Endometriosis

What Is Endometriosis?

Endometriosis is a disorder in which bits of tissue from the inner lining of the uterus (the endometrium) grow inside a woman’s body, outside of the uterus. The uterus is a hollow organ within a woman’s abdomen where a fertilized egg implants and where a developing baby is nourished and grows.

These misplaced bits of endometrial tissue can cause pain and irregular bleeding, and can affect a woman’s ability to become pregnant.

Each month, in a normal menstrual cycle:

• The ovaries (the organs where egg cells develop) produce hormones (the body’s chemical messengers) that stimulate the cells of the uterine lining – the endometrial cells – to multiply and prepare for a fertilized egg. These cells swell and thicken.
• If a pregnancy does not occur, this excess tissue is shed from the uterus and discharged from the body.
• This discharge of tissue is a woman’s menstrual period.

In endometriosis:

• Patches of misplaced endometrial tissue implant themselves on organs outside of the uterus, such as the ovaries, fallopian tubes rectum, and bladder.
• These cells also respond to the ovaries’ hormonal signals by swelling and thickening.
• However, these cells are unable to separate themselves and shed from the tissue to which they have adhered. They sometimes bleed a little and then heal.
• This happens repeatedly each month, and the ongoing process can cause scarring. It also can create adhesions, which are web-like tissues that can bind pelvic organs together.

How Common Is Endometriosis?

Endometriosis sometimes produces no symptoms, and many women are unaware that they have the condition. Therefore, the true incidence is hard to determine. But many experts believe it affects between 5 and 15 percent of all women of reproductive age.

Where In The Body Does Endometriosis Occur?

Endometrial tissue can grow anywhere in the abdomen, including:

• Ovaries
• Fallopian tubes
• Outer surface of the uterus
• Bladder
• Rectum

Less commonly, endometrial tissue may adhere to:

• Outer surfaces of the small and large intestines
• Ureters (tubes leading to from the kidneys to the bladder)
• Vagina
• Surgical scars in the abdomen
• Lining of the chest cavity
• Other areas outside the abdomen, such as the lung or thigh (this is rare)

What Causes Endometriosis?

The precise cause of endometriosis is unknown, but there are several theories to explain it:

• Retrograde Menstruation – It is known that menstrual blood can flow backwards along the fallopian tubes during a woman’s period, carrying with it living endometrial cells. Then, instead of flowing out through the cervix and vagina as in normal menstruation, the menstrual fluid flows into the abdominal cavity instead. According to this theory, some of the endometrial cells in this fluid is implanted into the abdomen this way.

  Some evidence for this theory comes from the observations that endometriosis is uncommon following a sterilization procedure in which the fallopian tubes are blocked. Endometriosis is associated with conditions in which the normal flow of menstrual blood is blocked, such as in women whose cervix did not develop properly.

• Lymphatic System Distribution – There is also a similar theory which suggests that wayward bits of endometrial tissue are distributed from the uterus to other parts of the body not necessarily through the fallopian tubes, but possibly through the lymphatic system. The lymphatic system consists of channels throughout the body that help to drain away excess fluids.
• Formation in Situ – According to this theory, inflammation or a hormonal change can cause normal tissue to transform itself into endometrial tissue.
• Immune System Defects – Endometriosis may result from a specific defect in the immune system (the body system that fights disease and infection), which normally would eradicate such stray cells migrating outside the uterus.
• Genetic Theory – Since endometriosis appears to run in families, this theory suggests that the likelihood for developing endometriosis may be contained in a woman’s genes.
• Embryonic Tissue Theory – This theory suggests that endometriosis is caused by microscopic remnants of a women’s embryonic tissue (from when she was an embryo), that later develops into endometriosis.
• Estrogen theory – Because endometriosis is linked to the activity of hormones, substances called “organochlorines” have come under scrutiny. Contained in pesticides, these man-made chemicals are known, as “environmental estrogens” for their abilities to act like estrogen.

  Organochlorines are suspected as the reason for an increase in estrogen-related conditions, including endometriosis. They also are suspected as one of the causes of a variety of cancers, such as reproductive cancers and some forms of breast cancer that respond to hormonal influences.

Who Is At Risk For Endometriosis?

