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JAMA Patient Page
December 25, 2018

Endometriosis

Author Affiliations
  • 1Texas Tech University Health Sciences Center School of Medicine, Lubbock, Texas
JAMA. 2018;320(24):2608. doi:10.1001/jama.2018.17953

Endometriosis is a common condition in women.

The endometrium is the inner lining of the uterus (womb); this tissue normally cycles through stages of growth and shedding during the menstrual cycle. Endometriosis occurs when the endometrium is present outside the usual location. Endometriosis may occur in the ovaries, fallopian tubes, vagina, or other parts of the uterus. Rarely, endometriosis may occur in the abdomen and lungs.

Endometriosis is common among women of reproductive age. An estimated 11% of women in the United States may have endometriosis. Women without prior pregnancies, women with a family history of endometriosis, and women with abnormal menstrual periods are more likely to have endometriosis.

Signs and Symptoms

Women can have endometriosis without symptoms or experience different types of pain, including painful menstrual cramps or heavy menstrual periods, pain during or after sexual intercourse, pain during a bowel movement or urination, and abdominal pain.

Abnormally located endometrium can grow and shed during the menstrual cycle, causing bleeding in between periods. Inflammation, cysts, scar tissue, and adhesions can develop, leading to intestinal problems, chronic pelvic inflammatory disease, or infertility.

Causes

The cause of endometriosis is not currently known. Backflow of menstrual blood is considered the most likely cause of endometriosis. Other possible causes include genetic factors, immune irregularities, estrogen imbalances, and surgery (such as cesarean deliveries or abdominal surgeries).

Diagnosis

A doctor will obtain a patient’s medical history and perform a detailed examination, including a pelvic examination to identify any palpable abnormalities. Imaging, such as transvaginal ultrasound and magnetic resonance imaging, may be done. Laparoscopy, a type of minimally invasive surgery, is the only way to confirm endometriosis. The biopsy and microscopic evaluation of possible endometriosis lesions can confirm endometriosis.

Treatment

The focus of treatment is symptom alleviation rather than cure.

Pain: The first-line treatment for endometrial pain is hormonal contraceptives. Oral contraceptive pills can prevent the ovaries from ovulating and therefore reduce endometriosis manifestations. Mild pain can be treated with over-the-counter pain relievers. In severe cases, a doctor may recommend laparoscopy to remove endometriosis patches. In some patients, gonadotropin-releasing hormone agonists (such as leuprolide) may help. Aromatase inhibitors (anastrozole) are reserved for women who do not have relief with other forms of treatment. Gonadotropin-releasing hormone antagonists are a possible emerging treatment.

Infertility: For women who wish to become pregnant, a doctor may recommend laparoscopy to remove endometriosis patches. This has been shown to increase pregnancy rates, but it is less likely to work in moderate to severe endometriosis. For women who have trouble becoming pregnant after laparoscopic endometriosis removal procedures, other fertility techniques such as in vitro fertilization may be recommended.

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The JAMA Patient Page is a public service of JAMA. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, call 312/464-0776.
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Article Information

Conflict of Interest Disclosures: None reported.

Sources: Eunice Kennedy Shriver National Institute of Child Health and Human Development, Department of Health and Human Services

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