Endometriosis is a problem affecting a woman’s uterus—the place where a baby grows when a woman is pregnant. Endometriosis is when the kind of tissue that normally lines the uterus grows somewhere else. It can grow on the ovaries, behind the uterus, on the bowels, or on the bladder. Rarely, it grows in other parts of the body.
This “misplaced” tissue can cause pain, infertility, and very heavy periods. The pain is usually in the abdomen, lower back, or pelvic areas. Some women have no symptoms at all, and having trouble getting pregnant may be the first sign they have endometriosis.
Uterine FibroidsExternal (MedlinePlus)
Uterine fibroids are the most common noncancerous tumors in women of childbearing age. Fibroids are made of muscle cells and other tissues that grow in and around the wall of the uterus, or womb. The cause of fibroids is unknown. Risk factors include being African-American or being overweight. The symptoms of fibroids include
- Heavy or painful periods or bleeding between periods.
- Feeling “full” in the lower abdomen.
- Urinating often.
- Pain during sex.
- Lower back pain.
- Reproductive problems, such as infertility, multiple miscarriages, or early labor.
But some women will have no symptoms. That is why it is important to see your health care provider for routine exams.
Gynecologic Cancer
CDC provides information and educational materials for women and health care providers to raise awareness about the five main gynecologic cancers. Gynecologic cancer is any cancer that starts in a woman’s reproductive organs. Gynecologic cancers begin in different places within a woman’s pelvis, which is the area below the stomach and in between the hip bones.
- Cervical cancer begins in the cervix, which is the lower, narrow end of the uterus.
- Ovarian cancer begins in the ovaries, which are located on each side of the uterus.
- Uterine cancer begins in the uterus, the pear-shaped organ in a woman’s pelvis where the baby grows when a woman is pregnant.
- Vaginal cancer begins in the vagina, which is the hollow, tube-like channel between the bottom of the uterus and the outside of the body.
- Vulvar cancer begins in the vulva, the outer part of the female genital organs.
HIV/AIDS
HIV can be spread through breast milk, so mothers in the US who have HIV should not breast-feed their babies.
HIV is the human immunodeficiency virus. HIV affects specific cells of the immune system (called CD4 cells). Over time, HIV can destroy so many of these cells that the body can’t fight off infection anymore. The human body cannot get rid of HIV—that means once a person has HIV, he or she has it for life. There is no cure at this time, but with proper medical care, the virus can be controlled. HIV is the virus that can lead to acquired immune deficiency syndrome, or AIDS. AIDS is the late stage of HIV infection, when a person’s immune system is severely damaged.
HIV in Women
Women who are infected with HIV typically get it by having sex with a man who is infected or by sharing needles with an infected person. Women of minority races/ethnicities are especially affected, and black or African American women are the most affected group.
Pregnant Women All pregnant women should know their HIV status. Pregnant women who are HIV-positive can work with their health care providers to ensure their babies do not contract HIV during pregnancy, delivery, or after delivery (through breast milk). It is possible for a mother to have HIV and not spread it to her baby, especially if she knows about her HIV status early and works with her health care provider to reduce the risk.
Learn more from CDC’s Act Against AIDS campaign including how HIV is spread, and how to prevent HIV.
Interstitial Cystitis
Interstitial cystitis (IC) is a chronic bladder condition resulting in recurring discomfort or pain in the bladder or surrounding pelvic region. People with IC usually have inflamed or irritated bladder walls that can cause scarring and stiffening of the bladder. IC can affect anyone; however, it is more common in women than men. Some people have some or none of the following symptoms:
- Abdominal or pelvic mild discomfort.
- Frequent urination.
- A feeling of urgency to urinate.
- Feeling of abdominal or pelvic pressure.
- Tenderness.
- Intense pain in the bladder or pelvic region.
- Severe lower abdominal pain that intensifies as the urinary bladder fills or empties.
Polycystic Ovary Syndrome (PCOS)
External
(MedlinePlus)Polycystic ovary syndrome happens when a woman’s ovaries or adrenal glands produce more male hormones than normal. One result is that cysts (fluid-filled sacs) develop on the ovaries. Women who are obese are more likely to have PCOS. Women with PCOS are at increased risk of developing diabetes and heart disease. Symptoms may include
- Infertility.
- Pelvic pain.
- Excess hair growth on the face, chest, stomach, thumbs, or toes.
- Baldness or thinning hair.
- Acne, oily skin, or dandruff.
- Patches of thickened dark brown or black skin.
Sexually Transmitted Diseases (STDs)
STDs are infections that you can get from having sex with someone who has the infection. The causes of STDs are bacteria, parasites, and viruses. There are more than 20 types of STDs. Read more about specific STDs from these CDC fact sheets.
Most STDs affect both men and women, but in many cases the health problems they cause can be more severe for women. If a pregnant woman has an STD, it can cause serious health problems for the baby.