Several factors make a woman more likely to develop endometriosis:

• Age – Endometriosis occurs most commonly in women between the ages of 25 and 44. It can also occur in teenagers, although this is less common. Women who have given birth after the age of 30 may also be more prone to develop it.
• Race – Endometriosis occurs more commonly in Caucasian women, although it can affect women of any race.
• Family History – Endometriosis seems to run in some families. It is more common in first-degree relatives (mother, sister, daughter) of women who have had the condition.
• Congenital Birth Defect – Women born with an abnormal uterus may be more likely to develop endometriosis.
• Infertility – As many as 25 to 50 percent of infertile women may have endometriosis, which can physically interfere with conception. So, in addition to endometriosis causing infertility, it has also been suggested that infertility may increase susceptibility to endometriosis.

What Are The Symptoms Of Endometriosis?

Endometriosis does not always produce symptoms. When it does, it can cause:

• Painful periods
• Pain during intercourse
• Pelvic pain unrelated to periods or intercourse
• Other symptoms

In some women, the only sign of endometriosis may be infertility. Occasionally, endometriosis is discovered unexpectedly during an exam or surgery for an unrelated condition.

Painful Periods

Many (although not all) women with endometriosis will experience deep pain that occurs when they have their period, a condition known asdysmenorrhea. The pain can occur in the:

• Lower abdomen
• Vagina
• Rear pelvic area
• Back

This pain usually begins from 5 to 7 days before the heaviest menstrual flow and lasts for 2 to 3 days. This type of pain differs from normal menstrual pain, which is more cramp-like and concentrated in the mid-abdomen.

Pain During Intercourse

Painful intercourse, or dyspareunia, can occur when a man’s penis enters the vagina and presses on tissues that may be affected by endometriosis. Painful intercourse may lead to reduced sexual activity, and some women find that intercourse becomes impossible.

Pelvic Pain

Women with endometriosis may experience pelvic pain that seems to be unrelated to menstruation or intercourse. Experts had thought that endometriosis produced pain because of the bleeding of the misplaced endometrial tissue. While this undoubtedly does happen in some women, this explanation now seems too simplistic.

Recent research indicates that the pain of endometriosis is linked to inflammation, not bleeding, around the misplaced endometriosis tissue. Chemicals within the body such as prostaglandins are thought to be involved. These are the hormone-like substances released by the endometrial tissue and are affected by inflammation.

Other Symptoms

Endometrial tissue attached to other locations may produce different symptoms. Women with endometrial tissue attached to non-reproductive organs such as the large intestine or bladder may experience:

• Abdominal swelling and pain when moving the bowels
• Painful urination
• Bleeding from the rectum during menstruation
• Nausea or vomiting that worsen before menstruation
• A painful swelling of the umbilicus, or belly button

Conditions That Can Cause Similar Symptoms

There are a number of conditions that can cause symptoms similar to endometriosis, including:

• A problem with an intrauterine device (IUD), which is used for birth control
• Pelvic infection
• Ovarian cysts caused by other conditions
• Painful periods, where no specific cause has been found
• Psychosexual problems, such as an extremely distressing past experience (for example, a rape or sexual abuse)

How Is Endometriosis Diagnosed?

Endometriosis is diagnosed by:

• Physical examination
• Laparoscopy
• Transvaginal ultrasound
• Other tests

Physical Examination

It’s not unusual for a pelvic examination to reveal no sign of possible endometriosis. In some cases, however, there are some signs:

• Occasionally during a pelvic exam, a physician may feel a cyst on an ovary that is caused by endometriosis.
• A physician can tell during a pelvic exam if a woman’s uterus is retroverted (tilted backwards) and cannot be moved easily, which may indicate endometriosis behind the uterus.
• A woman may feel pain during an examination that can range from mild to severe; this pelvic tenderness might be a sign of endometriosis.
• A physician may feel small bumps of tissue caused by endometriosis behind the uterus.
• In rare cases, endometriosis lesions may be seen in a woman’s belly button or in scars around the abdomen, the cervix, or the vagina.

