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Q: I would like information on endometriosis, including cause, symptoms, and treatment options.
A: Endometriosis is a disorder in which tissue resembling the inner lining of the uterus (endometrium) appears at unusual locations in the lower abdomen. This tissue may be found: on the ovary surfaces; behind the uterus, low in the pelvic cavity; on the intestinal wall; and rarely, at other sites far away.
Symptoms of endometriosis include increased pelvic pain during menstrual periods, pain with sexual intercourse, blood in the urine, back pain, pain with intestinal contractions, and sometimes blood in the stool.
The cause of endometriosis is unknown, but the following theory is most accepted among doctors: normally during ovulation, the uterus lining thickens to prepare for implantation of a fertilized egg. If this does not occur, the lining tissue peels away from the uterus and is expelled in the menstrual flow. In some cases, this material builds up and passes backward out of the Fallopian tubes into the pelvic cavity. Here it floats freely and attaches itself to other tissues. The transplanted tissue reacts each month as if it were still in the uterus, thickening and peeling away. New bits of peeled-off tissue create new implants. The growing endometrial tissue between pelvic organs may cause them to adhere together, producing pain and other symptoms. The risk of endometriosis increases among adult women who don't become pregnant, and women who have a family history of endometriosis.
Diagnosis of endometriosis is made by the patient's own observation of symptoms, medical history and exam by a doctor, laboratory blood studies, surgical diagnostic procedures, such as laparoscopy (which consists in the insertion of a tube with fiberoptic capability in the abdominal cavity in order to visualize the inner organs), and X-rays of the lower intestines (barium enema).
Possible complications of endometriosis include sterility from tissue implants that constrict the fallopian tubes, pain, and adhesions of pelvic organs. Without treatment, endometriosis becomes increasingly severe. It subsides after menopause when estrogen production decreases. Symptoms can be relieved with medication, and are sometimes curable with surgery.
Regarding treatment, surgery may be employed to remove implants, or a hysterectomy to remove the uterus, fallopian tubes and ovaries in women who don't want to become pregnant. If children are wanted, pregnancy is to be considered as soon as possible. Delaying pregnancy may cause infertility. Also, sanitary napkins should be used instead of tampons. Tampons may make backward menstrual flow more likely. Furthermore, heat is useful to relieve pain. A heating pad or hot-water bottle on the abdomen or back, or hot baths may be taken to relax muscles and relieve discomfort. Also, non-prescription drugs, such as acetaminophen, may be used to relieve minor pain. In addition, the doctor may prescribe other medicines, such as danazol, gonadotropin-releasing hormones, oral contraceptives or progestogens, in order to suppress ovarian function and improve symptoms.
Updated: 08/29/99
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