Endometriosis

Endometriosis is a condition in which tissue that forms the lining of the uterus grows in places outside the uterus. This tissue can grow in the organs that create the eggs (ovaries), in the tubes that carry the eggs to the uterus (fallopian tubes), in the vagina, and in the bowel. This tissue most often grows on the ovaries and inner lining of the pelvic cavity (peritoneum).

What are the causes?

The cause of this condition is not known.

What increases the risk?

• Having a family history of endometriosis.
• Having never given birth.
• Starting your menstrual period at age 10 or younger.

What are the signs or symptoms?

• Heavier bleeding during menstrual periods.
• Menstrual periods that happen more than once a month.
• Not being able to get pregnant.
• Pain in the area between your hip bones (pelvis).
• Pain during sex.
• Pain in the back or abdomen.
• Painful bowel movements and urination during menstrual periods. Rarely, you may see blood in your stool or urine.

• They may happen during your menstrual period (most often) or at the middle of your cycle.
• They may come and go. You may have no symptoms during some months.
• They may stop when you no longer have your monthly periods (menopause).

How is this diagnosed?

• Blood tests and urine tests to help rule out other causes.
• Ultrasound to look for tissues that are not normal. This is often done over your skin (transabdominal). It is sometimes done through the vagina (transvaginal).
• X-ray of the lower bowel (barium enema).
• CT scan.
• MRI.

To confirm the diagnosis, your health care provider may use a device with a small camera to check tissue inside your abdomen (laparoscopy). Abnormal tissue may be removed and checked in a lab (biopsy).

How is this treated?

• Medicines. These may include:
  • Medicines to relieve pain, including NSAIDs, such as ibuprofen.
  • Hormone therapy, such as birth control pills, to slow the growth of abnormal tissue.
• Surgery to remove the abnormal tissue. During surgery, the following may happen:
  • Tissue may be removed using a laparoscope and a laser (laparoscopic laser treatment).
  • The ovaries, fallopian tubes, and uterus may be removed (hysterectomy). This is done in very severe cases.

Follow these instructions at home:

Medicines

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Ask your health care provider if the medicine prescribed to you:
  • Requires you to avoid driving or using machinery.
  • Can cause constipation. You may need to take these actions to prevent or treat constipation:
    • Drink enough fluid to keep your urine pale yellow.
    • Take over-the-counter or prescription medicines.
    • Eat foods that are high in fiber, such as beans, whole grains, and fresh fruits and vegetables.
    • Limit foods that are high in fat and processed sugars, such as fried or sweet foods.

Eating and drinking

• If you drink alcohol:
  • Limit how much you have to 0–1 drink a day for women who are not pregnant.
  • Know how much alcohol is in your drink. In the U.S., one drink equals one 12 oz bottle of beer (355 mL), one 5 oz glass of wine (148 mL), or one 1½ oz glass of hard liquor (44 mL).
• Avoid caffeine.

Activity

• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Do exercises as told by your health care provider.

General instructions

• Do not use any products that contain nicotine or tobacco. These products include cigarettes, chewing tobacco, and vaping devices, such as e-cigarettes. If you need help quitting, ask your health care provider.
• Keep all follow-up visits. This is important.

Where to find more information

• American College of Obstetricians and Gynecologists: www.acog.org
• Office on Women's Health: www.womenshealth.gov

Contact a health care provider if:

• You have new pain or trouble controlling pain.
• You have problems getting pregnant.
• You have a fever.

Get help right away if:

• You have severe pain that does not get better with medicine.
• You have severe nausea and vomiting, or you cannot eat or drink without vomiting.
• You have pain in your abdomen only on the lower right side.
• Pain in your abdomen gets worse.
• You have swelling in your abdomen.
• You have blood in your stool.

Summary

• Endometriosis is a condition that happens when tissue that forms the lining of the uterus grows in places outside the uterus.
• The cause of this condition is not known.
• This condition may be treated with medicines to relieve pain, hormone therapy, or surgery.
• If you have this condition, get regular exercise, limit alcohol use, and avoid caffeine.
• Get help right away if you have severe pain that does not get better with medicine, severe nausea and vomiting, pain or swelling in your abdomen, or blood in your stool.