During a normal menstrual cycle, the lining of your uterus -- called the endometrium -- begins to thicken in preparation for becoming pregnant. If you don't become pregnant that month, your body sheds the endometrium during menstruation and the process starts over. In endometriosis, for reasons that doctors don't entirely understand, tissue very similar to the endometrium begins to grow outside the uterus in various places that it shouldn't. It can appear in or on the ovaries, the fallopian tubes, the various structures that support the uterus, and the lining of the pelvic cavity. Sometimes it's found in other places as well, including the cervix, vagina, rectum, bladder, bowel, and elsewhere.
Your doctor will ask you questions and do a pelvic exam. But your doctor won't know for sure that it's endometriosis until a surgeon can examine your body internally.
The most common procedure is called laparoscopy. During this surgery a thin, lighted tube is inserted into the abdomen through a small incision.
Women are usually unconscious when it's done. Many doctors remove a small piece of tissue and test it to confirm the diagnosis of endometriosis.
The problem is that this tissue behaves like normal endometrial tissue -- it builds up and breaks down with your menstrual cycle -- but it can't be shed like normal endometrial tissue during your period. As a result, endometriosis can cause irritation, inflammation, and the formation of scar tissue. This buildup of tissue can prevent the eggs from getting out of the ovaries or being fertilized by sperm. It can also scar and block the fallopian tubes, preventing the egg and sperm from meeting.
In addition to fertility problems, some common signs and symptoms of endometriosis include:
Most women who have endometriosis can conceive normally. But if you're having problems getting pregnant, endometriosis may be the cause. To find out, your doctor may suggest a laparoscopy. In this procedure, a surgeon inserts a small camera through a tube into your abdomen to check for abnormal endometrial tissue. The surgeon might want to confirm the diagnosis with a biopsy. If you've been diagnosed with endometriosis, you have several treatment options, depending on the severity of the disease.
Medication, either alone or in combination with surgery, can often decrease inflammation and reduce pain. If you and your doctor opt for surgery, the surgeon can attempt to remove as much of the diseased tissue as possible. In some women, surgery significantly improves their chances of getting pregnant. You should know, however, that pregnancy rates tend to be lower for women with severe endometriosis.
Since many women with endometriosis have ovulation problems, another treatment option is the use of fertility drugs such as Clomid to induce ovulation. Injectable hormones also may be prescribed for the same reason. Once you begin to successfully ovulate, your doctor may suggest trying artificial insemination, in which sperm is inserted directly into your uterus.
Keep in mind that some standard treatments for endometriosis can either prevent pregnancy or, in the case of the hormone Danocrine, cause serious birth defects. Make sure your doctor knows that you are trying to conceive if you're being treated for endometriosis.