Endometriosis is a disease in which tissue resembling the lining of the uterus grows elsewhere in the body.

The word endometriosis comes from the word "endometrium" - endo means "inside" and metrium means "womb," where a mother carries her baby. Health care providers call the tissue that lines the lining of the uterus the endometrium.

Researchers aren't sure what causes endometriosis, but some theories include the following:

• Retrograde menstruation. This theory proposes that endometriosis cells flow back through the fallopian tubes and into the pelvis during menstruation.
• Celomic metaplasia. This theory refers to a change in the characteristics of the cells that line the organs in the pelvis.

These theories do not explain every case of endometriosis, such as endometriosis occurring in organs such as the lungs (possibly due to spreading through the blood system or lymph vessels) or the rare cases of endometriosis in men.

Healthcare providers may use the terms 'implants', 'nodules' or 'lesions' to describe areas or sites of endometriosis. Most endometriosis patches are found in the pelvic cavity:

• On the ovaries
• On the fallopian tubes, which carry eggs from the ovaries to the uterus
• Behind the womb
• On the tissues that hold the uterus in place
• On the intestines or bladder

In rare cases, endometriosis can grow outside of the pelvic cavity, such as on the lungs or in other parts of the body. ¹

Researchers' understanding of endometriosis is changing with new scientific evidence. For example, researchers thought that pain from endometriosis was related to the size of the patches that grew outside the uterus. But there is some evidence that this is not the case. In fact, the size and location of the lesions are not related to the severity or location of the pain. ^{2, 3} Studies also show that pain is not associated with a woman's ability to conceive. ^{4, 5}

Symptoms

The most common symptoms of endometriosis are pain and infertility. ¹

Other common symptoms of endometriosis are: ¹

• Painful or even debilitating menstrual cramps, which can get worse over time
• Pain during or after sex
• Pain in the gut or lower abdomen
• Painful bowel movements or painful urination during menstruation
• Heavy periods
• Premenstrual spotting or bleeding between periods ²
• Problems getting pregnant ³

In addition, women with endometriosis may have painful bladder syndrome, digestive or gastrointestinal symptoms that resemble a bowel disease, as well as fatigue or lack of energy. ^{4, 5}

For some women, the pain associated with endometriosis gets milder after menopause. Hormone therapy, such as estrogen or birth control pills given to reduce menopausal symptoms, can cause pain and other symptoms to persist.

Endometriosis-related pain

Researchers know that pain is a primary symptom of endometriosis, but they are not sure what causes the pain.

The severity of the pain does not match the number, location, or size of endometriotic lesions. Some women with only a few minor lesions experience severe pain; other women may have very large patches of endometriosis but experience little pain. ^{1, 6}

Current evidence suggests several possible explanations for pain associated with endometriosis, including the following: ^{1, 6}

• Patches of endometriosis respond to hormones in the same way as the lining of the uterus. These tissues may bleed or develop inflammation every month, just like a normal period. However, the blood and tissue released from endometriosis patches remain in the body and are irritating, which can cause pain.
• In some cases, inflammation and chemicals produced by the endometriosis areas can cause the pelvic organs to stick together, causing scar tissue. This makes the uterus, ovaries, fallopian tubes, bladder and rectum appear as one large organ.
• Hormones and chemicals released by endometriosis tissue can affect nearby tissuel irritate and cause it to release other chemicals that cause pain.
• Over time, some areas of endometriosis may form nodules or bumps on the surface of pelvic organs or become cysts (fluid-filled sacs) on the ovaries.
• Some endometriosis lesions have nerves that bind the patches directly in the central nervous system. These nerves can be more sensitive to pain-causing chemicals released into the lesions and surrounding areas. Over time, they can be more easily activated by the chemicals than normal nerve cells.
• Patches of endometriosis can also press against nearby nerve cells to cause pain.
• Some women report less endometriosis pain after pregnancy, but the reason for this is unclear. Researchers are trying to determine whether the pain relief is due to the hormones the body releases during pregnancy or to changes in the cervix, uterus, or endometrium that occur during pregnancy and delivery.

Endometriosis pain can be serious and interfere with daily activities. Understanding how endometriosis is related to pain is a very active area of research as it could enable more effective treatments for this type of pain.

Therapy

There is currently no cure for endometriosis, but there are treatment options for related pain and infertility.

Health care providers consider several factors when determining the best treatment for endometriosis symptoms, including:

• Your age
• How severe your symptoms are
• How serious the disease is
• Whether you want children

Not all treatments work well for all women with endometriosis. Also, the symptoms of endometriosis may return after treatment is stopped or, in the case of surgery, the more time passes after the procedure.

Pain treatments

• Hormone Therapy
• Painkillers
• Surgical treatments

Hormone Therapy

Because hormones cause endometriosis patches to go through a cycle similar to the menstrual cycle, hormones can also be effective in treating endometriosis symptoms. In addition, different hormones can change our perception of pain.

Hormone therapy is used to treat endometriosis-related pain. Hormones come in the form of a pill, an injection or injection, or a nasal spray.

Hormone treatments stop the ovaries from producing hormones, including estrogen, and usually prevent ovulation. This can help slow the growth and local activity of both the endometrium and the endometrial lesions. Treatment also prevents new areas and scars (adhesions) from growing, but it keeps existing adhesions from disappearing.

Health care providers may recommend one of the following hormone treatments to treat pain from endometriosis: ^{1, 2, 3}

• Gonadotropin-releasing hormone (GnRH) drugs stop the production of certain hormones to prevent ovulation, menstruation, and the growth of endometriosis. This treatment puts the body in a 'menopausal' state.
  • A GnRH drug called elagolix (also ^called Orilissa ^®) also stops the release of hormones to prevent the growth of endometriosis. It is the first pill approved by the United States Food and Drug Administration (FDA) to treat pain related to endometriosis. Fundamental research leading to the new drug was supported by NICHD through its Small Business Innovation Research program. ⁴
    • The low-dose pill should not be taken for more than 24 months and the high-dose pill should not be taken for longer than 6 months, as this can cause bone loss. ⁵
    • The most common side effects of the drug are headache, nausea, trouble sleeping, absence of menstrual periods, anxiety, depression, and joint pain. ⁵
  • Some GnRH drugs come in a nasal spray that is taken daily, as an injection that is given once a month, or as an injection that is given every 3 months.
  • Most health care providers recommend staying on the GnRH drug for only about 6 months at a time, with several months between treatments if repeated. The risk of heart complications and bones
    
    
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