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What is endometriosis?
What causes endometriosis?
Who is at risk?
Incidence
Where does it occur?
What does Endometriosis look like?
What are the signs and symptoms?
When do I seek help?
How is endometriosis diagnosed?
How is endometriosis treated?
Infertility
Where can I get more information?
What is endometriosis?
Endometriosis is a common and often painful disorder affecting a woman's female organs. The endometrium (the tissue that normally lines the inside of the uterus) becomes implanted outside the uterus, most commonly on the fallopian tubes, ovaries or the tissue lining the pelvis (peritoneum). Endometriosis may cause adhesions (fibrous scar tissue) between the different organs in the pelvis and lead to an endometrioma (chocolate cyst) in the ovaries.
Endometrial cells from the uterus, which are normally shed during the period, can flow back along the tubes into the pelvis. This is called retrograde menstruation. These cells stick onto the tissues and organs in the pelvis and start to grow and multiply. They undergo the same changes that the lining (endometrial) cells of the uterus do and will bleed at the same time the period occurs.
Over time these cells form small patches, which increase in size and may develop into nodules. Because the blood is unable to escape, it becomes sticky, so that the surrounding tissues and organs can adhere and stick to each other, leading to scarring. On the ovary, the patches can increase in size and ‘burrow’ into the ovary to form cysts, known as chocolate cysts or endometriomas.
Pockets of endometrial cells can occur in the muscle (myometrium) of the uterus. This is called adenomyosis.
Female Reproductive System
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What causes endometriosis?
The cause or causes of endometriosis are not fully understood and there may be many reasons why it occurs in about ten percent of women.
Retrograde menstruation (see above) is considered the main source of endometrial cells reaching the pelvis and pelvic organs. However, in most women these cells are normally absorbed or disintegrate. Where there is endometriosis present, this process is either inadequate or does not occur, so the cells survive and grow. Theories include, genetic causes (especially if there are other family members with the condition), environmental or racial factors.
Who is at risk?
Endometriosis is a major cause of lifestyle impairment and infertility in women, especially for women in their 30s. Endometriosis can occur in any woman or girl once their periods begin, regardless of age, class or educational background.
Incidence
Endometriosis occurs in about one in ten women during the reproductive years. It can occur anytime, from when periods start, right up to the time of menopause, but it rarely continues to be active after menopause. Occasionally, it is reactivated by hormone therapy after menopause.
Where does it occur?
Endometriosis occurs mainly in the pelvis around the ovaries, uterus, uterine (Fallopian) tubes, rectum and bladder, but may also occur in other organs (although this is rare).
The main sites that endometriosis can occur are:
Other sites for endometriosis include:
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Bladder - over the surface, rarely into the bladder
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Rectum and bowel - over the surface but sometimes into the rectum or other parts of the bowel
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Appendix
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Anywhere in the body, such as in the umbilicus (belly button), in a scar after surgery, and rarely, in the lungs 
What does endometriosis look like?
Endometriosis is found as surface patches or lesions, which are like red, brown or clear blisters, but can also be whitish or yellowish in colour. It is also found deeper in tissues as black/brown or white scarring. Sometimes the deeper patches form nodules or scarred clumps, which grow into surrounding tissues or organs.
What are the signs and symptoms?
Some women have no symptoms. Pain, however, is the most common symptom experienced.
Pain may be in any of the following forms:
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Period pain – immediately before the period and with the period
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Dyspareunia - pain during or after sexual intercourse
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Abdominal pain and/or pelvic pain
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Back pain
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Pain with opening bowels, passing wind or urinating
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Ovulation pain, including thigh or leg pain
Bleeding:
Other symptoms may include:
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Bowel or bladder symptoms, including bleeding from bladder or bowel
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Irregular bowel habits, e.g. constipation, diarrhoea
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Urinary frequency or change in normal function
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Infertility - 30-40 per cent of women with infertility have endometriosis; however about 50 per cent of these women will become pregnant with full treatment
General symptoms may also include:
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Tiredness
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Mood changes
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Bloating
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Premenstrual symptoms
When do I seek help?
When symptoms interfere with your daily living and quality of life, such as:
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Missing work, school or recreational activities
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When medicines used for period pain don’t help
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When you need to stay in bed
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When symptoms are getting worse
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When symptoms occur cyclically
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When going frequently to see the doctor with symptoms (see above)
Who do I see?
