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Endometriosis Complications Explained

Posted on December 23, 2021
Medically reviewed by
Dan Martin, M.D.
Article written by
Kristopher Bunting, M.D.

Endometriosis is a widespread condition that affects at least 1 in 10 women worldwide, according to the World Health Organization. Endometriosis commonly causes complications — secondary diseases or conditions caused by another disease.

Complications can arise from endometriosis itself or from treatment of endometriosis. Some of the most common complications affect the pelvis and abdomen, but other complications can affect the entire body.

Adhesions

Adhesions are bands of scar tissue that form between internal organs in the pelvis and abdomen, causing them to stick together. Adhesions are a common complication of both endometriosis and surgery to treat endometriosis that can impact quality of life.

Adhesions can cause or contribute to other complications of endometriosis. Pelvic adhesions and abdominal adhesions can occur due to inflammation from endometriosis lesions. They may also develop following any kind of surgery, including surgery to diagnose and treat endometriosis.

Adhesions do not always cause symptoms, but they can sometimes cause pain and lead to blockages of the bowels, urinary tract, and fallopian tubes. These blockages can lead to further complications, including bowel obstruction, kidney damage, and infertility.

Severe forms of endometriosis, like deep infiltrating endometriosis (DIE), can cause extensive adhesions in the pelvis. This can lead to so-called frozen pelvis, where the pelvic organs become fixed in place.

The primary treatment for adhesions is surgery, called adhesiolysis. Laparoscopy to diagnose and treat endometriosis typically includes removing any adhesions. Unfortunately, surgery can lead to the formation of more adhesions. However, this is much less likely in minimally invasive laparoscopic surgery as opposed to open surgery (laparotomy) of the abdomen or pelvis. Additionally, there are certain surgical techniques, such as using a thin film between organs, that can help prevent the formation of adhesions.

Learn more about adhesions and how to find relief.

Impaired Fertility

Perhaps the most common complication of endometriosis is difficulty getting pregnant. Impaired fertility or infertility (the inability to get pregnant) occurs in as many as half of all women with endometriosis, according to Mayo Clinic. Endometriosis can directly cause infertility or it can be caused by other complications and treatments. In some cases, fertility may be improved or restored.

Endometriosis lesions that occur in the ovaries, fallopian tubes, and uterus — as well as ovarian endometriomas (ovarian cysts containing endometrial tissue) — can lead to impaired fertility. Endometriosis causes the release of proinflammatory cytokines and prostaglandins, chemical messengers that are key components of inflammation. These cytokines promote pain and scarring. They also can directly affect the reproductive system, contributing to infertility.

Adhesions and masses formed by endometriosis (such as cysts) can disrupt the normal movement of eggs from the ovaries to the uterus during ovulation, preventing fertilization and implantation. Treatments for endometriosis meant to control pain can also have side effects that prevent pregnancy. These include surgery and the use of hormone therapy, such as oral contraceptives and gonadotropin-releasing hormone (GnRH) analogues.

Surgery to diagnose and treat endometriosis can cause adhesions that can contribute to infertility. Other surgeries to treat endometriosis include hysterectomy (removing the uterus) and oophorectomy (removing one or both ovaries). Hysterectomy or bilateral oophorectomy (removing both ovaries) both lead to irreversible infertility, so considering desired fertility is important when weighing treatment options.

Learn more about the pros and cons of a hysterectomy for endometriosis.

Treating endometriosis can also improve fertility. Surgery to remove endometriosis lesions and adhesions can improve fertility in many people, even those with more severe endometriosis. GnRH analogues can increase fertility in women with elevated endometrial inflammation. People with endometriosis who have an intact uterus and at least one ovary can often get pregnant using in vitro fertilization (IVF). IVF is a common fertility treatment that involves fertilizing eggs outside the body and implanting them in the uterus.

Learn more about endometriosis and infertility.

Bowel Problems

Endometriosis can lead to complications affecting the bowels. Scarring (adhesions) related to endometriosis can cause bowel blockages leading to bowel obstruction, a serious condition. Adhesions can also cause ischemia, cutting off blood flow, resulting in severe pain and damage to the bowels. Bowel obstruction and ischemia can be severe complications that require immediate treatment. DIE can also invade into the bowel wall, causing pain, inflammation, and intestinal damage.

Surgery can remove adhesions causing bowel symptoms, but may also cause more adhesions to form. Surgery to remove portions of bowel affected by endometriosis may be required, especially if there is DIE or ischemia.

