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Categories > Pelvic Pain and Disorders > Endometriosis

Putting an end to endometriosis pain
Signs of trouble
Pain management

Gauging your risk
Gauging your risk

Doctors don’t know what causes endometriosis, but some believe an immune system disorder is partly to blame. That’s because the body fails to recognize and remove “rogue” endometrial cells outside the uterus.

Endometriosis isn’t preventable, but your risk of developing it is less if you’re slightly underweight, have had multiple pregnancies and exercise regularly. On the flip side, your risk increases if you have a normally heavy menstrual flow and a cycle of 27 days or less.

There’s also evidence that the disorder is genetic—if your mother, sister or daughter has the condition, your risk is above average.

One in ten premenopausal women has endometriosis, a baffling and sometimes agonizing disorder of the reproductive system.

In endometriosis, tissue that normally lines the endometrium, or uterus, begins growing where it shouldn’t—usually on the ovaries, the fallopian tubes, the outside wall of the uterus or the connective tissue of the abdomen.

Trouble is, these patches of tissue keep responding to the patient’s menstrual cycle by thickening, then breaking down and shedding blood and dead cells each month. Unable to leave the body, the discarded cells pool inside the abdominal cavity, irritating nearby tissue. Sometimes, these cells produce cysts on the ovaries and can cause scar tissue to form around tubes and ovaries.

Worse, endometriosis leads to infertility if a woman’s egg can’t pass through the tissue growth to reach her fallopian tube.

Signs of trouble

Women with endometriosis commonly report symptoms such as:

  • heavy bleeding and severe discomfort
  • spotting between periods
  • back, pelvic or abdominal pain just before or after periods
  • painful intercourse
  • painful changes in bowel and bladder habits

Sometimes, however, the disease progresses silently. Doctors diagnose endometriosis by giving patients a pelvic exam, including an ultrasound of their reproductive system to find suspicious growths.

Unfortunately, no blood test yet exists that can screen for endometriosis. The only way to confirm a diagnosis is with exploratory surgery using a laparoscope—a tiny, flexible TV camera that allows doctors to see tissue patches so they can be treated.

Pain management

Once diagnosed, most women find welcome relief with therapies that make symptoms more bearable, such as:

  • GnRH agonists. A first-line treatment, oral or injected gonadotropin releasing hormone (GnRH) agonists temporarily cause female hormone levels to drop, which interrupts the menstrual cycle and relieves pain.
  • NSAIDs. Short for nonsteroidal anti-inflammatory agents (aspirin, naproxen and ibuprofen), they relieve pain from swelling.
  • Surgery. Laparoscopy lets surgeons use heat, lasers or a surgical knife to remove small tissue clumps. A laparotomy is a larger operation to remove tissue throughout the abdomen. As a last resort, surgeons sometimes perform a hysterectomy to remove the uterus, fallopian tubes and ovaries.
  • Lifestyle changes. Exercising, getting enough sleep and eating well helps the body fight pain; a heating pad or a hot bath can relieve discomfort.

And though it’s no cure, many women say their discomfort vanished as soon as they became pregnant and was less painful once menstruation resumed.