Endometriosis is a common condition where tissue similar to the endometrium, lining of the uterus, is found in other parts of the body. This disease affects girls and women during their most productive years, and impacts all aspects of woman's life.

Generally, endometriosis is most commonly found in the pelvic cavity. It can attach to any of the female reproductive organs, such as ovaries, fallopian tubes and the tissue lining the pelvis.  Endometriosis can also be found, though less commonly, on the bladder, bowel, intestines, appendix or rectum.

Many aspects of endometriosis are mysterious and require further research to define. The exact cause of endometriosis is unknown; however, it is likely the condition is caused by a combination of different factors.

The following theories have been suggested to contribute in the endometriosis including, retrograde menstruation where the endometriosis tissue flows back through the fallopian tubes and into the pelvic cavity rather than leaving the body as a period, transformation of peritoneal and embryonic cells into endometrial cells, transporting of endometrial cells through the circulatory or lymphatic system and a problem with the immune system that make the body unable to recognize and destroy endometrial tissue that is growing outside the uterus. Nevertheless, none of these theories completely explain why endometriosis occurs.

Through endometriosis, displaced endometrial tissue responds in the same way as intrauterine endometrium to cyclic hormonal changes in estrogen and progesterone, proliferation and secretory activity. Then, it thickens, breaks down and bleeds with each menstrual cycle. The presence of this abnormal tissue outside the uterus can initiate immune and inflammatory responses that may cause pain. Because this displaced tissue has no way to exit the body, it becomes trapped and may cause peritoneal adhesions, and may affect fertility.

The most common symptom of endometriosis is pelvic pain. Although many women during their menstrual period or intercourses experience pain, pelvic pain in women with endometriosis is far worse than usual. It also tends to increase over time. Other common signs and symptoms of endometriosis may include pain with bowel movements or urination, heavy periods or bleeding between periods or infertility. For some women, endometriosis can also cause fatigue, diarrhea, constipation, bloating or nausea, especially during menstrual periods.

Typically, it can be difficult to identify the endometriosis depending on the symptoms present, because many other conditions can cause pelvic pain and similar symptoms. Endometriosis is sometimes mistaken for other conditions that can cause pelvic pain, such as pelvic inflammatory disease. Doctors will usually start the diagnosis with manual examination for any abnormality in pelvis area, they may also use imaging methods to help detect endometriosis in the inside of the body. The two most common imaging tests are ultrasound, which uses sound waves to make the picture, and magnetic resonance imaging (MRI), which uses magnets and radio waves to make the picture. However, surgery is currently the only way to confirm a diagnosis of endometriosis; laparoscopy is the most common type of surgery, where doctors can look inside the pelvic area for signs of endometriosis using a surgical procedure.

There is currently no cure for endometriosis, but treatments are used to relieve pain, reduce the growth of cysts, increase fertility and avoid the recurrent of the condition. Treatment for endometriosis is usually depending on the severity of the signs and symptoms, age and whether the patient plans to be pregnant. Medication such as nonsteroidal anti-inflammatory drugs are the most common pain relievers, hormone therapy including birth control pills and gonadotrophin-releasing hormone, also can be effective in treating the symptoms of endometriosis through blocking the hormones produced by the ovaries. Additionally, surgery can be used to treat severe pain and improve fertility associated with endometriosis. Doctor will decide the kind of surgery depending on the location of the tissue. Laparoscopic surgery, it is the most commonly used technique also known as keyhole surgery, where surgeon makes small incisions in the abdomen to remove or destroy endometrial tissue. In severe cases of endometriosis, surgeon may have to remove the whole uterus in operation called hysterectomy.

One of the main complications of endometriosis is fertility problems. Endometriosis can damage the fallopian tubes or ovaries causing infertility, not being able to become pregnant at all. Ovarian cancer, adhesions and ovarian cysts all can be also a serious complication of the condition.

Woman can decrease the risk for developing the disease by reducing the level of hormone estrogen, which helps to thicken the lining of the uterus during the menstrual cycle. Taking hormonal control methods, making regular exercise and avoid excessive amount of alcohol may help to reduce the risk of endometriosis.

Endometriosis is a long-term condition that cannot be cured. However, treatment and early diagnosis in the majority of cases offer significant improve in symptoms.

The US journal, “Clinical obstetrics and gynecology”, has published an article revealing that endometriosis is the third leading cause of gynecologic hospitalization in the United States, and it also indicates that the precise incidence and prevalence of endometriosis remains elusive for a multitude of reasons, and their measurement remains difficult to accurately assess.

Endometriosis is a common condition where tissue that normally lines the inside of the uterus, endometrium, grows in other parts of the body. Endometriosis most commonly involves the ovaries, fallopian tubes and the tissue lining the pelvis, other sites, less commonly for growths can include the vagina, cervix, vulva, bowel, bladder, or rectum. Rarely, endometriosis appears in other parts of the body, such as the lungs, brain, and skin. It mainly occurs in girls and women of childbearing age, and with each menstrual cycle these cells react in the same way to those in the womb, thickening and then breaking down and bleeding. Unlike the cells in the womb that leave the body as a period, this blood becomes trapped.

