Endometriosis

Endometriosis is a condition in which tissue that is normally found in the lining of a girl’s uterus – known as the endometrium – is found growing outside of its normal location. This growth normally occurs in the pelvic area, such as on the ovaries, bowel or lining of the pelvis.

Each month, this displaced tissue goes through the normal menstrual process, thickening and then shedding through bleeding. However, since it has no way to exit the body, it becomes trapped and can irritate the areas around it, causing pain, scarring, infertility and other issues.

There is no cure for endometriosis, but treatment is available to relieve the pain and other symptoms, keep it from getting worse, and preserve fertility.

Patients can be seen by Texas Children's experts in Pediatric and Adolescent Gynecology.

Causes & Risk Factors

The cause is not yet known.

One common theory is that menstrual blood that contains this endometrial tissue gets “backed up,” causing it to flow backwards into the pelvic area instead of out of the body. The blood and tissue sticks to pelvic walls and surfaces outside the uterus.

Some other theories suggest that it is caused by genetics, the body’s immune system, or the endocrine system.

Any girl who has menstrual periods can get endometriosis.

Possible risk factors include:

• One or more relatives (mother, aunt or sister) with endometriosis
• Frequent menstrual cycles
• Periods that last longer than eight days
• Starting menstruation at an early age
• Any medical condition that prevents the normal passage of menstrual flow
• A history of pelvic infection
• Never given birth

Symptoms & Types

Symptoms may include:

• Severe cramps that limit activity
• Unexplained pelvic pain before, during or after the menstrual cycle
• Pain during bowel movements or when urinating
• Heavy periods
• Bleeding between periods
• Lower back pain
• Pain during or after intercourse

Many girls with endometriosis have no symptoms. In some cases, it may not be diagnosed until a girl has difficulty getting pregnant.

Diagnosis & Tests

Diagnosis starts with a detailed medical history and a physical exam, including a pelvic exam.

Additional testing may include:

• A laparoscopy – to view the internal organs and look for signs of endometriosis. A very thin tube with a camera on the end (a laparoscope) is inserted into the abdomen through a small incision.
• A biopsy – a small tissue sample removed during laparoscopy and examined under a microscope
• Blood tests
• Urine tests
• Imaging, such an ultrasound, to rule out other causes
• Pregnancy test and/or testing for sexually transmitted infections

Treatment & Care

Treatment depends on the individual patient and the severity of their symptoms.

Treatment strategies include:

• Observation and pain medications – including over-the-counter nonsteroidal anti-inflammatory drugs and prescription painkillers
• Hormone therapies – including oral contraceptive pills to help control or stop periods
• Surgery – to remove the areas of endometriosis and scar tissue. Surgery may be performed during the laparoscopy, a minimally invasive approach used to diagnose endometriosis
• Lifestyle changes – to relieve the pain including: exercise, diet, yoga and meditation

Living & Managing

Left untreated, severe endometriosis can make it more difficult for a young woman to become pregnant in the future. Early diagnosis and treatment can help preserve fertility.