Endometriosis: Understanding the Condition
Endometriosis is a common condition that affects women during their reproductive years. It occurs when tissue similar to the uterine lining (endometrium) attaches itself to the uterus, ovaries, fallopian tubes, or even the bladder and intestines and begins to grow. This tissue can cause irritation, leading to pain adhesions (scar tissue), and potentially infertility.
What are the Symptoms of Endometriosis?
Endometriosis presents a range of symptoms that can vary in intensity. Common symptoms of Endometriosis include:
- Pelvic Pain: Often associated with menstrual periods, this pain can begin before menstruation and extend several days into the period. It may also include lower back and abdominal pain.
- Pain with Intercourse (dyspareunia): Experiencing pain during or after sex is common for those with endometriosis.
- Pain with Bowel Movements or Urination: These symptoms are typically noticed during menstrual periods.
- Excessive Bleeding: Heavy menstrual periods (menorrhagia) or abnormal uterine bleeding between periods can occur.
- Infertility: Endometriosis can make it difficult to become pregnant. In fact, 30% to 50% of infertile women have endometriosis.
- Other Symptoms: Fatigue, diarrhea, constipation, bloating, and nausea, especially during menstrual periods.
Sometimes, endometriosis can develop inside the ovary and form a cyst (endometrioma). Unlike other endometriotic tissue, this can usually be seen on ultrasound. The only way to tell for certain if you have endometriosis is through a surgical procedure called laparoscopy.
The severity of symptoms can vary widely; some women experience mild symptoms, while others may have moderate to severe symptoms. Some women may not experience any symptoms at all.
How is Endometriosis Diagnosed?
If you suspect you have endometriosis, start by noting your symptoms and discussing them with your doctor during your first appointment. During this visit, your healthcare team will take a detailed medical history and perform a pelvic examination. Your doctor may check for tenderness, scarring, or nodules that suggest endometriosis during the vaginal and rectal exam.
Further testing may include:
- Ultrasound: To look for ovarian cysts or endometriomas.
- Hysterosalpingogram: An X-ray dye test to evaluate if your fallopian tubes are blocked.
The only definitive way to diagnose endometriosis is through a surgical procedure called Laparoscopy.
Laparoscopy is a “minimally invasive” surgery that involves making small incisions around your belly button and lower abdomen. A thin, telescope-like instrument called a laparoscope is inserted through one incision, allowing the doctor to inspect for endometriosis with a small camera.
If endometriosis is found, your doctor may remove any endometrial implants or scar tissue using scissors, electrosurgical, or laser instruments. These tools are inserted through additional small incisions to remove the tissue and adhesions. Typically, you can go home the same day as your surgery and return to your usual activities shortly after. The risk of complications is very low.
During surgery, your doctor may assess the extent, location, and depth of your endometriosis and assign you a “score” to classify the condition as minimal (Stage 1), mild (Stage 2), moderate (Stage 3), or severe (Stage 4).
For more advanced stages (3 or 4), surgery can help restore normal pelvic anatomy, enhancing the function of the ovaries and fallopian tubes. Removing large endometriomas can also improve fertility rates.
For more information and support, explore our resources:- Laparoscopy and Hysteroscopy Patient Education Booklet
- Minimally Invasive Surgery Patient Fact Sheet
- Robotic Surgery Patient Fact Sheet
Understanding the diagnosis process for endometriosis can bring clarity and comfort. Remember, you are not alone, and there are effective ways to manage this condition.
How Does Endometriosis Impact My Fertility?
Endometriosis can influence fertility in several ways: distorted anatomy of the pelvis, damaged ovaries, adhesions (scar tissue), scarred or blocked fallopian tubes, inflammation of the pelvic structures, altered immune system functioning, changes in the hormonal environment of the eggs, impaired implantation of a pregnancy, and altered egg quality.
View the Endometriosis Video (14 minutes)
Read the Fact Sheet - Endometriosis and Infertility
How is Endometriosis Treated?
The treatment for endometriosis depends on the severity of the symptoms and whether the woman desires future fertility. Common treatments include:
Medications
- Pain Relief: Over-the-counter pain relievers, such as ibuprofen (Advil, Motrin IB) or naproxen sodium (Aleve), can help reduce menstrual cramps.
- Hormone Therapy: Hormonal treatments can help reduce or eliminate the pain of endometriosis. These treatments include:
- Hormonal Contraceptives: Birth control pills, patches, and vaginal rings help control the hormones responsible for the buildup of endometrial tissue each month.
- Gonadotropin-Releasing Hormone (Gn-RH) Agonists and Antagonists: These drugs block the production of ovarian-stimulating hormones, lowering estrogen levels and preventing menstruation.
- Progestin Therapy: Progestin-only contraceptives, such as an intrauterine device (IUD) with levonorgestrel (Mirena, Skyla) or a contraceptive implant (Nexplanon), can reduce or eliminate menstruation.
- Aromatase Inhibitors: These drugs reduce the amount of estrogen in the body, which can help reduce endometrial growth.
Surgery
- Laparoscopy: A minimally invasive surgical procedure where the surgeon removes as much endometriosis as possible. This is often used for women with severe pain or those trying to become pregnant.
- Hysterectomy: In severe cases, removal of the uterus (hysterectomy) along with the ovaries (oophorectomy) may be recommended. This is usually considered a last resort, especially for women who still wish to have children.