Laparoscopy

A physician may suspect endometriosis from a woman’s symptoms or from a pelvic exam, but a definite diagnosis is made with laparoscopy. This is a short surgical procedure performed through a very small incision in the abdomen (usually the belly button). A pencil-thin instrument called a laparoscope is inserted into the incision, and it gives the physician an exceptionally clear view, on a television monitor, of the inside of the abdominal cavity.

Endometriosis resembles small bluish blisters, nodules, or spots. If endometriosis is suspected but isn’t visible, a small sample of tissue may be removed for study under a microscope (biopsy).

If endometriosis is found, it is classified from minimal to severe based on:

• Where the endometrial tissue is located
• Whether it is on or under an organ’s surface
• What type of adhesions are found

Transvaginal Ultrasound

Transvaginal ultrasound (also called pelvic ultrasound) uses high-frequency sound waves and a computer to create images of organs and structures inside the body. The test can be performed in a doctor’s office and is painless.

During the exam, a woman lies on her back on an exam table, and the doctor inserts a probe into her vagina. The probe releases high-frequency sound waves that bounce off the pelvic organs. A computer converts these “echoes” into images that can be viewed on a monitor, where areas of endometriosis may be visible.

Other Tests

Other tests that may be performed include:

• A barium enema for women who are experiencing rectal bleeding, to rule out the possibility of gastrointestinal ailments or diseases such as colon cancer. It involves x-rays of the colon using a contrast medium (barium), which is introduced into the rectum by enema and is visible on the x-rays. The barium fills the colon, and areas of abnormalities can be seen.
• Blood tests, such as CA-125. CA-125 is a protein that is elevated when certain conditions, including endometriosis, are present. This test generally is done to help a doctor evaluate the effectiveness of endometriosis treatment rather than diagnosis it. That’s because conditions other than endometriosis can cause this substance in the blood to be elevated.

How Is Endometriosis Treated?

In some women, endometriosis causes no symptoms or mild symptoms and does not need to be treated at all. However, untreated endometriosis can continue to worsen, so these women should continue to have regular examinations to monitor the condition.

If endometriosis is causing symptoms or is interfering with a woman’s ability to become pregnant, several treatment options are available:

• Medication
• Conservative surgery
• Hysterectomy

Which Treatment Is Best for You?

Treatment of endometriosis varies depending on the extent of the condition and a woman’s plans for childbearing.

• In women with mild to moderate endometriosis, medication can significantly or even completely relieve their symptoms. However, medication cannot cure endometriosis. In some cases, the pain will return about six months after the medication has stopped.
• In women with moderate to severe endometriosis who wish to preserve their ability to become pregnant in the future, conservative surgery such as laparoscopy would usually be required as well.
• In women with severe endometriosis who do not wish to have any or additional children, a hysterectomy will offer permanent relief. Hysterectomy also is an option for women with moderate endometriosis who have completed childbearing and women whose symptoms keep coming back after other treatments have been tried.

Medications To Treat Endometriosis

For women with mild to moderate symptoms, medication may be the best treatment option. A course of medication is also sometimes prescribed along with conservative surgery.

Medications to treat endometriosis include:

• Pain relievers
• Hormonal treatments
• Oral contraceptives
• Progesterone
• Danazol
• GnRH agonists

Pain Relievers

Over-the-counter pain relievers may include aspirin, acetaminophen (such as Tylenol), ibuprofen (such as Advil), naproxen sodium, indomethecin, and tolfenamic acid. In some cases, prescription pain-killing medication may be helpful.

Hormonal Treatments

Hormonal treatment is the mainstay of prescription medication for endometriosis. Treatment with medication is based on two important observations:

• The symptoms of endometriosis tend to improve during pregnancy.
• The symptoms of endometriosis tend to improve after menopause.

From these observations, two treatments have evolved:

• Pseuodopregnancy medical therapies, which are drugs that fool the body into thinking it is pregnant. These include oral contraceptives and progesterone.
• Pseudomenopause medical therapies, which are drugs that fool the body into thinking that it is past menopause. These include danazol and GnRH agonists.

Oral Contraceptives

When it was introduced, pseudopregnancy therapy (fooling the body into thinking it is pregnant) with high-dose birth control pills was an important advance in the treatment of endometriosis. This approach is used less now, since the introduction of other treatments.

However, in some women, oral contraceptives (birth-control pills) are the best option. The type of oral contraceptive used is the combination birth control pill (which contains two female hormones, estrogen and progestin).

