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(Image by Mayo Clinic)

(Image by Mayo Clinic)

Endometriosis is the abnormal growth of cells (endometrial cells) similar to those that form the inside of the uterus, but in a location outside of the uterus. Endometrial cells are cells that are shed each month during menstruation. In endometriosis, endometrial cells attach themselves to tissue outside the uterus and are called endometriosis implants. These implants are most commonly found on the ovaries, the Fallopian tubes, outer surfaces of the uterus or intestines, and on the surface lining of the pelvic cavity. They can also be found in the vaginacervix, and bladder, although less commonly than other locations in the pelvis.

  • Endometriosis affects women in their reproductive years. Most cases of endometriosis are diagnosed in women who are 25-35 years old. However, endometriosis has been reported in girls as young as 11 years of age.

  • The exact prevalence of endometriosis is not known, since many women may have the condition and have no symptoms. Endometriosis is estimated to affect from 3% to 18% of women in the United States.

  • It is estimated that 20% to 50% of women being treated for infertility have endometriosis, and up to 80% of women with chronic pelvic pain may be affected with endometriosis.

  • Endometriosis is a chronic condition that has reproductive and health consequences.

  • It is also among the leading cause in infertility in black women (NIH, DHHS, CDC, NIAID).

Prevalence of Endometriosis in Black Women

  • A great number of Black women are affected by endometriosis. The Endometriosis Association suggests that endometriosis, which is symptomatically characterized by pelvic pain, dysmenorrhea, infertility, and abnormal vaginal bleeding, has often been misdiagnosed in black women as Pelvic Inflammatory Disease (PID) a sexually transmitted disease.

  • A study by the American Journal of Obstetrics and Gynecology reported that 40% African American women who were told they had PID in reality had endometriosis.

What are the Symptoms of Endometriosis?

Most common symptoms are pain (usually pelvic) and infertility. Pelvic pain usually occurs during or just before menstruation and lessens after menstruation. Some women experience painful sexual intercourse (dyspareunia) or cramping during intercourse, and/ or pain during bowel movements and/or urination. Even pelvic examination by a doctor can be painful.  Other symptoms may include: lower abdominal paindiarrhea and/or constipationlow back painirregular or heavy menstrual bleeding, or blood in the urine.

Endometriosis and Infertility

  • Between 20% and 50% of women who are infertile have endometriosis. Some women may have more than one possible cause of infertility.

  • Doctors/researchers believe that the endometrial implants may change the chemical and hormonal makeup in the fluid that surrounds the organs in the abdominal cavity.

  • Such a change can: Interfere with or prevent the release of eggs from the ovaries (ovulation). Some women with endometriosis do not ovulate at all.

How is endometriosis diagnosed?

  • Endometriosis can be suspected based on symptoms of pelvic pain and findings during physical examinations in the doctor's office. Occasionally, during a rectovaginal, the doctor can feel nodules (endometrial implants) behind the uterus and along the ligaments that attach to the pelvic wall. At other times, no nodules are felt, but the examination itself causes unusual pain or discomfort.

  • Neither the symptoms nor the physical examinations can be relied upon to conclusively establish the diagnosis of endometriosis. Imaging studies, such as ultrasound, can be helpful in ruling out other pelvic diseases and may suggest the presence of endometriosis in the vaginal and bladder areas, but still cannot definitively diagnose endometriosis. For an accurate diagnosis, a direct visual inspection inside of the pelvis and abdomen, as well as tissue biopsy of the implants are necessary.

  • Laparoscopy is the most common surgical procedure for the diagnosis of endometriosis. Laparoscopy is a minor surgical procedure done under general anesthesia, or in some cases under local anesthesia. It is usually performed as an out-patient procedure (the patient goes home the same day).

How is Endometriosis Treated?

Endometriosis can be treated with medications and/or surgery. The goals of endometriosis treatment may include pain relief and/or enhancement of fertility.

Endometriosis Fact Sheet

No one knows for sure what causes this disease, but experts have a number of theories:

  • Since endometriosis runs in families, it may be carried in the genes, or some families may have traits that make them more likely to get it.

  • Endometrial tissue may move from the uterus to other body parts through the blood system or lymph system.

  • If a woman has a faulty immune system it will fail to find and destroy endometrial tissue growing outside of the uterus. Recent research shows that immune system disorders and certain cancers are more common in women with endometriosis.

  • The hormone estrogen appears to promote the growth of endometriosis. Researchers are looking at whether it is a disease of the endocrine system -the body’s system of glands, hormones, and other secretions.

  • New research shows a link between dioxin exposure and susceptibility to endometriosis. Dioxin is the name given to a group of 200+ chemicals that are formed as unwanted by-products of industrial manufacturing and burning activities. Dioxin is a powerful hormone-disrupting chemical (EDCs). More research is needed to find out whether man-made chemicals cause endometriosis.

  • Endometrial tissue may back up into the abdomen through the fallopian tubes during a woman's monthly period; this is usually referred to as “retrograde menstruation.”

For more information about endometriosis, please contact the following organizations:

- Endometriosis Association — Phone: 414-355-2200 - Office on Women’s Health — Phone: 800-994-9662 (TDD: 888-220-5446) - Endometriosis Research Center — Phone: 561-274-7442 - The American College of Obstetricians and Gynecologists — Phone: 202-638-5577 - Eunice Kennedy Shriver National Institute of Child Health and Human Development - Centers for Disease Control and Prevention — United States Cancer Statistics - National Institutes of Health