1. cramps and menstrual pain severe enough to keep you in bed a few days each month
2. severe pelvic pain during your period
3. trouble getting pregnant (infertility)
4. pain during sexual intercourse

Stages of Endometriosis

1. Mild
Shallow implants on pelvic lining and on one ovary, with light adhesions on the outer ovary.

2. Moderate
Deep implants on pelvic lining and one ovary, with dense adhesions on the other ovary.

3. Severe
Deep implants on ovaries, with dense adhesions on ovaries, fallopain tubes, and pelvic lining.

Types of Endometriosis

1. Classic blue-gray spots

2. Raspberry spots with shagy tissue

3. Flat or raised white tissue, like scarring

4. Clear "berries" with small peaks

5. Chocolate cysts filled with old blood

Medical Evaluation

The earlier endometriosis is diagnosed, the sooner you can get relief. You also have a better chance of preventing infertility and major surgery. Your evaluation may begin with a medical history. A pelvic exam and one or more lab tests may be done. You  may be recommend a laparoscopy. With this minor surgical procedure, your doctor can see into your pelvic cavity and look for endometrial growths.



Menstrual History

Your menstrual cycle may give clues as to whether you have endometriosis. At what age did your periods begin? Did your cramps or other symptoms start with your first period or years later? In what ways does the pain affect your lifestyle or cause emotional distress? These questions and others will help your health care provider diagnose your problem.

Pelvic Exam

This exam can help find the source of your pain. Your doctor feels for any lumps or tenderness and looks at your cervix and vagina to rule out inflammation. You may also have a rectovaginal exam (one finger inserted in the rectum) to check for endometriosis.

Lab Tests

A blood test and urinalysis may be done to help rule out other conditions. You might also have an ultrasound. It is a painless test that uses sound waves to make a "picture" of any abnormal tissue that might be endometriosis. If your bowel movements are painful around your periods, a barium enema (an x-ray of the lower bowel) may help find the source of your pain.

Treatment Options

If you have endometriosis, you have three options. They are hormone therapy, surgery, or a combination of both. Hormone therapy regulates or blocks the hormones that control your menstrual cycle. This means it can limit the swelling of your endometrium and endometrial implants. This treatment may be used before, instead of, or after surgery. The doctor will discuss side effects and dosage with you.

Almost every woman with endometriosis considers surgery at some time in her life. Surgery can range from the most minor procedure (laparoscopy) to complete removal of all reproductive organs. Your doctor will discuss your surgery options and their effects on your fertility with you. The best option for you will depend on your age, the severity of your disease, and whether you want to have children.

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Hormone Therapy
1. GnRH Agonists

GnRH agonists are forms of the gonadotropin releasing hormone.

How they work:

Over time, GnRH agonists keep the pituitary gland from producing FSH and LH. This stops production of estrogen and progesterone. You quit ovulating and stop having your period. Your endometrium may shrink. GnRH agonists are usually prescribed for 6 months or longer. Treatment results may last for 6 months or longer after therapy.



Side effects:

Hot flashes, insomnia, headaches, and vaginal dryness. Bone density may decrease slightly during treatment, but is usually regained after treatment is stopped.

2. Danazol

Danazol is a hormone.

How it works:

Danazol blocks FSH and LH at the pituitary gland. This means that estrogen and progesterone levels stay low. You quit ovulating and stop having your periods. Your endometrium may shrink. Danazol is often used for 6 months or longer. Treatment results may last 6 months or longer after therapy. It may be repeated later, if needed.

Side effects:
Weight gain, hair growth, acne, hot flashes, vaginal dryness, sleep problems, headache, decreased sex drive, and emotional changes. Liver problems may require you to stop treatment.

3. Birth Control Pills

Birth control pills contain estrogen and progestin, a form of progesterone. They may be taken every day for several months or prescribed in cycles, 3 weeks on and 1 week off.

