Endometriosis

 Symptoms & causes

 Diagnosis & treatment
 Doctors & departments
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Diagnosis: Pelvic exam, Transvaginal ultrasound

To diagnose endometriosis and other conditions that can cause pelvic pain, your
doctor will ask you to describe your symptoms, including the location of your pain
and when it occurs.

Tests to check for physical clues of endometriosis include:

 Pelvic exam. During a pelvic exam, your doctor manually feels (palpates)
areas in your pelvis for abnormalities, such as cysts on your reproductive
organs or scars behind your uterus. Often it's not possible to feel small areas of
endometriosis unless they've caused a cyst to form.
 Ultrasound. This test uses high-frequency sound waves to create images of
the inside of your body. To capture the images, a device called a transducer is
either pressed against your abdomen or inserted into your vagina (transvaginal
ultrasound). Both types of ultrasound may be done to get the best view of the
reproductive organs. A standard ultrasound imaging test won't definitively tell
your doctor whether you have endometriosis, but it can identify cysts
associated with endometriosis (endometriomas).
 Magnetic resonance imaging (MRI). An MRI is an exam that uses a
magnetic field and radio waves to create detailed images of the organs and
tissues within your body. For some, an MRI helps with surgical planning,
giving your surgeon detailed information about the location and size of
endometrial implants.
 Laparoscopy. In some cases, your doctor may refer you to a surgeon for a
procedure that allows the surgeon to view inside your abdomen (laparoscopy).
While you're under general anesthesia, your surgeon makes a tiny incision
near your navel and inserts a slender viewing instrument (laparoscope),
looking for signs of endometrial tissue outside the uterus.

A laparoscopy can provide information about the location, extent and size of
the endometrial implants. Your surgeon may take a tissue sample (biopsy) for
further testing. Often, with proper surgical planning, your surgeon can fully
treat endometriosis during the laparoscopy so that you need only one surgery.

More Information

 Endometriosis care at Mayo Clinic

 Testing for endometriosis
  Pelvic exam

Treatment
Treatment for endometriosis usually involves medication or surgery. The approach
you and your doctor choose will depend on how severe your signs and symptoms are
and whether you hope to become pregnant.

Doctors typically recommend trying conservative treatment approaches first, opting

for surgery if initial treatment fails.

Pain medication

Your doctor may recommend that you take an over-the-counter pain reliever, such as
the nonsteroidal anti-inflammatory drugs (NSAIDs) ibuprofen (Advil, Motrin IB,
others) or naproxen sodium (Aleve) to help ease painful menstrual cramps.

Your doctor may recommend hormone therapy in combination with pain relievers if
you're not trying to get pregnant.

Hormone therapy

Supplemental hormones are sometimes effective in reducing or eliminating the pain

of endometriosis. The rise and fall of hormones during the menstrual cycle causes
endometrial implants to thicken, break down and bleed. Hormone medication may
slow endometrial tissue growth and prevent new implants of endometrial tissue.

Hormone therapy isn't a permanent fix for endometriosis. You could experience a
return of your symptoms after stopping treatment.

Therapies used to treat endometriosis include:

 Hormonal contraceptives. Birth control pills, patches and vaginal rings help
control the hormones responsible for the buildup of endometrial tissue each
month. Many have lighter and shorter menstrual flow when they're using a
hormonal contraceptive. Using hormonal contraceptives — especially
continuous-cycle regimens — may reduce or eliminate pain in some cases.
 Gonadotropin-releasing hormone (Gn-RH) agonists and antagonists.
These drugs block the production of ovarian-stimulating hormones, lowering
estrogen levels and preventing menstruation. This causes endometrial tissue to
shrink. Because these drugs create an artificial menopause, taking a low dose
of estrogen or progestin along with Gn-RH agonists and antagonists may
decrease menopausal side effects, such as hot flashes, vaginal dryness and
bone loss. Menstrual periods and the ability to get pregnant return when you
stop taking the medication.
 Progestin therapy. A variety of progestin therapies, including an intrauterine
device with levonorgestrel (Mirena, Skyla), contraceptive implant
(Nexplanon), contraceptive injection (Depo-Provera) or progestin pill
 (Camila), can halt menstrual periods and the growth of endometrial implants,
which may relieve endometriosis signs and symptoms.
 Aromatase inhibitors. Aromatase inhibitors are a class of medicines that
reduce the amount of estrogen in your body. Your doctor may recommend an
aromatase inhibitor along with a progestin or combination hormonal
contraceptive to treat endometriosis.

Conservative surgery

If you have endometriosis and are trying to become pregnant, surgery to remove the
endometriosis implants while preserving your uterus and ovaries (conservative
surgery) may increase your chances of success. If you have severe pain from
endometriosis, you may also benefit from surgery — however, endometriosis and
pain may return.

Your doctor may do this procedure laparoscopically or, less commonly, through
traditional abdominal surgery in more-extensive cases. Even in severe cases of
endometriosis, most can be treated with laparoscopic surgery.

In laparoscopic surgery, your surgeon inserts a slender viewing instrument

(laparoscope) through a small incision near your navel and inserts instruments to
remove endometrial tissue through another small incision. After surgery, your doctor
may recommend taking hormone medication to help improve pain.

