Uterine tissue was found where? Why endometriosis can be such a pain
Q: I was 37 years old when I was diagnosed with endometriosis. Now my 22-year-old daughter is having a lot of the same problems that I did when she gets her period. What is actually happening when you have endometriosis?
A: To understand endometriosis, we first need to talk about the endometrial lining. Also known as the endometrium, it's a dual layer of specialized tissue found in people with uteruses. It lines the interior of the uterus and plays a role in both menstruation and pregnancy.
The inner layer of endometrial cells attaches to the smooth, muscular walls of the uterus and serves as something like an anchor. The top layer responds to the monthly hormonal shifts that take place in people of childbearing age. At the time of ovulation, the endometrium thickens and prepares to nourish a fertilized egg. If conception doesn't take place, the endometrial lining is shed. That's what we commonly refer to as a period.
When someone has endometriosis, it means that a tissue that is similar to the endometrial lining is growing outside of the uterus. These areas of abnormal tissue, known as implants, can be found throughout the pelvic cavity. Most often, they are seen on or beneath the ovaries, behind the uterus or growing on the tissues that anchor the uterus to the pelvis. Less often, this tissue may grow on the bladder or the bowel. It's estimated that up to 10% of people with uteruses in the U.S. between the ages of 25 and 40 are affected by endometriosis.
Just like the endometrial lining within the uterus, this extrauterine tissue responds to the monthly progression of hormones. However, since it's growing outside of the uterus, when the tissue breaks down, there's nowhere for it to go. Over time, it becomes trapped. This can result in inflammation and irritation, severe menstrual pain, cysts on the ovaries, and the formation of scar tissue. In some people, scar tissue can develop into adhesions. These are bands of fibrous tissue that can cause the organs and structures within the pelvic cavity to stick together. In addition to causing pain and discomfort, adhesions can affect a person's fertility.
Symptoms of endometriosis range from mild to severe. They include unusually heavy or painful periods, pain during or after sex, painful urination or bowel movements during one's period, spotting between periods and difficulty becoming pregnant. Diagnosis can include a pelvic exam, ultrasound, MRI or laparoscopy, each of which offers a different way to visualize the pelvic cavity. Treatment, which depends on the specifics of each person's case, can include pain medications; hormone therapy to manage pain and tissue growth; surgery to remove extrauterine tissue; and, if needed, fertility treatments. Hysterectomy, which at one time was the go-to procedure in severe cases, is no longer automatically recommended.
The cause of endometriosis is not yet known, but a family history is a risk factor for developing the condition. That makes it important for your daughter to let her gynecologist know about the symptoms she is experiencing.
• Dr. Eve Glazier is an internist and associate professor of medicine at UCLA Health. Dr. Elizabeth Ko is an internist and assistant professor of medicine at UCLA Health. Send your questions to askthedoctors@mednet.ucla.edu.