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December 25, 2018

Endometriosis
Alan N. Peiris, MD, PhD, FRCP(Lond)1; Ellen Chaljub, BS1; Dillon Medlock, BS1

 Author Affiliations | Article Information

JAMA. 2018;320(24):2608. doi:10.1001/jama.2018.17953

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E ndometriosis is a common condition in women.

The endometrium is the inner lining of the uterus (womb); this tissue normally cycles through
stages of growth and shedding during the menstrual cycle. Endometriosis occurs when the en-
dometrium is present outside the usual location. Endometriosis may occur in the ovaries, fallopian
tubes, vagina, or other parts of the uterus. Rarely, endometriosis may occur in the abdomen and lungs.

Endometriosis is common among women of reproductive age. An estimated 11% of women in the
United States may have endometriosis. Women without prior pregnancies, women with a family history
of endometriosis, and women with abnormal menstrual periods are more likely to have endometriosis.

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Signs and Symptoms

Women can have endometriosis without symptoms or experience different types of pain, including
painful menstrual cramps or heavy menstrual periods, pain during or after sexual intercourse, pain dur-
ing a bowel movement or urination, and abdominal pain.

Abnormally located endometrium can grow and shed during the menstrual cycle, causing bleeding in
between periods. Inflammation, cysts, scar tissue, and adhesions can develop, leading to intestinal
problems, chronic pelvic inflammatory disease, or infertility.

Causes
The cause of endometriosis is not currently known. Backflow of menstrual blood is considered the most
likely cause of endometriosis. Other possible causes include genetic factors, immune irregularities, es-
trogen imbalances, and surgery (such as cesarean deliveries or abdominal surgeries).

Diagnosis
A doctor will obtain a patient’s medical history and perform a detailed examination, including a pelvic
examination to identify any palpable abnormalities. Imaging, such as transvaginal ultrasound and mag-
netic resonance imaging, may be done. Laparoscopy, a type of minimally invasive surgery, is the only
way to confirm endometriosis. The biopsy and microscopic evaluation of possible endometriosis lesions
can confirm endometriosis.

Treatment
The focus of treatment is symptom alleviation rather than cure.

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Pain: The first-line treatment for endometrial pain is hormonal contraceptives. Oral contraceptive pills
can prevent the ovaries from ovulating and therefore reduce endometriosis manifestations. Mild pain
can be treated with over-the-counter pain relievers. In severe cases, a doctor may recommend la-
paroscopy to remove endometriosis patches. In some patients, gonadotropin-releasing hormone ago-
nists (such as leuprolide) may help. Aromatase inhibitors (anastrozole) are reserved for women who do
not have relief with other forms of treatment. Gonadotropin-releasing hormone antagonists are a pos-
sible emerging treatment.

Infertility: For women who wish to become pregnant, a doctor may recommend laparoscopy to remove
endometriosis patches. This has been shown to increase pregnancy rates, but it is less likely to work in
moderate to severe endometriosis. For women who have trouble becoming pregnant after laparoscopic
endometriosis removal procedures, other fertility techniques such as in vitro fertilization may be
recommended.

For More Information

Eunice Kennedy Shriver National Institute of Child Health and Human Development
https://www.nichd.nih.gov/health/topics/endometriosis

WomensHealth.gov
https://www.womenshealth.gov/a-z-topics/endometriosis

The JAMA Patient Page is a public service of JAMA. The information and recommendations appearing
on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For
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Article Information Back to top

Conflict of Interest Disclosures: None reported.

Sources: Eunice Kennedy Shriver National Institute of Child Health and Human Development,
Department of Health and Human Services

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