Causes of Endometriosis
There is no known cause of endometriosis. A common proposed mechanism is retrograde menstruation, in which there is a backflow of menstrual fluid containing endometrial cells into the abdominal cavity. However, the majority of women experience retrograde menstruation, and most do not develop endometriosis.
Risk factors for endometriosis include early age at menarche or the start of menstruation, shorter duration of menstrual cycle, heavy menstrual bleeding, and nulliparity.
Symptoms of Endometriosis
Approximately ¼ of individuals with endometriosis are asymptomatic. The symptoms of endometriosis may vary depending on the structures involved. Pain related to endometriosis may be chronic, cyclic, and/or progressive over time. Symptoms may include:
- Chronic pelvic pain
- Dysmenorrhea: pain with menstruation
- Dyspareunia: pain with sexual intercourse
- Abnormal uterine bleeding
- Impaired fertility
- Abdominal pain
- Bloating
- Abnormalities in bowel function: diarrhea, constipation, dyschezia
- Rectal bleeding
- Urinary abnormalities: pain with urination, urinary incontinence
- Hematuria: blood in the urine
Impact of Endometriosis
Endometriosis can cause debilitating symptoms and can negatively affect quality of life. Chronic pelvic pain and other symptoms of endometriosis, such as bowel or bladder dysfunction, can be physically, emotionally, and socially burdensome. Infertility or reduced fertility can have wide ranging impacts on the affected individual, as well as their family and loved ones. Research has shown that individuals with endometriosis have higher rates of depression and anxiety. Consult with your physician if you’re experiencing debilitating symptoms and/or changes in mood and energy levels.
Diagnosis of Endometriosis
Diagnosing endometriosis typically involves:
Medical History: Discussion of symptoms, past medical conditions, and menstrual and reproductive history.
Physical Examination: Examination of the abdomen and pelvis.
Diagnostic Imaging: Abdominal or transvaginal ultrasound may be able to detect endometriosis lesions and masses. CT and MRI are generally not utilized in the evaluation of endometriosis.
Laparoscopy: Minimally invasive surgical procedure to examine the structures in the abdomen and pelvis. Laparoscopy is required for the definitive diagnosis of endometriosis.
Treatment of Endometriosis
Endometriosis is a chronic condition, and treatment typically focuses on improvement of symptoms, rather than complete cure of endometriosis. Treatment options include:
Conservative Treatments: Non-surgical approaches include:
Pain Relieving Medications: Such as nonsteroidal anti-inflammatory drugs (NSAIDs) for pain management.
Hormonal Contraceptives: Oral contraception, intrauterine devices (IUDs), or other forms of hormonal birth control can help to regulate hormonal levels and reduce pain associated with endometriosis.
Additional Hormonal Therapies: Synthetic androgens, such as danazol, or GnRH agonists, such as buserelin or goserelin, may be used.
Pain Medicine Intervention: When conservative measures are ineffective or symptoms worsen, more invasive pain interventions may be considered:
Nerve Blocks: Targeted injections of local anesthetic near affected nerves to reduce pain.
Peripheral Nerve Stimulation: Electrodes are placed near affected peripheral nerves to interrupt pain signals to the brain.
Surgical Intervention: When conservative measures are ineffective or symptoms worsen, surgery may be considered:
Laparoscopy: Minimally invasive surgery in which endometriosis lesions are removed. This treatment option may improve fertility and symptoms caused by bowel or bladder endometriosis implants.
Hysterectomy: Removal of the uterus may be a treatment option in individuals with persistent symptoms despite treatment and in individuals who no longer desire future pregnancy. Hysterectomy may be accompanied by removal of the ovaries and fallopian tubes (salpingo-oophorectomy).
Superior Hypogastric Nerve Block
Lumbar Sympathetic Nerve Block
Peripheral Nerve Stimulation
Obturator Internus Nerve Block
Prognosis of Endometriosis
Approximately ⅓ of endometriosis lesions can spontaneously regress without treatment. However, endometriosis is generally thought of as a chronic condition, and recurrence rates are high, even after surgical intervention. Complications can include chronic pain, infertility or reduced fertility, and bowel dysfunction. Endometriosis is also associated with a slightly elevated risk of ovarian cancer. Symptoms typically resolve or become milder following menopause.
References
Endometriosis: What it Is and How it Can Affect Your Fertility. Berry Fertility. https://www.berryfertility.com/articles/endometriosis-what-it-is-and-how-it-can-affect-your-fertility. Accessed December 6, 2024
Endometriosis. Yale Medicine. Published March 11, 2024. https://www.yalemedicine.org/conditions/endometriosis. Accessed December 6, 2024
Tsamantioti ES, Mahdy H. Endometriosis. In: StatPearls. StatPearls Publishing; 2024.