Fertility treatment

Endometriosis can lead to trouble conceiving. If you're having difficulty getting

pregnant, your doctor may recommend fertility treatment supervised by a fertility
specialist. Fertility treatment ranges from stimulating your ovaries to make more eggs
to in vitro fertilization. Which treatment is right for you depends on your personal
situation.

Hysterectomy with removal of the ovaries

Surgery to remove the uterus (hysterectomy) and ovaries (oophorectomy) was once
considered the most effective treatment for endometriosis. But endometriosis experts
are moving away from this approach, instead focusing on the careful and thorough
removal of all endometriosis tissue.

Having your ovaries removed results in menopause. The lack of hormones produced
by the ovaries may improve endometriosis pain for some, but for others,
endometriosis that remains after surgery continues to cause symptoms. Early
menopause also carries a risk of heart and blood vessel (cardiovascular) diseases,
certain metabolic conditions and early death.

Removal of the uterus (hysterectomy) can sometimes be used to treat signs and
symptoms associated with endometriosis, such as heavy menstrual bleeding and
painful menses due to uterine cramping, in those who don't want to become pregnant.
Even when the ovaries are left in place, a hysterectomy may still have a long-term
effect on your health, especially if you have the surgery before age 35.
Finding a doctor with whom you feel comfortable is crucial in managing and treating
endometriosis. You may want to get a second opinion before starting any treatment to
be sure you know all of your options and the possible outcomes.

More Information

 Endometriosis care at Mayo Clinic

 Endometriosis: Treatment options
 Endometriosis: Working with your doctor

Request an Appointment at Mayo Clinic

Clinical trials
Explore Mayo Clinic studies testing new treatments, interventions and tests as a
means to prevent, detect, treat or manage this disease.

Lifestyle and home remedies

If your pain persists or if finding a treatment that works takes some time, you can try
measures at home to relieve your discomfort.

 Warm baths and a heating pad can help relax pelvic muscles, reducing
cramping and pain.
 Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as
ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve), can help
ease painful menstrual cramps.

More Information

 Endometriosis care at Mayo Clinic

 Endometriosis: Reduce pain during sex
 Finding balance: Tips to manage life with endometriosis

Alternative medicine
Some report relief from endometriosis pain after acupuncture treatment. However,
little research is available on this — or any other — alternative treatment for
endometriosis. If you're interested in pursuing this therapy in the hope that it could
help you, ask your doctor to recommend a reputable acupuncturist. Check with your
insurance company to see if the expense will be covered.

More Information

 Endometriosis care at Mayo Clinic

 Acupuncture
Coping and support
If you're dealing with endometriosis or its complications, consider joining a support
group for women with endometriosis or fertility problems. Sometimes it helps simply
to talk to other women who can relate to your feelings and experiences. If you can't
find a support group in your community, look for one online.

Preparing for your appointment

Your first appointment will likely be with either your primary care physician or a
gynecologist. If you're seeking treatment for infertility, you may be referred to a
doctor who specializes in reproductive hormones and optimizing fertility
(reproductive endocrinologist).

Because appointments can be brief and it can be difficult to remember everything you
want to discuss, it's a good idea to prepare in advance of your appointment.

What you can do

 Make a list of any symptoms you're experiencing. Include all of your

symptoms, even if you don't think they're related.
 Make a list of any medications, herbs or vitamin supplements you take.
Include how often you take them and the doses.
 Have a family member or close friend accompany you, if possible. You
may get a lot of information at your visit, and it can be difficult to remember
everything.
 Take a notepad or electronic device with you. Use it to make notes of
important information during your visit.
 Prepare a list of questions to ask your doctor. List your most important
questions first, to be sure you address those points.

For endometriosis, some basic questions to ask your doctor include:

 How is endometriosis diagnosed?

 What medications are available to treat endometriosis? Is there a medication
that can improve my symptoms?
 What side effects can I expect from medication use?
 Under what circumstances do you recommend surgery?
 Will I take a medication before or after surgery?
 Will endometriosis affect my ability to become pregnant?
 Can treatment of endometriosis improve my fertility?
 Can you recommend any alternative treatments I might try?

Make sure that you understand everything your doctor tells you. Don't hesitate to ask
your doctor to repeat information or to ask follow-up questions for clarification.

What to expect from your doctor

Some potential questions your doctor might ask include:

  How often do you experience these symptoms?
 How long have you had these symptoms?
 How severe are your symptoms?
 Do your symptoms seem to be related to your menstrual cycle?
 Does anything improve your symptoms?
 Does anything make your symptoms worse?

By Mayo Clinic Staff

Endometriosis care at Mayo Clinic

Request an Appointment at Mayo Clinic

Symptoms & causesDoctors & departments
March 23, 2019
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References

Related
 7 signs of endometriosis
 Acupuncture
 Can I still experience endometriosis after menopause?

News from Mayo Clinic

 Women's Wellness: Is endometriosis a risk factor for ovarian cancer? Dec. 20,
2018, 10:00 p.m. CDT
 Endometriosis: Mayo Clinic Radio Health Minute Oct. 26, 2018, 09:35 p.m.
CDT
 Mayo Clinic Q and A: Endometriosis and fertility June 05, 2018, 04:30 p.m.
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Endometriosis
 Symptoms & causes
 Diagnosis & treatment
 Doctors & departments
 Care at Mayo Clinic