The Mystery and Misery of Endometriosis

Pelvic pain, disabling cramps, extreme fatigue, painful sex, or infertility--all can warn of endometriosis.

This poorly understood disease devastates millions of women with no regard to race or income. It's a leading cause of infertility.

Cause unknown

No one's sure what causes endometriosis. Some doctors believe it occurs when menstrual fluid backs up through a woman's fallopian tubes (which move eggs from the ovaries to the womb) and falls into the pelvis behind the womb. Others blame heredity, immune disorders, or cellular changes. But it's not an infection or cancer.

A highly vascular tissue called the endometrium lines the uterus. In endometriosis, that tissue appears outside the uterus. It can grow on the outside of the uterus, fallopian tubes, ovaries, bowels, bladder, rectum, and surgical scars, or almost anywhere on the peritoneum, the lining of the abdominal cavity. In rare cases, it turns up in the lungs.

Outside the uterus, this tissue acts just as it would inside the uterus. Each month it breaks down and bleeds as a result of hormonal signals. But, without the normal cervical/vaginal outlet, the body can't get rid of the waste. Tissue and old blood can build up, causing inflammation, swelling, and scarring.

Severe pain

Endometriosis often causes great pain.

But the degree of pain doesn't reflect the severity of the disease. Some patients have no pain, while others with severe menstrual pain don't have the disease.

Surgery is the only sure way to diagnose the ailment. Doctors make a small incision and use a lighted instrument called a laparoscope to look inside the body.

Treatments include pain medicines, hormones, and surgery. Pregnancy also helps, by making lesions linked to the disease shrink and eventually heal, although they can return.

But the best treatment--and the degree of relief--varies from woman to woman.

Are you at risk?

How many of these symptoms have you had for at least six months?

• Pelvic pain. The pain may have a monthly pattern, for example being worse during your period and/or mid-cycle. Some women have constant pain.

• Fatigue, exhaustion, low energy.

• Diarrhea, painful bowel movements, or other stomach upset at the time of your period.

• Stomach bloating and swelling.

• Heavy or irregular menstrual bleeding.

If you said "yes" to any questions, tell your doctor about your symptoms.