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Endometriosis

UW Health obstetricians and gynecologists provide a broad range of medical and surgical services to diagnose and treat endometriosis.
 
Endometriosis happens when tissue that normally lines the inside of a woman's uterus (endometrium) grows elsewhere in the body.
 
Each month a woman's ovaries produce hormones that stimulate the cells of the uterine lining (endometrium) to multiply and prepare for a fertilized egg. If these cells, called endometrial cells, implant and grow outside the uterus, endometriosis results.
 
Unlike cells normally found in the uterus that fall off during menstruation, the ones outside the uterus stay in place.
 
This ongoing process leads to symptoms of endometriosis and can cause scarring and adhesions of the tubes, ovaries, and surrounding structures in the pelvis. The exact cause of endometriosis is unknown.
 
Symptoms of Endometriosis
 
Endometriosis is a benign (non-cancerous) condition, but still can cause many problems, including:

  • Painful periods 
  • Pain in the lower abdomen or pelvic cramps that can by felt for a week or two before menstruation 
  • Pain in the lower abdomen felt during menstruation (the pain and cramps may be steady and dull or quite severe) 
  • Pain during or following sexual intercourse 
  • Pain with bowel movements 
  • Pelvic or low back pain that may occur at any time during the menstrual cycle 
  • Premenstrual spotting 
  • Problems getting pregnant (infertility)

Symptoms of endometriosis vary from woman to woman. Some women with severe cases of endometriosis have no pain at all, while some women with mild endometriosis have severe pain. And yet other women may first find out that they have endometriosis when they are not able to get pregnant.
 
Risk Factors for Endometriosis
 
Endometriosis is a common problem. Although endometriosis is typically diagnosed between the ages of 25 and 35, the condition often begins several years before a diagnosis is made. Possible risk factors for endometriosis include:

  • Mother or sister with endometriosis
  • Starting menstruation at an early age
  • Frequent menstrual cycles
  • Periods lasting seven or more days

Diagnosis
 

The optimal way to diagnose endometriosis is by direct visualization of the implant(s). Laparoscopy is the preferred technique for diagnosis since endometriosis is located primarily on the pelvic organs.

 

Imaging studies are rarely helpful for diagnosis or determining extent of disease because they lack adequate resolution for visualizing adhesions and superficial peritoneal/ovarian implants. Ultrasound is useful in diagnosis of an endometrioma, and may be helpful in diagnosis of rectovaginal or bladder disease.

Treatments

Once physicians are able to diagnose the extent of the endometriosis they can determine the best course of treatment.

There are medical and surgical treatments for endometriosis. Medical options include NSAIDs and hormones such as oral contraceptive pills. Surgical treatment includes removal of endometrial implants and sometimes removal of the uterus.