Other Therapies
- Lifestyle: Regular exercise, heat application (like heating pads), and relaxation techniques can help manage symptoms. Weight control can reduce body fat to help keep the amount of estrogen low. It's also helpful to avoid large amounts of alcohol and caffeinated beverages.
- Alternative Medicine: Some women find relief from acupuncture and other forms of alternative medicine.
Fertility Treatment
Removing or destroying endometriosis via laparoscopic surgery can increase your chances of becoming pregnant naturally. For women with severe scarring and blocked fallopian tubes or damaged ovaries from endometriosis, advanced fertility treatments such as in vitro fertilization (IVF) may be recommended.
Real Life Experiences
Listen to an Endometriosis patient story on the SART Fertility Experts podcast
Endometriosis is a condition that can affect many facets of a person’s life, from pelvic pain to struggles with infertility. Listen as Christine discusses her experiences during her journey to motherhood with Dr. Joseph Findley, a reproductive endocrinologist and member of the Society of Reproductive Surgeons.
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Visit the Society for Assisted Reproductive Technology (SART) Website
Visit the Society of Reproductive Surgeons (SRS) Website
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Endometriosis
Endometriosis and Infertility: Can Surgery Help?
Endometriosis is when tissue is found outside the uterus that appears similar to the lining of the uterus (endometrium). Endometriosis may grow on the outside of your uterus, ovaries, and tubes and even on your bladder or intestines. This tissue can irritate structures that it touches, causing pain and adhesions (scar tissue) on these organs. View the Fact Sheet
Hydrosalpinx
The fallopian tubes are attached to the uterus (womb) on the left and right sides. View the Fact Sheet
Noncontraceptive Benefits of Birth Control Pills
Most women will use birth control pills at some time in their lives. View the fact sheet
Managing Pelvic Pain
Many women have pain in their pelvis (lower part of the belly) from time to time, usually during their period. View the fact sheet
What do I need to know about conceiving after surgery on my Fallopian tubes?
Fallopian tubes connect the ovary (where the eggs are stored and grow) to the uterus (womb), where the fertilized egg develops into a baby (fetus). View the fact sheet
SART Fertility Experts - Endometriosis
Endometriosis is a condition that can affect many facets of a person’s life, from pelvic pain to struggles with infertility. Listen to the Episode
Infertility: an Overview (booklet)
Infertility is typically defined as the inability to achieve pregnancy after one year of unprotected intercourse. View the booklet
Endometriosis (booklet)
Women with endometriosis may experience infertility, pelvic pain, or both. This booklet will describe options for diagnosing and treating pain or infertility that may be attributed to endometriosis. View the Booklet
Endometriosis
Endometriosis is a condition in which endometrial tissue, which normally lines the uterus, develops outside of the uterine cavity in abnormal locations. Watch Video
Causes of Female Infertility
Dr. Roger Lobo, of the American Society for Reproductive Medicine explains the causes of female infertility. Watch Video
Endometriosis Infographics
ASRM has prepared infographics to illustrate the subject of Endometriosis better. View the InfographicsSurgery (reproductive)
Conditions Treated with Surgery on the Fallopian Tubes and Ovaries
Surgery can be used to treat problems with the ovaries or fallopian tubes, such as cysts, endometriosis, or infections. View the Fact Sheet
Dilation and Curettage (D&C)
“Dilation and curettage” (D&C) is a short surgical procedure that removes tissue from your uterus (womb). You may need this procedure if you have unexplained or abnormal bleeding or if you have delivered a baby and placental tissue remains in your womb. View the Fact Sheet
Intrauterine adhesions: what are they?
The inside of the uterus is like a balloon with the front and backwalls flat against each other. View the fact sheet
Minimally invasive surgery
Surgery is termed “minimally invasive” if it uses small or no incisions (cuts). View the fact sheet
Nonhormonal Contraception
Despite a large number of contraceptive options available to couples, it is still thought that 50% of pregnancies in the United States are unintended. View the fact sheet
Treatment of uterine fibroids
Do all fibroids require treatment? Not usually, because most patients with fibroids do not have symptoms. View the fact sheet
Varicocele
A varicocele is a variation of normal anatomy in which veins in the scrotum (the sac that holds the testicles) become enlarged and sometimes even visible. View the fact sheet
Robotic Surgery
Robotic surgery is a form of laparoscopy. View the fact sheet
SART Fertility Experts - What is an REI?
These experts in infertility lead IVF programs, perform reproductive surgery, and perform research to enhance the field of reproductive medicine. Listen to the Episode
SART Fertility Experts - Tubal Surgery in the IVF Era
In this episode of SART Fertility Experts, Dr. Brad Hurst and Dr. Mark Trolice, to review the indications for tubal surgery. Listen to the Episode
Infertility: an Overview (booklet)
Infertility is typically defined as the inability to achieve pregnancy after one year of unprotected intercourse. View the booklet
Laparoscopy and Hysteroscopy
Laparoscopy and hysteroscopy can be used for both diagnostic (looking only) and operative (looking and treating) purposes. View the bookletPatient Journeys
Resources For You
The American Society for Reproductive Medicine (ASRM) is committed to providing patients with the highest quality information about reproductive care.
