Conditions InDepth: Endometriosis
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Endometriosis is a problem with the lining of the uterus (womb). The lining is called the endometrium. Normally, when you have your menstrual period every month, the lining will come out in the menstrual flow through the vagina.

Endometrial tissue is normally found only inside of the uterine cavity. However, endometriosis refers to the presence of the endometrial tissue outside of the uterus. The most common sites include: the ovaries; the outside surface of the uterus; the fallopian tubes; ligaments of the pelvis; and the spaces between the rectum, bladder, and uterus. Less commonly the rectum, bladder, intestine, and appendix may be involved. Rarely, deposits (or implants) of endometrial tissue may be found in the lung, arm, thigh, and skin far away from the reproductive tract.

Endometrial Lesions

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This misplaced endometrial tissue responds to the monthly cycles of reproductive hormones. It swells, breaks down, bleeds, and causes an inflammatory reaction. Whereas during the normal menstrual flow the blood exits through the vagina, there is no exit when this tissue is in other locations outside of the uterus. The pain is increased during the latter part of the menstrual cycle and the beginning of menses.

In the United States, endometriosis affects an estimated 10%-20% of women of reproductive age. Although endometriosis may occur at any age, it is most commonly seen between the ages of 25 and 40.

The exact cause of endometriosis is unknown. Some possible considerations include:

  • Menstrual blood and endometrial tissue flows backward through the fallopian tubes instead of forward through the vagina and out of the body.
  • The immune system does not destroy this misplaced tissue in the body and allows the tissue to implant and develop in unusual places in the body. This causes endometriosis.
  • The lymph (glands) and/or blood systems carry endometrial cells from the uterus to other areas of the body.
  • Genetic and environmental susceptibility.
Endometriosis is a major factor in female infertility. In fact, about 30%-45% of all women who are being treated for infertility have evidence of endometriosis.




References:
American Academy of Family Physicians website. Available at: http://www.aafp.org. Accessed March 2, 2006.

The American College of Obstetricians and Gynecologists. The Management of Endometriosis. Practice bulletin No. 114; July 2010.

The Endometriosis Association website. Available at: http://www.endometriosisassn.org. Accessed March 1, 2006.

Endometriosis Research Center website. Available at: http://www.endocenter.org. Accessed March 1, 2006.

Gabbe, SG, et al. Obstetrics: Normal and Problem Pregnancies. 5th ed. London: Churchill Livingstone; 2007.

Griffith’s 5-Minute Clinical Consult. Lippincott Williams and Wilkins; 1999.

Katz VL, et al. Comprehensive Gynecology. 5th ed. St. Louis: Mosby; 2007.

Kistner’s Gynecology and Women’s Health. 7th ed. Mosby-Year Book; 1999.

National Institute of Child Health and Human Development website. Available at: http://www.nichd.nih.gov. Accessed March 1, 2006.

National Library of Medicine website. Available at: http://www.nlm.nih.gov. Accessed March 2, 2006.

Rakel R. Textbook of Family Medicine 2007. 7th ed. Philadelphia: Saunders Elsevier; 2009.

Rakel RE, Bope ET. Conn's Current Therapy 2001. 53rd ed. Philadelphia, PA: W.B. Saunders Company; 2009.

Last Reviewed September 2014



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