1. ENDOMETRIOSIS

2. Table of Contents: Endometriosis: What is it? Signs & Symptoms
Tests & Diagnostics
Treatments & Medications
Important Risk Factors
Pregnancy & Infertility
Support Groups & Links
Glossary
References

3. Endometriosis: What is it?
Endometriosis is a pathological condition in which endometrial tissue has been placed to various sites in the abdominal or pelvic cavity.

4.  Endometriosis forms implants in the areas of the endometrial tissue– most often occurring in the:
Peritoneum
Ovaries
Fallopian Tube
Outer surfaces of the uterus, bladder, ureters, intestines, and rectum.
Cul-de-sac (the space behind the uterus).
Causes:
Endometrial implants respond to changes in hormones (estrogen).
Implants may grow and bleed like a menstrual cycle while surrounding tissue becomes irritated, inflamed, and swollen.
Breakdown and bleeding each month causes scar tissue (adhesions), to form and may cause organs to stick together.
Bleeding and inflammation are what cause most pain, especially before menstruation.

5. Signs & Symptoms Chronic pelvic pain (before/during menstruation).
Pain during sex.
Heavy menstrual bleeding
If present in bowel– pain during bowel movements.
If effects bladder– pain during urination
Many women have NO symptoms.

6. Tests & Diagnostics Physical and pelvic examination.
Laparoscopy/biopsy.

7. Treatments & Medications
Medication (pain/hormonal)
Surgery- endometrial implants are removed and can help relieve pain and improve infertility.
Both medication and surgery.
Hysterectomy (last resort)
Note: Depends on extent of disease, symptoms, and wanting to reproduce.
Pain relievers– nonsteroidal anti- inflammatory drugs (NSAID)
Hormonal medications such as birth control, progestin-only medications, and gonadotropin-hormonal medications.
Note: Hormonal medications helps slow the growth of endometrial tissue and keep new adhesions from forming. Hormonal medications do NOT get rid of endometrial tissue already present.

8. Important Risk Factors
40-80% of women have pain return within 24 months of surgery (the more severe, the more likely to return).
Pain and hormonal medications may become a part of your life (side effects may occur).
After surgery, if severe pain remains, a hysterectomy will be considered (less likely to come back if ovaries are removed).
If you decide to keep your ovaries but still remove endometrial implants during hysterectomy, endometriosis is less likely to come back.
There is a small chance endometriosis may return even after hysterectomy (due to endometrial tissue/implants not being visible during surgery removal).

9. Pregnancy & Infertility
5-10% of all women have endometriosis and most of these women are not infertile.
Note: Endometriosis can cause delay in getting pregnant, but once you are pregnant, pregnancy is expected to be no different from normal. There are reports of women who had more pain in the first few months of pregnancy. In general, pain improves, but may return after giving birth as periods return.
30-40% of infertile women have endometriosis.
Note: Endometriosis does not necessarily cause infertility but there is an association with fertility problems, although the cause is not fully established. Even with severe endometriosis, natural conception is still possible.

10. Support Groups & Links Endometriosis Foundation of America
Endometriosis Research Center
The Endometriosis Coalition
Endometriosis Association
More links in the U.S.
Worldwide Links
More Information on Endometriosis

11. GLOSSARY
Adhesions: Scarring that binds together the surfaces of tissues.
Biopsy: A minor surgical procedure to remove a small piece of tissue that is then examined under a microscope in a laboratory.
Bladder: A muscular organ in which urine is stored.
Endometriosis: A condition in which endometrial tissue has been displaced to various sites in the abdominal or pelvic cavity.
Endometrium: The lining of the uterus.
Estrogen: A female hormone produced in the ovaries.
Fallopian Tubes: Tubes through which an egg travels from the ovary to the uterus.

12. Gonadotropin-Releasing Hormone Agonists: Medical therapy used to block the effects of certain hormones.
Hormone: A substance produced by the body to control the functions of various organs.
Hysterectomy: Removal/surgical excision of the uterus.
Infertility: A condition in which a couple has been unable to get pregnant after 12 months without the use of any form of birth control.
Inflammation: Pain, swelling, redness, and irritation of tissues in the body.
Laparoscopy: A surgical procedure in which an instrument called a laparoscope is inserted into the pelvic cavity through small incisions. The laparoscope is used to view the pelvic organs. Other instruments can be used with it to perform surgery.
Ovaries: Two glands, located on either side of the uterus, that contain the eggs released at ovulation and that produce hormones.

13. Pelvic Exam: A physical examination of a woman’s reproductive organs.
Peritoneum: The membrane that lines the abdominal cavity and surrounds the internal organs.
Progestin: A synthetic form of progesterone that is similar to the hormone produced naturally by the body.
Rectum: The last part of the digestive tract.
Ureters: A pair of tubes, each leading from one of the kidneys to the bladder.
Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.

14. REFERENCES
Made by Nucleus Medical Media (December 16, 2013.) YouTube- Endometriosis.
E, J. (2015.) Medical Terminology for Health Care Professionals: Chapter 17- Female Reproductive System with an Overview of Obstetrics (Pg.610) Boston: Pearson.
Written by the American College of Obstetricians and Gynecologists (October 2012.) Frequently Asked Questions Gynecologic Problems- Endometriosis.
Written by Dr. Richard Sherbahn, MD, Program Director at Advanced Fertility Center of Chicago, S.C. (2017.) Advanced Fertility- The Effect of Endometriosis on Fertility and Infertility.
Written by Endometriosis UK (September 2008.) Endometriosis-UK- Endometriosis, fertility, and pregnancy.