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Endometriosis

Endometriosis is a disorder in which tissue (endometrial cells) that normally lines the inside of the uterus grows outside of the uterus. Endometriosis most commonly involves your ovaries, fallopian tubes and the tissue lining your pelvis. Rarely, endometrial tissue may spread beyond the pelvic organs.

With endometriosis, displaced endometrial tissue continues to respond to the hormones of the menstrual cycle--it thickens, breaks down and bleeds with each menstrual cycle. Surrounding tissue can become irritated, eventually developing scar tissue and adhesions — abnormal bands of fibrous tissue that can cause pelvic tissues and organs to stick to each other. When endometriosis involves the ovaries, cysts called endometriomas may form.

Common signs and symptoms of endometriosis may include:

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  • Painful periods (dysmenorrhea). Pelvic pain and cramping may begin before your period and extend several days into your period. You may also have lower back and abdominal pain.
  • Pain with intercourse. Pain during or after sex is common with endometriosis.
  • Pain with bowel movements or urination. You're most likely to experience these symptoms during your period.
  • Excessive bleeding. You may experience occasional heavy periods (menorrhagia) or bleeding between periods (menometrorrhagia).
  • Infertility. Endometriosis is first diagnosed in some women who are seeking treatment for infertility.
  • Other symptoms. You may also experience fatigue, diarrhea, constipation, bloating or nausea, especially during menstrual periods.

The severity of the pain is not necessarily a reliable indicator of the extent of the condition. Some women with mild endometriosis have intense pain, while others with advanced endometriosis may have little pain or even no pain.

Although the exact cause of endometriosis is not certain, possible explanations include:

  • 1 Retrograde menstruation. The most popular theory involves the flow of menstrual blood (containing endometrial cells) back through the fallopian tubes and into the pelvic cavity instead of out through the cervix. These displaced endometrial cells stick to the pelvic walls and surfaces of pelvic organs, where they grow and continue to thicken and bleed over the course of each menstrual cycle.
  • 2 Endometrial cells transport. The blood vessels or tissue fluid (lymphatic) system may transport endometrial cells to other parts of the body.
  • 3 Immune system disorder. Women with the disease may have a defect within their immune system which makes the body unable to recognize and destroy endometrial tissue that grow outside the uterus.

Endometriosis usually develops several years after the onset of menstruation (menarche). Signs and symptoms of endometriosis end temporarily with pregnancy and end permanently with menopause, unless you're taking estrogen. The main complication of endometriosis is impaired fertility. Approximately one-third to one-half of women with endometriosis have some difficulty getting pregnant.


Endometriosis can affect the ability of the fallopian tube to function normally. By mechanically obstructing the ability of the tube to capture the egg, endometriosis may contribute to the inability to conceive. Thus, even if ovulation does occur, the egg may not get into the fallopian tube. The condition also seems to affect fertility in less-direct ways, such as damage to the sperm or egg, possibly through inflammatory mediators such as prostaglandins.

The only way to definitively diagnose endometriosis is by visualizing it, most commonly done by laparoscopy surgery. A fertility specialist or OB/Gyn performing laparoscopy can evaluate if endometriosis is present and if any adhesions or scarring have formed. Surgical removal of ovarian endometriomas can be done at that time. Patients with mild to moderate disease can have increased pregnancy rates after laparoscopic surgery. Patients with severe disease should consider proceeding directly to IVF.

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