, this minimally invasive surgery can remove the excess endometrium or scar tissue.
In the most severe cases, nerve removal or a hysterectomy may be performed to control endometriosis pain, though these options are often last resorts.

Prognosis for Endometriosis:

Fortunately, medications such as NSAIDs and hormone therapy are effective at getting most cases of endometriosis under control. Laparoscopies are also fairly efficient at reducing endmotriosis symptoms and pain. A combination of these approaches is often used, and research indicates that they can relieve endometriosis pain in up to 75% or 80% of cases. Unfortunately, that means around 20% of women with endometriosis may require more aggressive intervention, and some may not be cured. Mild to moderate endometriosis cases seem to have the greatest success rates.

Sources:

Medline Plus Medical Encyclopedia. Endometriosis. Accessed 7/30/09. http://www.nlm.nih.gov/medlineplus/ency/article/000915.htm

Nasir, Laeth and Bope, Edward T. Management of Pelvic Pain from Dysmenorrhea or Endometriosis. The Journal of the American Board of Family Practice 17:S43-S47 (2004)

National Institute of Child Health and Human Development. What is Endometriosis? Accessed 7/30/09. http://www.nichd.nih.gov/publications/pubs/endometriosis/sub2.cfm#what

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