If you have an STD caused by bacteria or parasites, your health care provider can treat it with antibiotics or other medicines. If you have an STD caused by a virus, there is no cure, but antiviral medication can help control symptoms. Sometimes medicines can keep the disease under control. Correct usage of latex condoms greatly reduces, but does not completely eliminate, the risk of catching or spreading STDs.
Sexual Violence
Sexual Violence (SV) is a significant problem in the United States. SV refers to sexual activity where consent is not obtained or freely given. Anyone can experience SV, but most victims are female. The person responsible for the violence is typically male and is usually someone known to the victim. The person can be, but is not limited to, a friend, coworker, neighbor, or family member. Learn more about sexual violence risk and protective factors. The ultimate goal is to stop sexual violence before it begins.
Intimate partner violence (IPV) is a serious, preventable public health problem that affects millions of Americans. The term intimate partner violence describes physical, sexual, or psychological harm by a current or former partner or spouse. This type of violence can occur among heterosexual or same-sex couples and does not require sexual intimacy.
Resources
Find a Health CenterExternal
Health Resources Services Administration (HRSA) health centers care for you, even if you have no health insurance. You pay what you can afford, based on your income.
Womenshealth.gov: A—Z Health TopicsExternal
Endometriosis is a common gynecological condition affecting an estimated 2 to 10 percent of American women of childbearing age. The name of this condition comes from the word "endometrium," which is the tissue that lines the uterus.
During a woman's regular menstrual cycle, this tissue builds up and is shed if she does not become pregnant. Women with endometriosis develop tissue that looks and acts like endometrial tissue outside of the uterus, usually on other reproductive organs inside the pelvis or in the abdominal cavity. Each month, this misplaced tissue responds to the hormonal changes of the menstrual cycle by building up and breaking down just as the endometrium does, resulting in small bleeding inside of the pelvis. This leads to inflammation, swelling and scarring of the normal tissue surrounding the endometriosis implants.
When the ovary is involved, blood can become embedded in the normal ovarian tissue, forming a "blood blister" surrounded by a fibrous cyst, called an endometrioma.
Endometriosis affects hundreds of thousands of women every year. Cramps are never pleasant, but for women with endometriosis, they’re unbearable. Discover which symptoms may indicate endometriosis.
The causes of endometriosis are still unknown. One theory suggests that during menstruation, some of the tissue backs up through the fallopian tubes into the abdomen, a sort of "reverse menstruation," where it attaches and grows. Another theory suggests that endometrial tissue may travel and implant via blood or lymphatic channels, similar to the way cancer cells spread. A third theory suggests that cells in any location may transform into endometrial cells.
Endometriosis can also occur as a result of direct transplantation—in the abdominal wall after a cesarean section, for example. Additionally, it appears that certain families may have predisposing genetic factors to the disease.
The most common sites of endometriosis include:
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The ovaries
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The fallopian tubes
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Ligaments that support the uterus (uterosacral ligaments)
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The posterior cul-de-sac, i.e., the space between the uterus and rectum
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The anterior cul-de-sac, i.e., the space between the uterus and bladder
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The outer surface of the uterus
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The lining of the pelvic cavity
Occasionally, endometrial tissue is found in other places, such as:
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The intestines
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The rectum
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The bladder
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The vagina
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The cervix
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The vulva
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Abdominal surgery scars
When it comes to sexual and reproductive health, it can be hard to know what’s “normal” and what may be a sign of a potential health problem. Even if you feel embarrassed about certain issues, your gynecologist has seen and heard it all and is there to help you, not to pass judgment.
While any woman may develop endometriosis, the following women seem to be at an increased risk for the disease:
- Women who have a first-degree relative (mother, sister, daughter) with the disease
- Women who are giving birth for the first time after age 30
- Women with an abnormal uterus
Endometriosis Symptoms
The following are the most common symptoms for endometriosis, but each woman may experience symptoms differently or some may not exhibit any symptoms at all. Symptoms of endometriosis may include:
- Pain, especially excessive menstrual cramps that may be felt in the abdomen or lower back
- Pain during intercourse
- Abnormal or heavy menstrual flow
- Infertility
- Painful urination during menstrual periods
- Painful bowel movements during menstrual periods
- Other gastrointestinal problems, such as diarrhea, constipation and/or nausea
It is important to note that the amount of pain a woman experiences is not necessarily related to the severity of the disease. Some women with severe endometriosis may experience no pain, while others with a milder form of the disease may have severe pain or other symptoms.
Relationship of Endometriosis to Infertility
Endometriosis is considered one of the three major causes of female infertility. According to the American Society for Reproductive Medicine, endometriosis can be found in 24 to 50 percent of women who experience infertility. In mild to moderate cases, the infertility may be temporary. In these cases, surgery to remove adhesions, cysts and scar tissue can restore fertility. In other cases — a very small percentage — women may remain infertile.
