More than six million North American women suffer severe pelvic pain due to endometriosis. This condition occurs when parts of the uterine lining grows outside the uterus. Ordinarily, the lining, or endometrium, thickens during ovulation and then thins again, with the excess tissue being part of menses. However, in endometriosis, this tissue, not being in the uterus, has nowhere to go and build up. This causes pain, scarring, and sometimes adhesions connecting organs that are normally separate, and can threaten fertility.

In some cases, the pain occurs during menstruation, or mid-cycle, or both; for other patients, however, there is no detectible pattern. People with endometriosis may also experience pain during bowel movements, urination, or intercourse. The severity of the pain and the severity of the condition are not directly connected. Other symptoms include heavy periods, bleeding between periods, constipation, diarrhea, or bloating. Endometriosis tends to run in families, but it is not a congenital condition. It generally does not develop in people who have given birth. Women with short cycles are at risk.

What appears to cause endometriosis is what is called retrograde menstruation, in which some menstrual blood, with uterine cells in, goes the wrong way into the stomach or fallopian tubes, depositing bits of endometrium there. Endometrial cells outside the uterus are supposed to be taken care of by the immune system, but for unclear reasons, this doesn’t always happen.

People experiencing symptoms need to be tested to confirm that endometriosis is the cause. A pelvic exam or a vaginal ultrasound can find signs of the condition, though a laparoscopy, in which a small camera is inserted directly into the abdomen through a tiny incision, is the only way to be sure. If uterine lining cells are found where they don’t belong, treatment is generally focused on managing the condition with pain medications or hormone treatments. If the disease is causing fertility problems, surgery may be needed to remove the endometrial implants. Conversely, if the uterus is severely damaged, hysterectomy may be the only option.

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