Oral contraceptives cannot cure endometriosis, but they can be effective in temporarily relieving the pain. They do this by stopping the monthly hormonal cycle, which causes the endometrial tissue to swell.

Minor side effects include abdominal swelling, breast tenderness, increased appetite, ankle swelling, nausea, and bleeding between periods. In rare cases, oral contraceptives can cause deep vein thrombosis (blood clots).

Progesterone

Progesterone is one of the female sex hormones produced by the ovary that prepares the lining of the uterus for implantation of a fertilized egg. Given orally or by injection, progesterone induces a simulated state that mimics pregnancy. This relieves the symptoms of endometriosis by stopping the monthly swelling and discharge of the endometrial tissue.

Progestogens (drugs with properties similar to progesterone) that are used for treating endometriosis include medroxyprogesteron acetate, norethisterone, and norgestrel. Many women respond well to this treatment, but some experience side effects that include:

• Irregular menstrual bleeding (a common side effect)
• Weight gain
• Acne
• Mood swings
• Depression

Danazol

Since its introduction in 1971, danazol has become the main drug treatment for endometriosis.

Unlike oral contraceptives and progesterone, which induce a pregnancy-like state, danazol is a synthetic male hormone that relieves the pain of endometriosis by temporarily stopping the monthly hormonal cycle that causes endometrial tissue to swell.

Although it is true that danazol is a synthetic hormone, it can be thought of as an “anti-hormone,” since many of its actions oppose the effects of estrogen, the main female hormone. Although danazol does not increase the total amount of testosterone (male hormone) in a woman’s body, it renders it more biologically active.

Danazol is a very effective medication; it improves the symptoms of endometriosis in more than 95 percent of the women who take it. It is usually taken for six months. However, danazol can produce a number of side effects, including:

• Acne
• Greasy skin
• Weight gain
• High cholesterol levels
• Increase in body hair growth
• Voice changes
• Disruption of menstrual cycle
• Hot flushes and sweats
• Reduced sex drive
• Indigestion and stomach upsets
• Dizziness
• Reduced breast size
• Muscle cramps
• Irritability
• Headaches
• Tiredness

However, only a small percentage of women (5 to 10 percent) chose to discontinue danazol because of side effects. Most do not experience major problems and can complete the course of treatment. Women who become pain-free while on danazol often feel very well.

Treatment with danazol usually lasts six to nine months. Any side effects from danazol are reversible, and women will often tolerate them in exchange for the relief of the pain caused by endometriosis. When the medication is stopped, a woman’s fertility (ability to become pregnant) returns in two to three months.

GnRH Agonists

GnRH agonists is an abbreviation for gonadotropin-releasing hormone analogues. The role of this group of drugs is to suppress the pituitary gland.

The pituitary gland normally produces hormones that act on the ovary, which in turn produces the female sex hormones, estrogen and progesterone. By “turning off” the pituitary, the ovary is also “turned off.” As a result, the ovaries stop ovulating and no longer produce estrogen. The overall effect is termed “medical menopause.”

This group of drugs is proven to be effective in treating endometriosis, but they also tend to produce side effects that include:

• Vaginal dryness
• Mood swings
• Hot flashes (a more common side effect)

Unlike danazol, they do not raise cholesterol levels. But they do cause calcium loss from bone, which can result in osteoporosis. Less common side effects include decreased sex drive, reduced breast size, bloating, and excess hair growth.

The GnRH agonists (known also as GnRH analogues) are given as a monthly injection or daily nasal spray and have become a popular (although more expensive) alternative to danazol. These drugs include Lupron, Synarel, and Zoladex.

As with danazol, GnRH agonists should not be taken during pregnancy, so effective contraception methods should be used. A woman’s menstrual period will resume about two months after discontinuing the medication, and fertility usually returns in one to two months.

Conservative Surgery For Endometriosis

Surgery may be considered for women with severe pain whose symptoms are not relieved with medication. For these women, the treatment can be tailored depending on whether they want to be able to have children. Conservative surgery can help preserve a woman’s ability to become pregnant.

