Endometriosis, the presence of endometrial tissue (lining cells of the uterus) outside the uterine cavity, can be found both inside and outside the uterus. When found inside the myometrium, muscle tissue of the uterus, it is called adenomyosis.

The age range of this condition is anytime during the woman’s reproductive life. In other words, from puberty to menopause.

Adenomyosis can cause heavy bleeding, severe cramping during periods and an enlarged, boggy uterus which is tender on pelvic examination. However, sometimes no signs or symptoms are found.

Endometriosis can be found anywhere outside the uterus. It is most often found on the pelvic organs, including ovaries, fallopian tubes, surface of the uterus, and ligaments supporting and surrounding the uterus. It can also be found on the bowel, bladder and almost any other organ in the body.

The cause of endometriosis is unclear and has been debated for years. There does seem to be a family tendency for the disease. About 20% of women have a relative with endometriosis.

Endometriosis can cause pelvic pain, severe menstrual cramping, painful intercourse, premenstrual staining, heavy periods, diarrhea, blood in the urine and stool, and infertility. Many times even severe endometriosis causes no symptoms at all. It is often found during an infertility evaluation.

On physical examination, an immovable, backward uterus, ovarian cysts, and nodules found on the utero-sacral ligaments which are located behind the uterus may be found.

However, even with symptoms of endometriosis and physical examination findings that are consistent with endometriosis, a diagnosis of endometriosis CANNOT be made except by direst visualization with a laparoscope and possible biopsy if there is a question of the findings. Neither sonograms, x-rays, nor physical examination can give a definite diagnosis.

Endometriosis can now be treated both medically and surgically to decrease pain and increase pregnancy chances and is not a definitive reason for hysterectomy any more. In a future newsletter, I will discuss treatment of this disease.