How endometriosis affects fertility is not clearly understood. It is thought that scar tissue from endometriosis can impair the release of the egg from the ovary and subsequent pickup by the fallopian tube. Other mechanisms thought to affect fertility include changes in the pelvic environment that results in impaired implantation of the fertilized egg.
Johns Hopkins fertility and gynecology experts share the top three things they want women to be aware of regarding reproductive health.
For many women, simply having a diagnosis of endometriosis brings relief. Diagnosis begins with a gynecologist or other health care provider evaluating a patient’s medical history and completing a physical examination, including a pelvic exam. A diagnosis of endometriosis can only be certain, though, when the doctor performs a laparoscopy, biopsies any suspicious tissue and the diagnosis is confirmed by examining the tissue beneath a microscope. Laparoscopy is a minor surgical procedure in which a laparoscope, a thin tube with a camera at the end, is inserted into the abdomen through a small incision. Laparoscopy is also used to determine the location, extent and size of the endometrial growths.
Other examinations that may be used in the diagnosis of endometriosis include:
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Ultrasound: A diagnostic imaging technique that uses high-frequency sound waves to create an image of the internal organs
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CT scan: A noninvasive diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce horizontal, or axial, images — often called slices — of the body to detect any abnormalities that may not show up on an ordinary X-ray
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MRI scan: A noninvasive procedure that produces a two-dimensional view of an internal organ or structure
Stages of Endometriosis
A staging, or classification, system for endometriosis has been developed by the American Society of Reproductive Medicine. The stages are classified as follows:
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Stage 1: Minimal
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Stage 2: Mild
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Stage 3: Moderate
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Stage 4: Severe
The stage of endometriosis is based on the location, amount, depth and size of the endometrial tissue. Specific criteria include:
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The extent of the spread of the tissue
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The involvement of pelvic structures in the disease
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The extent of pelvic adhesions
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The blockage of the fallopian tubes
The stage of the endometriosis does not necessarily reflect the level of pain experienced, risk of infertility or symptoms present. For example, it is possible for a woman in stage 1 to be in tremendous pain, while a woman in stage 4 may be asymptomatic.
Endometriosis Treatment Options
Specific treatment for endometriosis will be determined by your health care provider based on:
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Your overall health and medical history
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Current symptoms
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Extent of the disease
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Your tolerance for specific medications, procedures or therapies
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Expectations for the course of the disease
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Your opinion or preference
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Your desire for pregnancy
If symptoms are mild, health care providers generally agree that no further treatment, other than pain medication, is necessary.
In general, treatment for endometriosis may include:
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“Watchful waiting” to observe the course of the disease
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Pain medication: nonsteroidal anti-inflammatory drugs, such as ibuprofen or other over-the-counter analgesics
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Hormone therapy, including:
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Oral contraceptives, with combined estrogen and progestin (a synthetic form of progesterone) hormones, to prevent ovulation and reduce menstrual flow
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Progestins alone
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Gonadotropin-releasing hormone agonist, which stops ovarian hormone production, creating a sort of “medical menopause”
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Danazol, a synthetic derivative of testosterone (a male hormone)
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Surgical techniques that may be used to treat endometriosis include:
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Laparoscopy (also used to help diagnose endometriosis): A minor surgical procedure in which a laparoscope, a thin tube with a lens and a light, is inserted into an incision in the abdominal wall; using the laparoscope to see into the pelvic area, the doctor can often remove the endometrial growths.
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Laparotomy: A more extensive surgery to remove as much of the displaced endometrium as possible without damaging healthy tissue
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Hysterectomy: Surgery to remove the uterus and possibly the ovaries
Our experts offer women experiencing fibroids a wide range of treatment options, including alternatives to hysterectomy. We are at the forefront of fibroid research aimed at improving our patients’ quality of life.
Simple tips that can help ease the pain of endometriosis include:
- Rest, relax and meditate.
- Take warm baths.
- Prevent constipation.
- Get regular exercise.
- Use a hot water bottle or heating pad on your abdomen.
Sometimes, a combination of therapies is used, such as conservative surgery (laparoscopy or laparotomy), along with hormone therapy.
Some women also benefit from alternative treatments used in conjunction with other medical and surgical therapies for the treatment of endometriosis. These include:
- Traditional Chinese medicine
- Nutritional approaches
- Homeopathy
- Allergy management
- Immune therapy
It is important to discuss any or all of these treatments thoroughly with your health care provider, as some may conflict with the effectiveness of others.
From the Johns Hopkins Medicine monthly webcast series, A Woman's Journey, Gynecologist Karen Wang, M.D., discusses the complexity of diagnosis and treatment of endometriosis as a part of "Conversations that Matter."