Conservative surgical procedures include:

• Laparoscopy
• Laparotomy
• Laser surgery
• Electrocautery

Conservative surgery for endometriosis is performed to remove areas of endometriosis and to divide adhesions without removing the uterus or the ovaries. It is offered to women who wish to be able to have children in the future.

One problem with conservative surgery is that it usually provides only a temporary measure of relief, as endometriosis recurs in most women.

Laparoscopy

When a laparoscopy is done to confirm a diagnosis of endometriosis, the endometrial tissue can be removed at the same time. Laparoscopy is performed by inserting a pencil-thin instrument through an incision in the abdomen (usually in the belly button). It gives the physician an exceptionally clear view, on a television monitor, of the inside of the abdominal cavity.

The physician can pass other instruments through the same incision, or through other tiny incisions, to remove the misplaced endometrial tissue.

Laparotomy

In laparotomy, an incision is made in the abdomen and the abdominal cavity is opened and explored for signs of disease. Any endometrial tissue is removed, and the incision is then closed.

Laparotomy is major surgery that requires a brief hospital stay and three to four weeks of recuperation afterwards. This procedure is not performed as commonly as laparoscopy.

Laser Surgery

A laser is a device that concentrates light into an intense beam to produce heat that can destroy misplaced endometrial tissue. A variety of lasers can been used for treating endometriosis during laparoscopy. Although laser surgery is an important advance, it has not been shown to be superior or safer than other laparoscopic methods that destroy tissue, such as the use of electrical probes or direct heat.

Electrocautery

This procedure uses an electrical current to produce heat and destroy the patches of endometrial tissue. As with laser surgery, electrocautery is performed during laparoscopy.

Hysterectomy For Endometriosis

Hysterectomy, the most radical treatment for endometriosis, involves surgically removing the uterus, both ovaries and both fallopian tubes, along with as many areas as possible of misplaced endometrial tissue.

A hysterectomy can be performed by making a cut (incision) in your abdomen, which exposes the organs and tissues that need to be removed. This is called an abdominal hysterectomy. During the procedure, a woman will have general anesthesia and will be asleep.

A hysterectomy also can be performed through the vagina (vaginal hysterectomy), which eliminates the need for an abdominal incision. However, in women with endometriosis, an open incision allows the surgeon the opportunity to better view the abdominal cavity to look for and remove areas of endometriosis.

The major advantage of hysterectomy is that it is very effective, and recurrences of endometriosis are rare. After a hysterectomy, a woman will no longer have menstrual periods and may experience symptoms of menopause. However, those symptoms can be controlled with hormone replacement therapy and other medication.

Endometriosis And Infertility

It’s estimated that 40 to 50 percent of infertile women may have endometriosis. Endometriosis may be related to infertility in several ways:

• Women who experience deep pain during intercourse may choose to have intercourse less often, reducing the likelihood of becoming pregnant.
• Scar tissue from endometriosis can form adhesions around the ovary and restrict the available surface area of the ovary for egg release.
• Adhesions affecting the fallopian tubes may interfere with their ability to pick up an egg released by an ovary and transport it to the uterus.
• Occasionally, endometriosis will form inside the fallopian tube, resulting in blockage and making fertilization impossible.
• Endometriosis can disrupt the ovaries’ normal cycle of egg development and release.
• The peritoneal fluid in women with endometriosis contains an increased number of scavenger cells, which have the ability to destroy sperm cells, making fertilization unlikely.

Becoming Pregnant After Treatment

Pregnancy rates following various treatments for endometriosis vary between about 35 percent and 65 percent. Research has shown that for women with minimal or mild endometriosis, there is no proven benefit from medical or surgical treatment versus no treatment at all. Also, the more endometriosis a patient has, the less likely she is to become pregnancy following treatment.

Pregnancy rates are highest in the first one to two years following treatment. If danazol is used together with surgical treatment, pregnancy rates tend to be better when the medication is given before the surgery.

Women who only have minimal or mild endometriosis and who are pain-free will not overall have their fertility prospects improved by having their endometriosis treated. However, if no other cause of infertility is identified, it is reasonable to offer treatment to prevent the endometriosis from progressing. Laparoscopic surgery may be the best treatment in this case.