How they work:

Birth control pills regulate the levels of estrogen and progesterone in your body. Ovulation, bleeding, and endometrial growth are controlled. Birth control pills may be used for 6 months or longer. Treatment results may last for 6 months or longer after therapy.

Side effects:

Weight gain, nausea, blood clots, and phlebitis (inflammation of veins).

4. Progestins

Progestins are a form of progesterone.

How they work:

Progestins keep estrogen and progesterone levels low. This prevents ovulation and limits endometrial growth. Progestins may be used for 6 months or longer. Treatment results may last for 6 months or longer after therapy.

Side effects:

Midcycle bleeding, weight gain, headaches, stomach upset, acne.

5. Other Medicines 

This medicine helps you have less cramping and pain during your period. Many women also find relief in over-the-counter medicines such as aspirin and other anti-inflammatories. These work best if taken early in the pain cycle.

Surgery

1. Surgical Laparoscopy

Laparoscopy is often used for mild or moderate endometriosis. Looking through the laparoscope, your doctor uses tiny surgical tools to remove implants. Implants may be trimmed (excision), burned away (cautery), or removed with a laser. Because your doctor operates through tiny incisions, you will have less bleeding and scarring than with other surgeries. Laparoscopy preserves your ability to have children. You will need 3 to 10 days to recover.

3. Hysterectomy

Hysterectomy is the surgical removal of your uterus. Any implants or adhesions in your pelvic cavity will also be removed. This surgery is often advised if your disease is severe but involves mainly your uterus. It may also be used if other methods have failed to relieve your symptoms and if you're past childbearing age or interest. Because your fertility is lost, this decision is best made after discussing it with your doctor and partner. Hysterectomy can be done Hyparoscopially.

4. Total Hysterectomy with Bilateral Salpingo-oophorectomy

With this procedure, all of your reproductive organs-uterus, ovaries and fallopian tubes are removed. Any implants or adhesions in nearby tissue are also removed. This surgery is advised for the most severe endometriosis when you're past childbearing age. It is the most complete treatment for endometriosis. But you may have symptoms of menopause once your ovaries are removed.
This is also done Laparoscopically.

Living with Endometriosis

Once you know you have endometriosis, you can learn to manage your symptoms and live a comfortable, active life. One of the biggest hurdles you may face is accepting that this is a disease you may live with throughout your childbearing years. Only a few women never have symptoms again after treatment. Most women have symptoms off and on until menopause. Then symptoms usually subside or disappear. For some women, pregnancy relieves symptoms, but only temporarily. In the meantime, there is a lot you can do to help yourself feel better.

Emotions

Along with cycles of pain, you may have emotional cycles or mood swings. You may feel angry if you're up all night with cramps. You may feel depressed if you can't do the things you used to do. Your feelings about being a woman and your sexuality may also be affected. Don't suffer in silence. Talking to someone you trust can really help.

Managing Pain

You can manage your pain by taking medication suggested by your health care provider. A hot bath or heating pad may also relieve your pain. Some women find relief in meditation, yoga, acupuncture, nutritional therapies, and other alternative treatments. To divert there attention from the pain.

Exercise

Exercise often helps relieve pain, especially cramps. But don't exercise if it makes the pain worse. Keeping yourself healthy can help you feel better all over and keep your mind off minor pain.

A Partner's Role

Some men are afraid to touch women in pain. Others think the pain is all in her head.? Your partner needs to know that endometriosis causes real pain and distress. If wants help, tell him what he can do to help you better. You may feel better with low-back massage or by being left alone for a while.

Communicating About Sex

Many women with endometriosis have pain with sex during the worst part of their cycles. Others have pain throughout the month. Talk with your partner about other ways you can both show affection. You may also want to find positions for intercourse that are more comfortable.

Early Detection

Women can teach their daughters that severe cramps or pain aren't normal during their period. A teenager with heavy cramps or irregular, heavy bleeding should be evaluated. This is especially important if the mother has endometriosis.