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Symptoms and Causes of Endometriosis

What is endometriosis?
Symptoms of endometriosis
Causes of endometriosis
How common is endometriosis?

What is Endometriosis?

Endometriosis is a condition where endometrium (the lining of the uterus) is found in locations outside the uterus. This misplaced tissue may be found on the ovaries, uterus, bowel, bladder utero-sacral ligaments (ligaments that hold the uterus in place), or peritoneum (covering lining of the pelvis and abdominal cavity). On rare occasions it can be found in other distant sites.

What are the Symptoms of Endometriosis?

Endometriosis is typically detected through pain which may be felt :

With period
During ovulation
In the bowel during menstruation
When urinating
During intercourse
In the lower back
Diarrhea or constipation
Heavy bloating
Fatigue
“Premenstrual syndrome” (PMS-type symptoms)
Heavy periods

Endometriosis may also be found during the investigation of infertility.

What are the Causes of Endometriosis?

Commonly during the menstrual period, cells can be found in the fluid behind the uterus. The most widely held theory, retrograde menstruation, states that endometriosis occurs when endometrial fragments attach to nearby pelvic structures and grow. Other theories include tissue transplantation, induction of changes in peritoneal lining cells, spread through uterine veins, and direct extension through the lymphatic system. No one theory seems to explain all cases.

As endometrial cells are frequently seen in peritoneal fluid in all women at the time of menses, one would expect endometriosis to develop in everyone. Obviously this is not the case. Unfortunately, we don't really know why. Is the immune system the cause? Immunological changes have been demonstrated in women with endometriosis, however, it is uncertain whether these immunologic findings are responsible for the endometriosis or are a result of the inflammation caused by endometriosis.

How Common is Endometriosis?

At the time of tubal ligation 2-5% of women will have endometriosis, while between 25-50% of infertile women have been reported to have endometriosis. Endometriosis effects 5 million U.S. women, approximately 6-7% of all females, 30-40% of whom are infertile.

The American Society of Reproductive Medicine (ASRM) has established a grading system to document the degree of severity of the disease. Unfortunately, this has not been particularly helpful in predicting response to therapy. Stage I constitutes a mild form of endometriosis whereas Stage IV is the most severe form.