Ectopic endometrial tissue is tissue similar to the uterine lining (endometrium) found outside the uterus. Though not cancerous, its presence can cause issues because it behaves like normal endometrium, responding to hormonal fluctuations throughout the menstrual cycle.
What Ectopic Endometrial Tissue Is
Ectopic endometrial tissue is similar to the uterine lining (endometrium), which thickens and sheds monthly. Like the endometrium, ectopic tissue responds to hormonal signals, thickening, breaking down, and bleeding in sync with the menstrual cycle.
Unlike the tissue inside the uterus, which can exit the body during menstruation, blood and tissue from ectopic endometrial implants have no clear pathway to leave the body. This trapped material causes inflammation, irritation, and scar tissue.
Common locations include the ovaries, fallopian tubes, and the outer surface of the uterus. It can also appear on organs within the pelvic and abdominal cavities, such as the bowel, bladder, and peritoneum. Rarely, it’s found in distant sites like the lungs or brain.
Recognizing Its Signs and Diagnosis
Individuals with ectopic endometrial tissue often experience a range of symptoms. Pelvic pain, often worsening during menstruation (dysmenorrhea), is common, manifesting as cramping or a dull ache. Pain during sexual intercourse (dyspareunia) is also common, especially when tissue is near reproductive organs.
Beyond pain, individuals may also experience digestive issues, especially during menstruation, such as bloating, constipation, or diarrhea, if the tissue affects the bowel. Urinary symptoms like painful urination or increased urinary frequency can occur if the bladder is involved. Infertility is also a primary concern, as ectopic endometrial tissue can interfere with reproductive function.
Diagnosing ectopic endometrial tissue typically begins with a thorough review of an individual’s medical history and a physical examination. During the physical exam, a healthcare provider may identify tenderness or abnormal growths.
Imaging tests, such as transvaginal ultrasound or magnetic resonance imaging (MRI), can help visualize the location and size of implants, cysts, or scar tissue associated with the condition.
While imaging can suggest the presence of ectopic endometrial tissue, the definitive diagnosis often requires a surgical procedure called laparoscopy. During a laparoscopy, a small incision is made, usually near the navel, and a thin, lighted tube with a camera is inserted to directly visualize the pelvic and abdominal organs. Tissue samples can be taken for biopsy to confirm the presence of endometrial cells.
Managing Ectopic Endometrial Tissue
Management strategies for ectopic endometrial tissue are tailored to individual symptoms, condition extent, and personal goals like fertility preservation. Pain management is often a primary focus, initially involving over-the-counter pain relievers like nonsteroidal anti-inflammatory drugs (NSAIDs). For more severe pain, prescription medications may be necessary to provide relief.
Hormonal therapies are used to suppress ectopic endometrial tissue growth by altering the hormonal environment. Oral contraceptive pills, for instance, can reduce menstrual flow and pain by stabilizing hormone levels. Progestins, a synthetic form of progesterone, can also be prescribed to thin the endometrial-like tissue and reduce its growth.
Another class of hormonal medications, gonadotropin-releasing hormone (GnRH) agonists, work by temporarily inducing a menopause-like state, which significantly reduces estrogen levels and shrinks the endometrial implants. These therapies reduce hormonal stimulation, alleviating symptoms. The choice of hormonal therapy depends on the individual’s symptoms, potential side effects, and long-term goals.
Surgical intervention, typically performed via laparoscopy, can be an option for managing ectopic endometrial tissue. During this procedure, visible implants and scar tissue can be carefully removed or destroyed using various techniques, such as excision or ablation. Surgery aims to reduce pain, improve fertility outcomes, and remove problematic tissue. Surgical decisions depend on symptom severity, tissue location, and effectiveness of other treatments.