Endometriosis

What is Endometriosis?

The inside of a woman’s uterus is lined by tissue known as the endometrium. Each month, this tissue is shed during the menstrual period. The term “endometriosis” refers to the abnormal growth of endometrial tissue outside of the uterus. This “misplaced” endometrial tissue is most commonly found in the ovaries, on the fallopian tubes, and around the ligaments that support the uterus. Uncommonly, it can be found in or around the intestines, bladder, vagina, or even the rectum.

Endometriosis in African American women

Endometriosis affects approximately 10% of women of reproductive age, and there does not appear to be a strong racial prevalence. Characteristics of women with endometriosis include women who have never been pregnant, infertile women, women with regular menstrual cycles less than 27 days in length, and those with prolonged menstrual bleeding of 8 or more days.

What are the signs and symptoms of Endometriosis?

* Pelvic pain

* Excessive menstrual cramps: This pain usually begins prior to a woman’s period and may be felt in the abdomen or lower back.

* Pain during or after intercourse: It is typically worse around the time of the period.

* Low back pain.

The symptoms of endometriosis vary; some women have severe pelvic pain, whereas others have no symptoms at all. There is poor correlation between the degree of pain and extent of the disease; that is, some patients with severe disease may have no pain, whereas some patients with mild disease may have excruciating pain.
Complications of Endometriosis

In addition to pelvic pain, the scar tissue that develops from endometriosis may form on the fallopian tube and/or on the ovary, blocking the release of the egg and its passage through the tube toward the uterus. This, in turn, will inhibit a woman’s ability to conceive, causing infertility.

How can you be evaluated for endometriosis?
Diagnosis is based on evaluation of your history, and a complete physical exam, including a pelvic exam. However, diagnosis can only be proven by laparoscopy. Laparoscopy is a surgical procedure in which a laparoscope (camera) is inserted into the abdominal cavity through a small incision. The laparoscope will allow the physician to identify the location, and extent of the endometriosis. This method also allows the physician to rule out other conditions with similar symptoms.

Treatment Options

Principles of management for women with symptoms of endometriosis include:

1. Recognizing that it is a chronic disorder.

2. Discussing treatment options with your doctor.

3. Planning long term therapy based on your age, presenting symptoms, severity of disease, and desire to have kids.

Medical Management

When mild to moderate pain is the principal symptom, medical therapy is recommended in most cases. Management is directed at suppressing a woman’s level of estrogen, the hormone which stimulates the endometrial growths. Examples of medications which help to decrease levels of estrongen in the body include:

1. Low dose birth control pills.

2. Progestins such as provera.

3. Danazol (a weak androgen that produces a low estrogen environment).

4. Depo-Lupron (a medication which inhibits ovarian production of estrogen).

Surgical Management

Surgical treatment falls into two categories: conservative and non-conservative management.

Conservative surgical treatment is designed to preserve the ability of a woman to become pregnant and bear children in the future. This involves removing selected areas of endometriotic tissue, commonly through a laproscope (a camera placed through small incisions in the abdomen).

Nonconservative surgical treatment is undertaken to relieve a woman of severe pain after all other options have failed. This can include removing the uterus and both ovaries; or removal of both ovaries and fallopian tubes. In either case, a woman must accept the fact that she will not be able to have children in the future. This definitive surgery offers the best chance for sustained relief.

Empowerment Points


1. Endometriosis is the growth of endometrial tissue outside of the uterus.

2. Endometriosis affects many women regardless of race or economic status.

3. Symptoms include chronic pelvic pain, pain during sexual intercourse, and pain associated with monthly periods.

4. There are many different treatment options and you should not opt to suffer in pain.

5. Medical therapy is usually initiated as a first line of therapy and may include birth control pills, or other hormonal treatments.

6. Surgical therapy is reserved for women with moderate to severe symptoms or in women who have failed medical therapy.

7. Optimal treatment can be achieved with an open, honest discussion with you health care provider.