Endometriosis occurs when tissues that usually grow inside uterus instead grow on the outside.  These tissues often grow on the surfaces of organs in the pelvis or abdomen, where they are not supposed to grow. It is the most common cause of pelvic pain and occurs in 20-25% of women with infertility, and is commonly diagnosed in at least 15% of all women of reproductive age.

Endometriosis mostly affects women in their reproductive years. Research has found that most women diagnosed with endometriosis are between 25 and 35 years of age. It is rare in postmenopausal women and common in Caucasian women as compared to African American and Asian women. It is therefore low in Hispanic women. Studies have also reported that endometriosis tends to occur commonly in taller, thin women with a low body mass index (BMI)

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The exact cause of endometriosis is unknown. Endometriosis may result from something called “retrograde menstrual flow,” in which some of the tissue that a woman sheds during her period flows into her pelvis. While most women who get their periods have some retrograde menstrual flow, not all of these women have endometriosis. Researchers are trying to uncover what other factors might cause the tissue to grow in some women, but not in others.

Another theory about the cause of endometriosis involves genes. This disease could be inherited, or it could result from genetic errors, making some women more likely than others to develop the condition. If researchers can find a specific gene or genes related to endometriosis in some women, genetic testing might allow health care providers to detect endometriosis much earlier, or even prevent it from happening at all.

Researchers are exploring other possible causes, as well. Estrogen, a hormone involved in the female reproductive cycle, appears to promote the growth of endometriosis. Therefore, some research is looking into endometriosis as a disease of the endocrine system, the body’s system of glands, hormones, and other secretions. Or, it may be that a woman’s immune system does not remove the menstrual fluid in the pelvic cavity properly, or the chemicals made by areas of endometriosis may irritate or promote growth of more areas. So, other researchers are studying the role of the immune system in either stimulating, or reacting to endometriosis.

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The two most common symptoms of endometriosis are pain and infertility.

Symptoms can include:

•    Pain before or after menstrual periods, as well as during or after sex
•    Lower back, intestinal, or pelvic pain
•    Heavy menstrual periods, or spotting and bleeding between periods
•    Painful bowel movements or painful urination during menstrual periods
•    Infertility – About 30 percent to 40 percent of women with endometriosis are infertile, making it one of the top three causes for female infertility

In most cases, the symptoms of endometriosis become milder after menopause because the growths begin to get smaller.

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Exams and Tests
The health care provider will perform a physical exam, including a pelvic exam. Tests that are done to help diagnose endometriosis include:

•    Pelvic exam
•    Transvaginal ultrasound
•    Pelvic laparoscopy

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There is currently no cure for endometriosis.  But a variety of treatment options exist, and there are ways to minimize the symptoms caused by the condition.

There are several ways to treat pain, including:

•    Pain medication – may be used to relieve symptoms
•    Hormone therapy – may be used to control the growth of endometriosis
•    Surgery – may be used to remove growths or control the size of very large endometriosis and to relieve pain.

Hormone treatments and surgery may help women who are unable to become pregnant.  There are also other treatments for infertility associated with endometriosis.

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Possible Complications
Endometriosis can lead to problems getting pregnant (infertility). Not all women, especially those with mild endometriosis, will have infertility. Laparoscopy to remove scarring related to the condition may help improve your chances of becoming pregnant. If it does not, fertility treatments should be considered.

Other complications of endometriosis include:
•    Long-term (chronic) pelvic pain that interferes with social and work activities
•    Large cysts in the pelvis (called endometriomas) that may break open (rupture)

In a few cases, endometriosis implants may cause blockages of the gastrointestinal or urinary tracts. This is rare.
Very rarely, cancer may develop in the areas of endometriosis after menopause.
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When to Contact a Medical Professional
Call for an appointment with your health care provider if:
•    You have symptoms of endometriosis
•    Back pain or other symptoms come back after endometriosis is treated

Consider getting screened for endometriosis if your mother or sister has been diagnosed with endometriosis, or if you are unable to become pregnant after trying for 1 year.

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Birth control pills may help to prevent or slow down the development of the endometriosis.

Natural Remedies

Chronic pain and bloating in a woman’s abdomen may point to an abnormality of the endometrial tissue. According toresearch or other evidence, the following self-care steps may provide some relief:

What You Need To Know:

Ease the soreness with C and E
Lessen the pain by
taking a daily combination of 1,000 mg of vitamin C and 1,200 IU of vitamin E

These recommendations are not comprehensive and are not intended to replace the advice of your doctor or pharmacist. Continue reading the full endometriosis article for more in-depth, fully-referenced information on medicines, vitamins, herbs, and dietary and lifestyle changes that may be helpful.

Dietary changes that may be helpful
There has been no research investigating the effect of any specific diet in women with endometriosis. Preliminary research suggests
that women who consume more than 5 grams of caffeine per month (about 1.5 cups of coffee a day) are more likely to have endometriosis. No study has
investigated whether avoiding caffeine improves the symptoms of endometriosis.

Lifestyle changes that may be helpful
Preliminary studies suggest that women who exercise two to four hours per week have less risk of developing endometriosis. However,
the benefit seems to be limited to those women who participate in vigorous exercise, such as jogging or other activities that raise the heart rate. Whether
exercise will reduce the symptoms of existing endometriosis is unknown.

Other therapies
Surgical treatments, such as removal of the endometrial areas, ovaries, or uterus mayalso be recommended.

Vitamins that may be helpful
In a study of women with pelvic pain presumed to be due to endometriosis, supplementation with vitamin E (1,200 IU per day) and
vitamin C (1,000 mg per day) for two months resulted in an improvement of pain in 43% of women, whereas none of the women receiving a placebo reported pain relief.

Animal research suggests that fish oils may reduce the severity of endometriosis, and fish oils have been shown to improve symptoms of dysmenorrhea
(painful menstruation), which may be caused by endometriosis. Therefore, while no specific research has been done on the effects of fish oils in women with endometriosis, some health practitioners recommend several grams of fish oil per day for this condition.

Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.

Herbs that may be helpful 

Vitex is recommended either alone or in combination with other herbs, such as dandelion root, prickly ash, and motherwort, by some doctors to treat the symptoms of endometriosis. Although vitex affects hormones that in turn affect the severity of endometriosis, and it may be effective for premenstrual syndrome, no research has tested the effect of vitex supplementation on women with endometriosis. Similarly, no other botanical medicines have been scientifically researched for treating this disease.

Are there any side effects or interactions?
Refer to the individual herb for information about any side effects or interactions.

Holistic approaches that may be helpful
According to preliminary reports, regular meetings with other endometriosis sufferers may help women with endometriosis learn about
the disease and cope better with the many psychological and emotional issues that often accompany this condition. One preliminary study found that women who had the opportunity to speak with other women with endometriosis, as well as to meet with their physician, had a higher satisfaction with their overall care.

Acupuncture has been reported anecdotally to help control the pain associated with some cases of endometriosis, but no controlled studies
have confirmed this claim. One small, preliminary study found that auricular acupuncture (acupuncture of the ear) was as effective as hormone therapy in treating infertility due to endometriosis.

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