Endometriosis is a painful disorder where the tissue that normally lines the inside of the uterus grows elsewhere in the abdominal cavity. Endometriosis most commonly involves the ovaries, fallopian tubes and the tissue lining the pelvis. Rarely, endometrial tissue may spread beyond pelvic organs.

According to the Endometriosis Foundation of America approximately 176 million women worldwide are impacted by this disease, and an estimated 1 out of 10 women suffer in the United States. Endometriosis affects women equally across all racial/ethnic and socioeconomic backgrounds. This disorder typically begins when women are in their reproductive years (25-35 years old), but can even affect those in their youth, starting as early as the age of 11.

Endometriosis can cause pain especially during a woman’s period. Fertility problems also may develop. Fortunately, effective treatments are available which we will discuss here.

Symptoms

The main symptom of endometriosis is pelvic pain. Cramps are experienced by many women during their period, but women who suffer with endometriosis have menstrual pain that's far worse than typical cramping. Pelvic pain and cramping begin before a woman’s period and extend several days into her period. They may also experience lower back and abdominal pain during this time.

Some other signs and symptoms of endometriosis include:

• Pain with intercourse. Pain during or after sex is common with endometriosis.
• Pain with bowel movements or urination. These symptoms typically occur during a woman’s period.
• Excessive bleeding. A woman may experience occasional heavy periods (menorrhagia) or bleeding between periods (menometrorrhagia).
• Infertility. Endometriosis is first diagnosed in some women who are seeking treatment for infertility.

Those with endometriosis may also experience fatigue, diarrhea, constipation, bloating or nausea, especially during menstrual periods. The severity of pain should not be used as an indicator of the extent of the condition. Some women with mild endometriosis have intense pain, while others with advanced endometriosis may have little pain or even no pain at all. Endometriosis can often be misdiagnosed with other conditions that cause pelvic pain, like pelvic inflammatory disease or ovarian cysts. It can also be confused with irritable bowel syndrome (IBS), which is a condition that causes bouts of diarrhea, constipation and abdominal cramping. However, IBS can accompany endometriosis.

Causes

Unfortunately, the exact cause of endometriosis is still unknown. Medical professionals and researchers have come up with a few explanations and theories. This is the a list of possible causes from the Mayo Clinic:

• Retrograde menstruation. In retrograde menstruation, menstrual blood containing endometrial cells flows back through the fallopian tubes and into the pelvic cavity instead of out of the body. These displaced endometrial cells stick to the pelvic walls and surfaces of pelvic organs, where they grow and continue to thicken and bleed over the course of each menstrual cycle.
• Transformation of peritoneal cells. In what's known as the "induction theory," experts propose that hormones or immune factors promote transformation of peritoneal cells — cells that line the inner side of the abdomen — into endometrial cells.
• Embryonic cell transformation. Hormones such as estrogen may transform embryonic cells — cells in the earliest stages of development — into endometrial cell implants during puberty.
• Surgical scar implantation. After a surgery, such as a hysterectomy or C-section, endometrial cells may attach to a surgical incision.
• Endometrial cells transport. The blood vessels or tissue fluid (lymphatic) system may transport endometrial cells to other parts of the body.
• Immune system disorder. It's possible that a problem with the immune system may make the body unable to recognize and destroy endometrial tissue that's growing outside the uterus.

Managing Endometriosis

The best treatment option for endometriosis is a minimally invasive laparoscopic excision surgery. A deep-excision should be performed during the laparoscopic surgery to reap the most benefits of this procedure. The surgeon will carefully remove the lesion including the tissue beneath the surface. Think of endometriosis like an iceberg; the disease is often identified as being above the surface of the tissue, but a majority is implanted into the tissue below the surface. This is why surgeons must perform a deep-excision in order to remove lesions in their entirety.

It is also ideal to have surgery with minimal use of heat and electricity. Surgeons will often use techniques like ablation (lasers that destroy the disease) or cauterization (burning off the disease) to remove endometriosis lesions. This can increase the chance of not fully removing the endometriosis lesions and can potentially damage the surrounding healthy tissue. This does not mean that lasers and high-energy devices cannot be used during surgery, but they should not be used for removing the lesions themselves.

It is a common myth that having a hysterectomy will cure endometriosis. A hysterectomy is rarely the best treatment, as most endometriosis is located in areas other than the reproductive organs. If a surgeon simply removes the uterus and does not excise the remaining lesions, the patient will continue to have pain. Decisions regarding a hysterectomy should be made with a doctor experienced in treating endometriosis and should only be performed if agreed upon by the patient.