The information provided by Advanced Healthcare for Women and E. Daniel Biggerstaff, III, M.D. is for informational purposes only. As each woman is unique, do not rely on this information for diagnosis and treatment. We cannot guarantee the accuracy of the content and advise that you see a qualified Health Care Professional for individual needs and care.

What is Endometriosis?

The tissue lining the inside of the uterus is called the endometrium. When this tissue grows outside the uterus and into the pelvis or abdomen, the condition is called endometriosis.  Endometriosis most often affects the reproductive organs (ovaries, fallopian tubes, uterus) and the thin, saran wrap™-like lining of the abdominal cavity called the peritoneum. The growth may be very superficial or it may deeply invade the surrounding tissues.  Endometriosis may also grow on the intestines or bladder or, more rarely, in distant sites.  Endosalpingiosis is a condition similar in appearance and symptoms to endometriosis.  It differs from endometriosis in that microscopically the tissue looks like the inside of the fallopian tube, rather than like the lining of the uterus.  Endosalpingiosis is diagnosed and treated the same way as endometriosis.

This image shows classic endometriosis as a dark spot in the center. The dark spot is surrounded by subtle endometriosis, seen as orange discoloration of the peritoneum.


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This image shows a normal appearing uterus, fallopian tubes, and ovaries.  An area of dark endometriosis is seen on the posterior aspect of the cervix.


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Endometriosis tissue responds to the hormones of the menstrual cycle, bleeding each month in the same way the lining of the uterus responds to hormones.  However since endometriosis tissue is not in the uterus, then the blood it sheds has no way to leave the body.  When the tissue bleeds, this causes irritation and inflammation. Cysts, adhesions and scar tissue can form, and the area around the endometriosis thickens.

How does it occur?

Why some women develop endometriosis and not others is simply not known.  There are many theories, but none of them explains all cases. One theory suggests that in some women part of the endometrial tissue flows backwards during menstrual flow into the fallopian tubes and abdomen.  There, it attaches and grows.  Still another theory states that either the presence or absence of unknown substances may stimulate the growth of endometriosis from multi-potential cells (cells in the body that can become many different types of tissue).  One final theory is that endometrial tissue may travel to areas outside the uterus through blood vessels or the lymph system.  In recent years, researchers have found certain chemicals present in higher amounts in women with endometriosis than in women who do not have endometriosis.


What are the symptoms of endometriosis?

Some women have no symptoms.  If symptoms do occur, they may include:

     •   Abnormal or heavy menstrual flow
     •   Pelvic, back or flank pain before or during menstrual period
     •   Very painful menstrual cramps
     •   Painful intercourse
     •   Painful bowel movements, diarrhea, constipation or other intestinal           upsets during your period
     •   Painful urination or feeling the need to urinate often during the                   menstrual cycle
     •   Difficulty becoming pregnant


How is endometriosis diagnosed?

Before treatment can begin, a definite diagnosis is required.  First, the doctor may do a physical exam, feeling for cysts or nodules or any abnormal tenderness or thickening in your pelvis.  Unfortunately, endometriosis cannot be diagnosed with ultrasound, CT or MRI.   Usually, an outpatient surgical procedure called a laparoscopy is required.  Your surgeon inserts a small instrument called a laparoscope through an incision in the navel to look at the organs in the abdomen and pelvic cavity.  With laparoscopy, the size, location, and number of endometrial growths can be seen.  If endometriosis is seen or suspected, the tissue is removed to confirm the diagnosis and to treat the condition.


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