Infertile patients with moderate or severe endometriosis should be treated even if they have little pain. A six-month course of danazol or GnRH agonists followed by conservative surgery is probably the most effective treatment. Alternatively, conservative (laparoscopic) surgery alone may be used.

Infertility Treatments

Infertility treatments can increase the chances of pregnancy in women with endometriosis. The first step often involves the use of medication to boost the ovaries’ production of eggs. This is combined with inserting male sperm directly into the uterus.

If a woman does not become pregnant within one to two years, she may wish to explore assisted conception. This can be of two types:

• In-Vitro Fertilization (IVF) is a method for treating infertility in which an egg is surgically removed from the ovary and fertilized with the man’s sperm outside the body. If all goes well, the eggs fertilize and the resulting embryos are transferred to the women’s uterus two days later. This is often done if a woman has blocked fallopian tubes.
• Gamete Intrafallopian Transfer (GIFT) involves putting eggs and sperm into the fallopian tubes to be fertilized there. This method is suitable for woman with healthy fallopian tubes.

The decision to try assisted conception techniques may be particularly appropriate for women over age 35. Good pregnancy rates have been reported for both of these techniques, although the success rate was lower in women with severe endometriosis.

Can Endometriosis Be Prevented?

There are certain steps that a woman can take to either help prevent endometriosis or keep it from becoming worse:

• A woman with abdominal pain, especially if it occurs just before the start of her period, should see a physician. Early diagnosis offers the best chance of effective treatment.
• Women who have a problem with their reproductive organs that obstructs the menstrual flow should consider surgery to relieve the obstruction.
• A woman with a family history of endometriosis should be aware that she is at increased risk for developing endometriosis. There is evidence that taking oral contraceptives (birth control pills) may help keep endometriosis from developing.
• Since endometriosis is associated with childlessness, childbearing may give a protective effect. Therefore, women at risk for endometriosis may want to try to have children before their late 30s.

Endometriosis: Frequently Asked Questions

Here are some frequently asked questions related to endometriosis.

Q: I have endometriosis. Could my daughters inherit it?

A: Endometriosis does appear to run in families, and your daughters might inherit the tendency to develop it. This would put them at higher-than-average risk for the disorder.

Q: How can you tell the difference between normal menstrual pain and pain from endometriosis?

A: This sometimes is not easy. Generally, though, normal menstrual pain starts at the beginning of the flow and lasts one or two days. Pelvic pain from endometriosis tends to occur before the flow starts and may last several days.

Q: How can a physician tell the difference between such gastrointestinal disorders as irritable bowel syndrome (IBS) and endometriosis that may affect the bowel?

A: Again, the difference between the symptoms caused by these two conditions may be difficult to discern. Pain from IBS usually follows along the tract of the large intestine, and also may be accompanied by diarrhea, constipation, and gas and bloating. If the pain occurs with an obvious trigger, like eating, it is more likely IBS; if it occurs during the time of menstruation, endometriosis is a more likely diagnosis.

Q: I’m in my early 30s and I want to have children. Since I have endometriosis, my doctor has advised me to have children sooner, rather than later. Why?

A: Endometriosis is a progressive disorders. Since it is associated with infertility, and infertility increases generally after the age of 35, most doctors advice women with endometriosis to try and get pregnant before that age.

Endometriosis: Putting It All Together

Here is a summary of the important facts and information related to endometriosis.

• Endometriosis is a disorder in which the type of tissue with lines the uterus grows outside the uterus, causing inflammation and scarring that can lead to pain and/or infertility.
• Endometriosis is found most commonly on the ovaries, fallopian tubes, and the outside of the uterus.
• Endometriosis can cause no symptoms, mild symptoms, or severe pain. Pain often occurs during a woman’s menstrual period or during intercourse.
• Endometriosis is usually diagnosed by laparoscopy, a procedure in which a small incision is made and a viewing tube inserted so that any misplaced endometrial tissue can be seen.
• In recent years there have been many important advances in the medical and surgical treatment of endometriosis.
• In most women, endometriosis is mild and can be successfully treated with medication. Women with moderate or severe endometriosis often need surgery.
• Endometriosis is a cause of infertility; however, treatments are available that can enable many women with the condition to become pregnant.

Endometriosis: Glossary

Here are definitions of medical terms related to endometriosis.

