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Endometriosis Can Cause Pain and Infertility

Endometriosis, a common gynecological disorder, affects an estimated 5.5 million women in North America, making it one of the leading causes of infertility. It is a condition where tissue similar to the lining of the uterus is found elsewhere in the body.

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What is Endometriosis?

It is a condition where tissue similar to the lining of the uterus is found elsewhere in the body. The two most common symptoms of endometriosis are pelvic pain and infertility. The pain often correlates to the menstrual cycle, but a woman with endometriosis may also experience pain at other times.

For many women, the pain of endometriosis is so severe and debilitating that it impacts their everyday lives and activities in significant ways. Others may not find out they have endometriosis until they try to get pregnant.

Endometriosis may cause scar tissue and adhesions to develop that can distort a woman’s internal anatomy. In advanced stages, internal organs may fuse together, causing a condition known as a "frozen pelvis." Most women do not have the disease to this extent.

What Causes Endometriosis?

The cause of endometriosis is unknown but different hypotheses have been put forward as to its cause. Although, several theories have become accepted, most feel it may be a combination of factors.

- Lymphatic or Vascular Distribution
Endometrial fragments may travel through blood vessels or the lymphatic system to other parts of the body. This may explain how endometriosis ends up in distant sites, such as the lung, brain, skin, or eye.

- Metaplasia
Metaplasia means to change from one normal type of tissue to another normal type of tissue. It has been proposed by some that endometrial tissue has the ability in some cases to replace other types of tissues outside the uterus.

Studies have shown that first-degree relatives of women with this disease are more likely to develop endometriosis. And when there is a hereditary link, the disease tends to be worse in the next generation.

- Retrograde Menstruation Theory
Retrograde menstruation suggests that during menstruation some of the menstrual tissue backs up through the fallopian tubes, implants in the abdomen, and grows. Most women experience some menstrual tissue backup and it is unclear why, but in some women this tissue grows and the women develop endometriosis.

Symptoms of Endometriosis

The most common symptom of endometriosis is pelvic pain. The pain often correlates to the menstrual cycle, however a woman with endometriosis may also experience pain at other times during her monthly cycle.

Pain may be felt:

  • Before/during/after menstruation
  • During ovulation
  • In the bowel during menstruation
  • When passing urine
  • During or after sexual intercourse in the lower back region

Other symptoms may include:

  • Infertility
  • Diarrhea or constipation (in particular in connection with menstruation)
  • Abdominal bloating (again, in connection with menstruation)
  • Heavy or irregular bleeding fatigue
It is estimated that 30-40% of women with endometriosis are infertile.

Treatment Options

Although there is no cure for endometriosis, a variety of treatment options exist. Goals may include: relieving/reducing pain symptoms, shrinking or slowing endometrial growths, preserving or restoring fertility, and preventing/delaying recurrence of the disease.

Pain Medication
Over-the-counter pain relievers may include aspirin and acetaminophen, as well as prostaglandin inhibitors such as ibuprofen and naproxen sodium. In some cases, prescription drugs may be required.

Hormonal Therapy
Hormonal treatment aims to stop ovulation for as long as possible and may include: oral contraceptives, progestational agents, a testosterone derivative or gonadotropin releasing hormone agonist.

Surgery
Surgery is performed to remove or destroy the growths, relieve pain, and may allow pregnancy to occur in some cases. It can involve laparoscopy (outpatient surgery in which the surgeon can operate through two or more tiny abdominal incisions) or a laparotomy, a more extensive procedure, which includes a larger abdominal incision and a longer recovery period. Hormonal therapy may be prescribed along with surgery. In certain cases, a more radical surgery may be necessary which can involve a hysterectomy, removal of all growths, and removal of the ovaries.

Education and research is helpful, but the best form of information about endometriosis is from a well qualified physician. For more information or to make an appointment, please call (314) 286-2400.

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Copyright 2014 Washington University School of Medicine
Copyright 2014 Washington University School of Medicine