What Is Endometriosis? What Causes Endometriosis?

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Main Category: Women's Health / Gynecology
Article Date: 07 May 2009 - 4:00 PDT

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The word endometriosis comes from the Greek endon meaning "within" and the Greek metra meaning "uterus", akin to Greek meter meaning "mother". The word osis comes from the Greek and/or Latin suffix meanings "affected with, condition, abnormal process". The Medilexicon medical dictionary says endometriosis is "Ectopic occurrence of endometrial tissue, frequently forming cysts containing altered blood." (ectopic = not in its proper place, not in its proper position).

Endometriosis is a condition in which cells that are normally found inside the uterus (endometrial cells) are found growing outside of the uterus. That is, the lining of the inside of the uterus is found outside of it. Endometrial cells are the cells that shed every month during menstruation, and so endometriosis is most likely to affect women during their childbearing years. The cellular growth is not cancerous, but benign. Though there are not always symptoms, it can be painful and lead to other problems. The lining of the uterus consists of a type of tissue called endometrium - composed of endometrial cells - that thickens each month to prepare for an egg. It is here where an egg cell implants and grows if it is fertilized. If an egg is not fertilized, the endometrium breaks down and exits the body during the menstrual period.

Endometrial cells that grow outside of the uterus - usually on the ovaries, fallopian tubes, outer wall of the uterus, or intestines - are called implants. However, these implants follow the same pattern as the endometrium lining the uterus of getting thicker, breaking down, and bleeding. Problems occur because these growths are outside of the uterus, and the blood cannot flow out of the body. This can lead to the formation of scar tissue and cysts as well as difficulties getting pregnant.

Who is at risk of endometriosis?

It is estimated that endometriosis affects over one million women in the United States, and most cases are diagnosed in women between 25 and 35 years of age. However, because many women have no symptoms, the exact prevalence is unknown. The condition is very rare in postmenopausal women. Other risk factors for endometriosis include being white (compared to African American and Asian), being tall and thin with a low body mass index, being infertile, and delaying pregnancy until older ages.

What causes endometriosis?

We do not know the exact causes of endometriosis, but there are several theories. Researchers do know that the hormone estrogen, which is at its highest levels during childbearing years, is likely to contribute to endometriosis. Other possible causes of endometriosis include:

• Retrograde menstruation - when endometrial tissue is deposited in strange locations because of menstrual flow that backs up into the fallopian tubes and abdominal cavity.


• Ceolomic metaplasia - the areas lining the pelvic organs have certain cells that can grow into other forms of tissue such as endometrial cells.


• Surgery - endometrial tissues are directly transferred outside the uterus during episiotomy or Cesarean section.


• Blood and lymph systems - endometrial cells travel via the bloodstream or lymphatic system to distant places such as the brain and other places far from the pelvis.


• Immune system problems - cause the body to not recognize and destroy cells or tissue that is growing where it should not be.

What are the symptoms of endometriosis?

Although most women with endometriosis do not have symptoms and symptoms vary from woman to woman, the following symptoms have been known to occur:

• Pain in the pelvis, lower belly, rectum, vagina, or lower back. Pain may only occur at certain points in the menstrual cycle, during sex, during bowel movements, during ovulation, or all the time.


• Abnormal bleeding such as heavy periods, spotting or bleeding between periods, bleeding after sex, or blood in the urine or stool.


• Infertility


• Diarrhea and/or constipation

How is endometriosis diagnosed?

In order to diagnose endometriosis, a physician will investigate family medical history, symptoms, menstruation activities, and the patient's current state of health. It is also common for doctors to conduct a pelvic exam, which may include an analysis of the vagina and rectum (rectovaginal exam). One diagnostic strategy is to prescribe treatment for endometriosis and see what happens; an improvement after medication usually indicates that the problem was endometriosis.

Imaging tests, such as ultrasounds, magnetic resonance image (MRI) tests, and CT scans also may be employed to look for ovarian cysts. However, the only way to be sure that a patient has endometriosis is through laparoscopy - a thin, lighted tube with a camera on one end that is surgically inserted into the abdomen to look for implants, scar tissue, or cysts. If laparoscopy is unavailable, it may be necessary to conduct a larger-incision laparotomy. Either of these surgical methods can also provide tissue samples with which to conduct biopsies, which are also important for ruling out diseases such as ovarian cancer.

How is endometriosis treated?

Although there is no cure for endometriosis, there are some good treatments. Treatment options depend on the goal of the patient and can differ if the woman wants to get pregnant or is focused on treating pain. The two most common general classes of treatment are medicines and surgery.

Medicine treatments for endometriosis are summarized below:

• Pain medicines (NSAIDs or anti-inflammatory drugs) such as ibuprofen or naproxen sodium are designed to reduce bleeding and pain associated with menstrual cramping and the pelvis.


• Birth control pills can reduce pain and shrink implants, but cannot be used by women wishing to become pregnant.


• Hormone therapy (such as gonadotropin-releasing hormone analogs, danazol, and progestins) often stops menstruation and shrinks implants, but it can cause effects, provide only temporary pain relief, and will prevent a woman from becoming pregnant.


• Aromatase inhibitors interfere with local estrogen formation within the endometriosis implants themselves.

Surgery for endometriosis is usually not recommended for women who are approaching menopause because endometriosis problems tend to cease after one stops having periods. However, sometimes surgery is a viable option, especially if the endometriosis is not responding to medicine treatment or there is obstruction of urinary or bowel organs.

Surgical treatments are summarized below.

• Laparoscopy removes implants and scar tissue, reducing pain and often aiding fertility.
• Laparotomy is recommended for extensive disease with distorted anatomy.
• Hysterectomy (removal of uterus) is a last resort for severe pain.
• Oophorectomy (removal of ovaries) is also a last resort for severe pain.

Surgical treatments have been very effective in reducing pain, but the endometriosis recurrence rate is thought to be as high as 40%.

How can endometriosis be prevented?

There are no known methods for preventing endometriosis, and it is not a disease that can be contracted or caused by anyone or anything known to the patient.

Video: Understanding Endometriosis - Illumistream Health

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Links to endometriosis articles

• Endometriosis Doubles Risk Of Premature Birth
• Endometriosis risk reduced if you eat more fruit and green vegetables
• Pine Bark Significantly Reduces Endometriosis, New Study Finds
• Scientists Identify Possible Cause Of Endometriosis
• Uncontrollable Stress Worsens Symptoms Of Endometriosis

Written by Peter Crosta M.A.
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today