Although the exact cause of endometriosis is not certain, a combination of factors, such as genetics and hormones, is thought to be responsible for developing the disease.

Since the cause of endometriosis isn't known, several theories have been suggested, including:

1. Genetics, because the condition tends to run in families, genes are probably involved with endometriosis to some degree.
2. Environmental causes, such as chemicals, like dioxin and organochlorine pesticides, have also been linked to developing endometriosis.
3. Immune system disorder, some women, their immune system fails to fight off endometriosis that allows it to grow outside the uterus. This indicates that immune system dysfunction plays a role in these cases.
4. Retrograde menstruation, when menstrual blood containing endometrial cells flows back through the fallopian tubes and into the abdomen instead of out of the body. These replaced endometrial cells implant, grow and continue to thicken and bleed in the pelvic walls and surfaces of pelvic organs over the course of each menstrual cycle. This theory does not explain why endometriosis has developed in some women after hysterectomy.
5. Estrogen, a hormone involved in the female reproductive cycle, appears to promote endometriosis. Research indicates that endometriosis is an estrogen-dependent, inflammatory disease. Some studies show that estrogen may convert embryonic cells, cells in the earliest stages of development, into endometrial cell during puberty.
6. Surgical scars, in some abdominal surgeries, such as a hysterectomy or C-section, endometrial cells may attach to a surgical incision.
7. Peritoneal cells transformation, due to hormones or immune factors the cells lining the inner side of abdomen known as peritoneal cells transform into endometrial cells.
8. Lymphatic or circulatory spread, some endometrial cells transport through the circulatory or lymphatic system to other parts of the body. This could explain why it has been found in areas such as the lungs and brain.
9. Metaplasia, is type of transformation, where one type of cell changes into a different kind of cell. This could explain the appearance of endometriosis cells in women with no womb or in men who have taken hormone treatments.

Endometriosis is the presence of endometrial tissue external of the uterine cavity, most commonly in the female pelvis. Although the exact cause of endometriosis is not certain, a combination of factors, such as retrograde menstruation and lymphatic or circulatory spread appear to contribute in the disease. Endometrial tissue implanted outside the uterus responds in much the same way as intrauterine endometrium to cyclic hormonal changes in estrogen and progesterone, proliferation and secretory activity. Therefore, it is thickening and then breaking down and bleeding.

The presence of this abnormal tissue outside the uterus can initiate immune and inflammatory responses, which may cause pain.

Because the displaced tissue has no way to exit the body, surrounding tissue can become irritated, eventually developing adhesions, an abnormal bands of fibrous tissue, that can cause pelvic tissues and organs to stick to each other.

The severity of symptoms vary from one woman to another; some women with endometriosis experience serious symptoms while others do not. Symptoms can include:

1. Pain

This is the most common symptom. The severity of pain does not always correspond to the extent of the endometriosis. Women with endometriosis may have many different kinds of pain. These include:

• Period pain, the pain may get worse over time without responding to painkillers.
• Chronic pain in the lower back and pelvis. Endometriosis is sometimes mistaken for other pelvic conditions, such as pelvic inflammatory disease.
• Pain during or after sex.
• Intestinal pain
• Painful bowel movements or pain when urinating during menstrual periods.

1. Heavy periods, this condition involves excessive bleeding through the period or between periods.
2. Bleeding from your bottom
3. Other symptoms, such as fatigue, diarrhea, constipation, bloating or nausea, especially during menstrual periods.
4. Infertility, endometriosis is first diagnosed in some women who are not being able to be pregnant.

Diagnosis of endometriosis can be a challenging, because the symptoms can vary considerably, and many other conditions can cause pelvic pain and similar symptoms. Tests to check for endometriosis include:

1. Pelvic exam: Doctor will manually palpate for any abnormality in pelvis area, such as large cysts or scars. It will not aid in the diagnosis of small endometriosis.
2. Imaging test: The two most common imaging tests are ultrasound, and magnetic resonance imaging (MRI). Ultrasound uses sound waves to make the picture for reproductive organs, via a transducer that is either pressed across abdomen or inserted into vagina. While magnetic resonance imaging (MRI), uses magnets and radio waves to make the picture.

1. Laparoscopy: The most common type of surgery that is used to confirm a diagnosis of endometriosis. In this procedure, a surgeon passes a thin tube through a small cut in your skin so they can see any growth of endometriosis tissue. In some cases, the surgeon will also take a small sample of tissue, biopsy, and study it under a microscope to confirm the condition. Laparoscopy usually follows the medical management that fails to remove the symptoms. It can provide information about the location, extent and size of the condition to help determine the best treatment choices.

