A woman’s uterus is lined with endometrial tissue. This lining is called the endometrium. Your body grows a new endometrium with each menstrual cycle to prepare for a fertilized egg. Endometriosis is a condition in which endometrial tissue grows outside the uterus.
Endometrial tissue growing in these areas does not shed during a menstrual cycle like healthy endometrial tissue inside the uterus does. The buildup of abnormal tissue outside the uterus can lead to inflammation, scarring and painful cysts. It can also lead to buildup of fibrous tissues between reproductive organs that causes them to “stick” together.
Endometriosis affects up to 10% of women between the ages of 15 and 44. It most often occurs on or around reproductive organs in the pelvis or abdomen, including:
More rarely, it can also grow on and around the:
The most common signs of endometriosis are pain and infertility. Endometriosis pain typically presents as:
Other symptoms may include:
Each person’s experience with endometriosis is different. Women with endometriosis may have some of these symptoms, all of these symptoms or none of them. Having severe pain or other symptoms is not necessarily a sign of more severe endometriosis.
There is no lasting treatment for endometriosis, but doctors can offer treatments that help you manage it. Finding the right treatment depends on many different factors, including your age and symptoms. Also discuss whether you want to have children, which can help determine the best treatment options.
The most common treatments for endometriosis that do not require surgery are hormone therapy and pain management.
Endometriosis tissues are affected by hormones in the same way as endometrial tissues inside the uterus. Hormone changes that occur with a menstrual cycle can make endometriosis pain worse.
Treatments that include hormone therapy can alter hormone levels or stop your body from producing certain hormones. Hormone therapy can affect your ability to get pregnant, so it may not be right for everyone.
Hormone therapy can be taken as pills, shots or a nasal spray. The most common options include:
Pain medications, including nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, can be effective for managing endometriosis pain. A doctor can also discuss whether you need prescription medications for more severe pain.
Patients who have more advanced endometriosis, pain that does not resolve with other treatments or are trying to conceive may need surgery. Laparoscopy is the most common surgery doctors use to treat endometriosis.
During this procedure, a surgeon makes a few small incisions in your abdomen. In one incision they insert a thin tube with a light and a camera. In the other incisions they insert small tools. These tools can remove endometrial tissue (excision) or use intense heat to destroy the tissues (ablation).
The surgeon can also remove any scar tissue that has built up in the area. Laparoscopic surgeries usually have a shorter recovery time and smaller scars compared with traditional open surgery (laparotomy).
In some cases, a doctor may need to do a laparotomy for endometriosis instead of laparoscopy. That means the doctor will make a larger incision (cut) in the abdomen to remove the endometrial tissue. This is uncommon.
Removing endometrial tissues with laparoscopy or laparotomy can provide short-term pain relief. However, the pain may come back.
A hysterectomy is a surgical procedure to remove the uterus. Doctors may recommend this as an option to treat endometriosis. Your doctor may also recommend removing the ovaries (oophorectomy) with or without a hysterectomy. This will stop the release of hormones and should definitively treat endometriosis, but it will put you into menopause.
Removing the ovaries will significantly lower estrogen levels and slow or stop endometrial tissue growth. But it does come with the risks and side effects of menopause, including hot flashes, bone loss, heart disease, decreased sexual desire, memory problems, and depression or anxiety. For those reasons, the decision to proceed with oophorectomy is one made between the patient and their physician based on case-specific factors and the patient’s personal goals.
After a hysterectomy, you will no longer have a uterus, and you will not be able to become pregnant or carry a pregnancy. If you are interested in having a child, talk with your doctor about other treatment options.
Women who have an oophorectomy (ovary removal) but still have their uterus may be able to get pregnant with IVF. Doctors can harvest eggs from your ovaries before the surgery and preserve those eggs for fertilization and implantation in your uterus later, or an egg donor can be used.