The first person to see is your local doctor. The diagnosis of endometriosis is often delayed because no abnormalities are found on examination or on tests such as a pelvic ultrasound of the uterus and ovaries. Your doctor may refer you to a specialist gynaecologist, especially one with an interest in endometriosis. Period pain is not normal, especially when it impairs normal living. A combination of period pain, heavy periods and other pain should be investigated. Request investigation or referral to a specialist.
How is endometriosis diagnosed?
At this point in time the only sure way to diagnose endometriosis is by laparoscopy. This is an operation performed under a general anaesthetic, where a small telescope is inserted into the abdomen through a small incision in the umbilicus, to look into the pelvis and see evidence of endometriosis. There are degrees of the condition depending on the amount of endometriosis seen and the degree of scarring. Endometriosis may be classified either as mild, moderate or severe, or by Stages 1 through to 5.
How is endometriosis treated?
Treatment will depend on the severity of endometriosis, the symptoms occurring and if having a baby is desired. Treatments can include natural therapies, hormonal therapies and surgery, as well as medicines for pain relief, including analgesics and antiinflammatories.
Natural therapies
Natural therapies, including nutrition, herbal medicine, homeopathy and acupuncture may help to manage the symptoms of medical treatments, and some herbs may be taken at the same time as some of the hormone therapies. At least three to six months of treatment is usually needed before deciding whether natural therapies will work for you.
Nutrition tips
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Eat plenty of soluble fibre, such as two to three dessert spoons of a mix of sunflower seeds and pepitas (pumpkin seeds) added to breakfast or in yoghurt
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Increase good fats and oils to help with pain, like olive and flaxseed oils, avocados, pine nuts, pistachio nuts, peanuts and sesame seeds
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Have fish, such as sardines and salmon at least three times per week
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Include raw seeds and nuts
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Decrease 'bad fats' by trimming fat off meat; avoid hidden fats in cakes, pastries, milk chocolate and coconut milk
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Consume low-fat dairy products
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Eat vegetables from the 'cabbage family' (broccoli, cauliflower, bok choy, brussel sprouts, cabbage)
Hormone therapies
Hormone therapies may be used as a treatment in mild endometriosis or as an added or adjuvant therapy prior to, or after, surgery, especially in moderate to severe forms. The aim of hormonal therapies is to suppress the growth of the endometrial cells, including the endometriotic patches, and to lead to a reduction in pain symptoms.
Hormone therapies include:
These therapies may produce side effects and are not suitable whilst trying to get pregnant. Ask your doctor to explain the differences between the therapies or to give you some reading material.
Surgical treatment
Laparoscopic surgery (keyhole surgery) can remove the endometriotic patches or nodules to reduce symptoms and improve fertility. The patches may be excised (cut out) or diathermied (burnt) and the nodules excised. Laser surgery has been used in the past, but is rarely used today.
There is evidence to show that endometriomas, or chocolate cysts in the ovaries, may increase the risk of ovarian cancer and therefore they should be removed.
A laparotomy, or an open operation requiring a cut in the skin, may be necessary if the endometriosis is severe and extensive. Sometimes it is necessary because of previous abdominal surgery, making laparoscopic surgery unsafe.
Hysterectomy is necessary when longstanding severe endometriosis has not responded to previous repeated treatments and surgery in women experiencing ongoing severe chronic pain. In most cases the ovaries are removed, which would lead to early menopause.
Infertility
Infertility is present in about 30 per cent of women with endometriosis.
In mild endometriosis there is no obvious reason why infertility occurs, but it is believed that there may be some chemicals released from the endometriosis cells that interfere with the ability to conceive or affect early normal development of the embryo.
In moderate to severe forms scarring may cause interference with ovulation and passage of the egg along the tube because of damage or blockage.
Where can I get more information?
The Jean Hailes Foundation for Women's Health Endometriosis website(www.endometriosis.org.au)
Endometriosis Care Centre Australia (www.ecca.com.au)
Endometriosis Association of Queensland (www.qendo.org.au)
Links - for more on Women's Health sites around Australia.
Further resources
 Endometriosis (95.49 KB)
Content updated August 21, 2008
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