Adhesions: Web-like tissue that develops from endometriosis and may bind pelvic organs together.

CA-125 blood test: A test to measure a certain protein in the blood and a tumor marker for ovarian cancer; it often is elevated when certain conditions, including endometriosis, are present.

Cervix: The neck of the uterus.

Cyst: A fluid-filled growth within the body.

Danazol: Synthetic male hormone that relieves the pain of endometriosis by stopping the monthly hormonal cycle that causes endometrial tissue to swell.

Dysmenorrhea: Painful menstrual periods.

Dyspareunia: Painful intercourse.

Electrocautery: An electrical current that produces heat in order to destroy tissue.

Endometrial implant: A patch of misplaced tissue from the lining of the uterus.

Endometrioma: A cyst in the ovary caused by endometriosis.

Endometriosis: A disorder in which bits of tissue from the lining of the uterus (the endometrium) grow outside of a woman’s uterus, causing pain and sometimes infertility.

Endometrium: The type of tissue that lines the uterus.

Estrogen: The main female sex hormone; produced by the ovaries, it controls the development and (along with progesterone) the functioning of the reproductive system.

Fallopian tube: The egg duct that transports an egg to the uterus; fertilization takes place here.

Gamete Intrafallopian Transfer (GIFT): An assisted conception technique that involves placing eggs and sperms into the fallopian tubes for fertilization.

Genes: Units of inherited material contained in the cells of our bodies.

GnRH agonists: A group of drugs that suppress the pituitary gland (the gland that produces hormones that regulate the function of the ovaries).

Hormones: Chemicals produced by an organ or body part and carried in the bloodstream to affect the function of another organ or body part.

Hysterectomy: Surgical removal of the uterus and sometimes the ovaries and fallopian tubes as well.

In-Vitro Fertilization (IVF): An assisted conception technique that involves surgically removing eggs from the ovaries, fertilizing them with male sperm outside the body, and then placing them in the uterus.

Infertility: In a woman, the inability to become pregnant.

Laparoscopy: A method of examining the abdominal cavity by means of a laparoscope (viewing tube).

Laparotomy: Exploratory abdominal surgery.

Lasers: A device that concentrates light into an intense beam to produce heat that destroys tissue.

Lymphatic system: A system of channels throughout the body that help to drain away excess bodily fluids.

Menopause: The end of menstrual periods in a woman.

Menstruation: The monthly shedding of the lining of the uterus (the endometrium), which occurs in a woman who has not become pregnant.

Organochlorines: Man-made chemicals that act like the hormone estrogen.

Osteoporosis: A condition in which the bones become brittle and can break easily.

Ovary: One of a pair of almond-shaped glands located on either side of the uterus, containing numerous follicles in which egg cells develop.

Peritoneal fluid: The small amount of fluid in the peritoneal cavity, which is one of the body’s main cavities (it contains the stomach, liver, intestines, and, in women, the uterus and ovaries).

Pituitary gland: A small gland within the head that produces hormones called gonadotropin, which effect the ovaries.

Progesterone: One of the main female sex hormones produced by the ovary; it prepares the lining of the uterus for implantation of a fertilized egg (drugs with similar properties are known as progestogens or progestins).

Prostaglandins: A group of hormone-like chemicals, some of which have an effect on the female reproductive system.

Retrograde menstruation: The backward flow of menstrual blood up into the fallopian tubes, thought to be a cause of endometriosis.

Rectum: Lowest part of the bowel.

Retroverted uterus: A uterus that is tilted backwards.

Testosterone: The main male sex hormone; tiny amounts are naturally present in women.

Umbilicus: Navel or belly button.

Uterus: The hollow, muscular organ of the female reproductive system in which a fertilized egg becomes imbedded and in which a developing embryo is nourished and grows.

Endometriosis: Additional Sources Of Information

Here are some reliable sources that can provide more information on endometriosis.

Endometriosis Association 
Phone: 414-355-2200 
Phone: 414-355-6065

http://www.endometriosisassn.org/

Resolve 
Phone: 617-623-0744

Online: http://www.resolve.org.

US National Library of Medicine

http://www.nlm.nih.gov/

American College of Obstetricians and Gynecologists 
Phone: 202-638-5577

Online: http://www.acog.com