Endometriosis

Experts don't know what causes endometriosis. But they do know that the hormone estrogen makes the problem worse.

Here are some possible causes.

• Your immune system may not get rid of endometrial cells outside of the uterus like it should.
• Abnormal structure of the uterus, cervix, or vagina may cause too many endometrial cells to go up through the fallopian tubes and then into the belly. (This is called retrograde menstruation).
• Blood or lymph fluid may carry endometrial cells to other parts of the body. Or the cells may be moved during a surgery, such as a cesarean delivery.
• Cells in the belly and pelvis may change into endometrial cells.
• Endometrial cells may have formed outside your uterus before you were born.
• Genetics. Endometriosis can run in families.

Sometimes endometriosis does not cause symptoms. But when symptoms are present, they can range from mild to severe. Symptoms may include:

• Pain. You may have:
  • Pelvic pain.
  • Severe menstrual cramps.
  • Low backache.
  • Pain during sexual intercourse.
  • Rectal pain.
  • Pain during bowel movements.
• Trouble getting pregnant (infertility). This may be the only sign that you have endometriosis.
• Abnormal bleeding. This may include:
  • Heavy periods or bleeding between periods.
  • Vaginal bleeding after sex.
  • Blood in the urine or stool.

Symptoms are often most severe just before and during your menstrual period. They may get better as your period is ending. But sometimes pain occurs all the time.

To find out if you have endometriosis, your doctor will ask questions about your symptoms, periods, past health, and family history. (It sometimes runs in families.) You may also have a pelvic exam. And you may have imaging tests, such as a pelvic ultrasound or MRI, to look at the organs in your belly.

Your exam, symptoms, and risk factors may strongly suggest that you have endometriosis. But the only way to be sure that you have it is to have surgery. Laparoscopy is often the surgery used. During this surgery, the doctor puts a thin, lighted tube through a small cut in your belly. This lets the doctor see what's inside your belly.

Treatment depends on how much pain you have and whether you want to get pregnant. Treatments include:

• Over-the-counter pain medicines like ibuprofen (such as Advil or Motrin) or naproxen (such as Aleve). These can reduce bleeding and pain.
• Hormone therapy. This can help reduce pain and menstrual bleeding. It can include hormonal birth control and other medicines.
• Laparoscopy to remove growths and scar tissue. This may reduce pain, and it may help you get pregnant.

A hysterectomy and oophorectomy (removal of the uterus and ovaries) are sometimes used as a last resort for severe pain.

If you're close to menopause, you may consider treatment with medicines rather than surgery. Endometriosis usually stops causing problems when you stop having periods.

Endometriosis cannot be prevented. This is in part because the cause is poorly understood. But long-term use of birth control hormones (patch, pills, or ring) may prevent endometriosis from becoming worse.