Endometriosis is a disease in which tissue that normally grows inside the uterus grows outside it. The main symptoms are pelvic pain and infertility. Nearly half of those affected have chronic pelvic pain, while in 70% pain occurs during menstruation. Pain with sex is also common. Infertility occurs in up to half of women affected. Less common symptoms include urinary or bowel symptoms. About 25% of women have no symptoms. Endometriosis can have both social and psychological effects. The cause is not entirely clear. Risk factors include having a family history of the condition. Most often the ovaries, fallopian tubes, and tissue around the uterus and ovaries are affected; however, in rare cases it may also occur in other parts of the body. The areas of endometriosis bleed each month which results in inflammation and scarring. The growths due to endometriosis are not cancer. Diagnosis is usually based on symptom in combination with medical imaging. Biopsy is the most sure method of diagnosis. Other causes of similar symptoms include irritable bowel syndrome, interstitial cystitis, and fibromyalgia.
A major symptom of endometriosis is pain, mostly in the lower abdomen, lower back, and pelvic area. The amount of pain a woman feels is not necessarily related to the extent or stage (1 through 4) of endometriosis. Some women will have little or no pain despite having extensive endometriosis affecting large areas or endometriosis with scarring. On the other hand, women may have severe pain even though they have only a few small areas of endometriosis. The common signs and symptoms are: Pelvic pain, Infertility, Other. Symptoms of endometriosis-related to pelvic pain may include: • dysmenorrhea – painful, sometimes disabling cramps during the menstrual period; pain may get worse over time (progressive pain), also lower back pains linked to the pelvis • chronic pelvic pain – typically accompanied by lower back pain or abdominal pain • dyspareunia – painful sex • dysuria – urinary urgency, frequency, and sometimes painful voiding Throbbing, gnawing, and dragging pain to the legs are reported more commonly by women with endometriosis. Compared with women with superficial endometriosis, those with deep disease appear to be more likely to report shooting rectal pain and a sense of their insides being pulled down. Individual pain areas and pain intensity appears to be unrelated to the surgical diagnosis, and the area of pain unrelated to area of endometriosis. Endometriosis lesions react to hormonal stimulation and may "bleed" at the time of menstruation. The blood accumulates locally, causes swelling, and triggers inflammatory responses with the activation of cytokines. This process may cause pain. Pain can also occur from adhesions (internal scar tissue) binding internal organs to each other, causing organ dislocation. Fallopian tubes, ovaries, the uterus, the bowels, and the bladder can be bound together in ways that are painful on a daily basis, not just during menstrual periods. Also, endometriotic lesions can develop their own nerve supply, thereby creating a direct and two-way interaction between lesions and the central nervous system, potentially producing a variety of individual differences in pain that can, in some women, become independent of the disease itself. Nerve fibres and blood vessels are thought to grow into endometriosis lesions by a process known as Neuro angiogenesis. Symptoms of endometriosis can include: Painful, sometimes disabling menstrual cramps, pain may get worse over time, Chronic pain, Painful intercourse, Painful bowel movements or painful urination, Heavy menstrual periods, Nausea and vomiting, Premenstrual or inter menstrual spotting, Infertility and subfertility. Endometriosis may lead to fallopian tube obstruction. There may be difficulty in conceiving. In some women, subfertility is the major symptom and endometriosis is the only discovered disease after fertility investigations. Women who got diagnosed with endometriosis may have gastrointestinal symptoms that may be similar to irritable bowel syndrome and fatigue. Patients who rupture an endometriotic cyst may present with an acute abdomen as a medical emergency. Endometriotic cysts in the thoracic cavity may cause some form of thoracic endometriosis syndrome, most often catamenial pneumothorax.
Endometriosis is estimated to occur in roughly 6–10% of women. It is most common in those in their thirties and forties. It results in few deaths with this being estimated at 200 globally in 2013. Endometriosis was first determined to be a separate condition in the 1920s. Before that time endometriosis and adenomyosis were considered together. It is unclear who first described the disease. Endometriosis can affect any female, from premenarche to postmenopause, regardless of race or ethnicity or whether or not they have had children. It is primarily a disease of the reproductive years. The number of women affected is between 6–10%. It is more common in women with infertility and chronic pelvic pain (35–50%). Incidences of endometriosis have occurred in postmenopausal women, and in less common cases, girls may have endometriosis symptoms before they even reach menarche. Tentative evidence suggests that the use of combined oral contraceptives reduces the risk of endometriosis. Exercise and avoiding large amount of alcohol may also be preventative. There is no cure for endometriosis, but a number of treatments may improve symptoms. This may include pain medication, hormonal treatments, or surgery. The recommended pain medication is usually an NSAID such as naproxen. Taking the active component of the birth control pill continuously or an intrauterine device with progestogen may also be useful. Gonadotropin-releasing hormone agonist may improve the ability of those who are infertile to get pregnant. Surgical removal of endometriosis may be done in those whose symptoms are not manageable with other treatment. While there is no cure for endometriosis, there are two types of interventions; treatment of pain and treatment of endometriosis-associated infertility. In many women menopause (natural or surgical) will abate the process. In women in the reproductive years, endometriosis is merely managed: the goal is to provide pain relief, to restrict progression of the process, and to restore or preserve fertility where needed. In younger women with unfulfilled reproductive potential, surgical treatment attempts to remove endometrial tissue and preserve the ovaries without damaging normal tissue. In general, the diagnosis of endometriosis is confirmed during surgery, at which time ablative steps can be taken. Further steps depend on circumstances: a woman without infertility can be managed with hormonal medication that suppress the natural cycle and pain medication, while an infertile woman may be treated expectantly after surgery, with fertility medication, or with IVF. As to the surgical procedure, ablation (or fulguration) of endometriosis (burning and vaporizing the lesions with an electric device) has shown high rate of short-term recurrence after the procedure. The best surgical procedure with much less rate of short-term recurrence is to excise (cut and remove) the lesions completely. The other advanced treatment methods are: Surgery, Hormonal Therapy, Other medication, Comparison of interventions, Treatment of infertility.