There is currently no cure for endometriosis, but treatments are available for the symptoms and problems it causes. Treatment for endometriosis is usually given to relieve pain, slow the growth of cysts, improve fertility and avoid the recurrent of the condition. Treatment for endometriosis is usually depending on several factors such as, age, the severity of the symptoms and the condition and whether you are trying to get pregnant. Treatment includes:

1. Pain medications

These medications range from mild to strong prescription pain relievers. Nonsteroidal anti-inflammatory drugs are the most common types of pain relievers, such as ibuprofen. This is because they act against the inflammation caused by the condition that may help relief pain.

1. Hormone treatment

Hormonal therapy is used mainly to stop the ovaries from producing hormones, including estrogen, and usually prevent ovulation, which prevent new implants of endometrial tissue and reduce the pain caused by endometriosis. This type of therapy is not a long-lasting fix for endometriosis; symptoms may return after stopping treatment. Hormone treatment includes:

•  Hormonal contraceptives

Birth control pills, patches and vaginal rings may help to stop ovulation and make the symptoms of period lighter, more regular, and shorter. The therapy contains usually two hormones, estrogen and progestin, a progesterone-like hormone, which are responsible for the buildup of endometrial tissue each month.

• Progesterone and progestin

These are synthetic hormones that prevent pregnancy, and have several forms such as contraceptive implant or contraceptive injection. The hormones work by preventing the lining of the womb and the growth of endometrial implants, which may relieve endometriosis signs and symptoms.

• Gonadotropin-releasing hormone agonists and antagonists

These drugs stop the production of hormones responsible for ovulation to help prevent ovulation, menstruation, and the growth of endometriosis. This treatment causes endometrial tissue to shrink and sends the body into a temporary menopausal state.

• Danazol

This drug works in similar way to a gonadotropin-releasing hormone, by blocking the production of ovarian-stimulating hormones, preventing menstruation and the growth of endometriosis. However, danazol may not be the first choice because it can harm a developing fetus.

1. Surgical Treatments

Surgery can be used to locate any areas of endometriosis, examine the size and degree of growth and remove or destroy areas of endometriosis tissue. Surgical treatment is the last choice that is considered to help improve severe symptoms and fertility problems. Doctor will decide the kind of surgery depending on the location of the tissue, and the option usually are:

• Laparoscopy

Surgeon during laparoscopy makes small incisions in the abdomen to remove or destroy endometrial tissue, it is the most commonly used technique also known as keyhole surgery. If pregnancy does not occur after laparoscopic treatment, in vitro fertilization may be the best option to increase fertility.

• Laparotomy

This is a major abdominal surgery, which is required in more severe cases of endometriosis or when the organs detached together due to the same condition. Unlike laparoscopy, the recovery time is longer, and the surgeon may also during the procedure remove the whole uterus for those who decided not to have more children. Removing the uterus is called hysterectomy.

Women with endometriosis can sometimes cause a number of complications:

1. Fertility problems

Infertility is the main complication of endometriosis that involves damages to fallopian tubes or ovaries. However, mild to moderate cases of endometriosis can still conceive and carry a chance of getting pregnant.

1. Ovarian cancer

An increased association between ovarian cancer and endometrioses have been found; however, despite the increase, the risk remains relatively low. Some studies show that endometriosis increases the risk for developing endometriosis-associated adenocarcinoma later in life.

1. Adhesions and ovarian cysts

Both adhesions and ovarian cysts occur when the endometriosis tissue is in or near the ovaries. Adhesions take place when the organs join together. Ovarian cysts, are fluid-filled cysts in the ovaries that can sometimes become very large and painful.

1. Bladder and bowel problems

Complication of endometriosis in the bowel or bladder can be difficult to treat, and it may require a major surgery. This surgery involves usually removing a section of bowel or bladder affected by endometriosis.

Although prevention of endometriosis is not possible; however, woman can decrease the risk for developing it by reducing the level of hormone estrogen, which helps to thicken the lining of the uterus during the menstrual cycle. Lowering estrogen levels may enhanced by taking hormonal control methods, making regular exercise, avoid excessive amount of alcohol and reduce the amount of caffeinated drink.

Endometriosis is a chronic condition that cannot be cured. However, treatment and early diagnosis in the majority of cases provides significant relief of pain, reduces the growth of endometriosis tissue and aids women to achieve pregnancy.

Endometriosis is the third leading cause of gynecologic hospitalization in the United States, according to the US journal “Clinical obstetrics and gynecology”.

The US journal “Annals of the New York Academy of Sciences”, has published an article that shows the prevalence estimates of the disease in clinic populations vary from about a 4% occurrence of largely asymptomatic endometriosis found in women undergoing tubal ligation to 50% of teenagers with intractable dysmenorrhea. It also found that blacks have lower rates of endometriosis and Orientals have higher rates than whites.

Information about the epidemiology of endometriosis is vulnerable due to disability to diagnose this disease in the general population. Based on a single study, it is estimated that there is a 10% prevalence of endometriosis in the general population as stated in the US journal “Obstetrics and gynecology clinics of North America”.