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 Slideshow Pictures
- Take the Endometriosis Quiz!
- Pelvic Pain Pictures Slideshow
- Endometriosis FAQs
- Find a local Obstetrician-Gynecologist in your town
What are the signs and symptoms endometriosis?
Most women who have endometriosis, in fact, do not have symptoms. Of those who do, the most common include:
- 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
- Pain with pelvic examinations
The intensity of the pain can vary from month to month, and can vary greatly among affected individuals. 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 endometrial implants of endometriosis are located.
- Deeper implants and implants in areas of high nerve density are more apt to produce pain.
- The implants may also release substances into the bloodstream which are capable of eliciting pain.
- Pain can result when endometriotic implants incite scarring of surrounding tissues. There appears to be no relationship between severity of pain and the amount of anatomical disease which is present.
Endometriosis can be one of the reasons for infertility for otherwise healthy couples. When laparoscopic examinations are performed during evaluations for infertility, implants are often found in individuals who are totally asymptomatic. The reasons diminished fertility in many patients with endometriosis are not understood. Endometriosis may incite scar tissue formation within the pelvis. If the ovaries and Fallopian tubes are involved, the mechanical processes involved in the transfer of fertilized eggs into the tubes may be altered. Alternatively, the endometriotic lesions may produce inflammatory substances which adversely affect ovulation, fertilization, and implantation.
Other symptoms that can be related to endometriosis include
- lower abdominal pain,
- diarrhea and/or constipation,
- low back pain,
- chronic fatigue
- irregular or heavy menstruation,
- painful urination, or
- bloody urine (particularly during menstruation).
Does endometriosis increase a woman's risk of getting cancer?
Some studies have postulated that women with endometriosis have an increased risk for development of certain types of ovarian cancer, known as epithelial ovarian cancer (EOC). This risk is highest in women with both endometriosis and primary infertility (those who have never conceived a pregnancy). The use of combination 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 malignant transformation to cancer. Another possibility is that the presence of endometriosis may be related to other genetic or environmental factors that serve to increase a women's risk of developing ovarian cancer.
What causes endometriosis?
The cause of endometriosis is unknown. One theory is that the endometrial tissue is deposited in unusual locations by the retrograde flow of menstrual debris through the Fallopian tubes into the pelvic and abdominal cavities. The cause of this retrograde menstruation is not clearly understood. It is clear that retrograde menstruation is not the only cause of endometriosis, as many women who have retrograde menstruation do not develop the condition.
Another possibility is that areas lining the pelvic organs possess primitive cells that are able to develop into other forms of tissue, such as endometrium. (This process is termed coelomic metaplasia.)
It is also likely the direct transfer of endometrial tissues at the time of surgery may be responsible for the endometriosis implants occasionally found in surgical scars (for example, episiotomy or Cesarean section scars). Transfer of endometrial cells via the bloodstream or lymphatic system is the most plausible explanation for the rare cases of endometriosis that are found in the brain and other organs remote from the pelvis.
Finally, there is evidence that some women with endometriosis have an altered immune response in women with endometriosis, which may affect the body's natural ability to recognize ectopic endometrial tissue.
Find out what women really need.