Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
In this Article
- Endometriosis facts
- What is endometriosis?
- Who is affected by endometriosis?
- What causes endometriosis?
- What are endometriosis symptoms?
- Endometriosis and cancer risk
- Does diet affect endometriosis?
- How is endometriosis diagnosed?
- How is endometriosis treated?
- Medical treatment of endometriosis
- Surgical treatment of endometriosis
- Treatment of infertility associated with endometriosis
- Endometriosis FAQs
- Find a local Obstetrician-Gynecologist in your town
What are endometriosis symptoms?
Most women who have endometriosis, in fact, do not have symptoms. Of those who do experience symptoms, the common symptoms are:
- Pain (usually pelvic) that usually occurs just before menstruation and lessens after menstruation
- Painful sexual intercourse
- Cramping during intercourse
- Cramping or pain during bowel movements or urination
- Painful pelvic exam
The pain intensity can change from month to month, and vary greatly among women. Some women experience progressive worsening of symptoms, while others can have resolution of pain without treatment.
Pelvic pain in women with endometriosis depends partly on where the implants of endometriosis are located.
- Deeper implants and implants in areas with many pain-sensing nerves may be more likely to produce pain.
- The implants may also produce substances that circulate in the bloodstream and cause pain.
- Lastly, pain can result when endometriosis implants form scars. There is no relationship between severity of pain and how widespread the endometriosis is (the "stage" of endometriosis).
Endometriosis can be one of the reasons for infertility for otherwise healthy couples. When laparoscopic examinations are performed for infertility evaluations, endometrial implants can be found in some of these patients, many of whom do not have painful symptoms of endometriosis. The reasons for a decrease in fertility are not completely understood, but might be due to both anatomic and hormonal factors. The presence of endometriosis may involve masses of tissue or scarring (adhesions) within the pelvis that may distort normal anatomical structures, such as Fallopian tubes, which transport the eggs from the ovaries. Alternatively, endometriosis may affect fertility through the production of hormones and other substances that have a negative effect on ovulation, fertilization of the egg, and/or implantation of the embryo.
Other symptoms that can be related to endometriosis include:
- lower abdominal pain,
- diarrhea and/or constipation,
- low back pain,
- chronic fatigue
- irregular or heavy menstrual bleeding,
- painful urination, or
- blood in the urine.
Endometriosis and cancer risk
Women with endometriosis have an increased risk for development of certain types of cancer of the ovary, known as epithelial ovarian cancer (EOC), according to some research studies. This risk is highest in women with endometriosis and primary infertility (those who have never borne a child), but the use of oral contraceptive pills (OCPs), which are sometimes used in the treatment of endometriosis, appears to significantly reduce this risk.
The reasons for the association between endometriosis and ovarian epithelial cancer are not clearly understood. One theory is that the endometriosis implants themselves undergo transformation to cancer. Another possibility is that the presence of endometriosis may be related to other genetic or environmental factors that also increase a women's risk of developing ovarian cancer.
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