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Johns Hopkins Symptoms and Remedies

Johns Hopkins Medicine

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Endometriosis

What is it?

Endometriosis is a benign disorder characterized by the presence of endometrial tissue (the tissue that lines the uterus) outside the uterine cavity where it becomes attached to reproductive or abdominal organs. The patches of endometrial tissue swell with blood during menstruation as if they were still in the uterus. Because this blood is trapped within the tissue and cannot be shed through the vagina, blood blisters form, and they may develop further into cysts, scar tissue, or adhesions (fibrous bands that link together other tissues that are normally separated). Cysts may range from the size of a pinhead to the size of a grapefruit; cysts, scars, and adhesions may all lead to infertility.

Endometriosis is a common disorder, most prevalent between the ages of 25 and 40. Symptoms vary and are not strictly correlated with the severity of the disease; they may worsen with time, but tend to diminish during pregnancy and cease with menopause. Many women have no symptoms at all. Treatment depends on the severity of symptoms, the age of the woman, and whether she wishes to have children.

What Causes It?

  • The cause of endometriosis is unknown. Hereditary factors may be involved.
  • Hormonal changes or recent pelvic surgery may promote endometriosis.

Prevention

  • While endometriosis cannot be prevented, women should have regular pelvic examinations once they reach age 18 or become sexually active, to aid in early detection and treatment of any reproductive system abnormalities.

Diagnosis

  • A pelvic examination may reveal a suspicion of endometriosis. The doctor presses upon the uterus and ovaries to feel for any abnormalities.
  • A definitive diagnosis requires direct visualization and biopsy or sampling of the extrauterine endometrial tissue. This is usually done by laparoscopy (the insertion of a thin, lighted viewing instrument into the abdomen through a small incision).

How to Treat It

  • Young women with endometriosis who wish to bear children may be advised to have children sooner rather than later.
  • Over-the-counter pain relievers may be taken for mild menstrual pain.
  • Danazol, progestins, or Gn-RH (gonadotropin-releasing hor mone) agonists may be administered to halt menstruation for three to six months in an effort to shrink endometrial tissue.
  • Surgical removal of the tissue may be required to relieve severe symptoms or to allow impregnation. Tissue may be destroyed by heat (electrocautery) or removed with lasers during laparoscopy (usually done on an outpatient basis under local anesthesia).
  • A hysterectomy, the surgical removal of the uterus (and sometimes other reproductive organs), may be advised in severe cases. Hormone replacement is required if both ovaries are removed.

When to Call a Doctor

  • Call a doctor if you experience severe pain and heavy bleeding during menstruation, with or without additional symptoms of endometriosis.