If the remaining bowel cannot be immediately reconnected, a stoma (such as a colostomy) may be required. A stoma connects the bowels to an opening in the abdominal wall and is often temporary, allowing the remaining bowel to heal before being reconnected.

Surgery for DIE that involves the rectum can also lead to the formation of a rectovaginal fistula, an opening between the vagina and rectum that may require surgery to repair.

Urinary Tract Problems

Endometriosis can affect the urinary tract in several ways. Urinary tract endometriosis can directly affect the bladder and/or ureters, the tubes that connect the kidneys to the bladder. Bladder endometriosis can occur on the surface of the bladder or invade into the bladder muscle. This can cause a array of problems, including pain, urinary urgency, incontinence, and bleeding.

Adhesions or masses formed by endometriosis lesions or endometriomas can obstruct one or both ureters; this can lead to serious kidney damage due to urine backing up into the kidney. Endometriosis lesions and endometriomas can also put pressure on the nerves that control the bladder, causing lower urinary tract symptoms.

Surgery is used to treat endometriosis that affects the bladder and ureters. Surface lesions, adhesions, and masses causing symptoms can all be removed surgically. DIE of the bladder may require surgical removal of part of the bladder wall.

Chronic Pain

Endometriosis is a common cause of chronic pelvic pain. Even with treatment using medication or surgery, pain can persist. Chronic pain can also contribute to depression and anxiety.

The science behind how the body experiences pain with endometriosis is complex. Inflammation at the site of lesions can cause immediate pain. It also contributes to a variety of processes in the body that can change how pain is perceived and experienced. Recurrent and long-term pain and inflammation can change how nerves react to pain and actually alter the structure and function of the brain.

Treating chronic pain can be difficult. There is no single treatment for endometriosis pain, but there are ways to reduce it. Treatments include:

Depression and Anxiety

Depression and anxiety often accompany endometriosis and other causes of chronic pelvic pain. Regardless of severity, endometriosis can drastically affect your mental health.

People with endometriosis can face chronic and recurrent pain, infertility, and other symptoms. Many people spend years trying to get a diagnosis for their symptoms of endometriosis before getting proper care.

All of these factors can contribute to a significantly reduced quality of life. Not only can chronic pain generate depression and anxiety, but depression and anxiety can make chronic pain worse, creating a vicious cycle of physical pain and emotional suffering.

There are several ways to address depression, anxiety, and other mental health conditions. Treatments that improve endometriosis symptoms also help improve depression and anxiety. Numerous medications are available to treat anxiety and depression, as well as nondrug therapies, including talk therapy and cognitive behavioral therapy. Diet, exercise, and yoga can also contribute to improved mental health.

Living With Endometriosis

Learning about the symptoms and many potential complications caused by both disease and treatment can paint a very grim picture of life with endometriosis, but there is hope. Endometriosis is treatable.

You can help make life with endometriosis better by learning all you can about how to manage your disease. Talk to your health care provider about finding relief from your symptoms and share your concerns about the complications of endometriosis.

Talk With Others Who Understand

MyEndometriosisTeam is the social network for people with endometriosis and their loved ones. On MyEndometriosisTeam, more than 122,000 members come together to ask questions, give advice, and share their stories with others who understand life with endometriosis.

Are you or someone you care for living with endometriosis? Share your experience in the comments below, or start a conversation by posting on your Activities page.

References
  1. Endometriosis — MedlinePlus
  2. Endometriosis — World Health Organization
  3. Endometriosis — Complications — NHS
  4. Abdominal Adhesions — National Institute of Diabetes and Digestive and Kidney Diseases
  5. Adhesions — Endometriosis.org
  6. Impact of Endometriosis-Related Adhesions on Quality of Life Among Infertile Women — International Journal of Fertility & Sterility
  7. Deeply Infiltrative Endometriosis — Brigham and Women’s Hospital
  8. What Is Frozen Pelvis? — Endometriosis.net
  9. Diagnostic Laparoscopy — UCSF Health
  10. Laparoscopy — Johns Hopkins Medicine
  11. Benefits and Harms of Adhesion Barriers for Abdominal Surgery: A Systematic Review and Meta-Analysis — Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews
  12. Endometriosis and Infertility: How and When To Treat? — Frontiers in Surgery
  13. Endometriosis — Mayo Clinic
  14. Endometrioma — StatPearls
  15. Cytokines, Inflammation and Pain — International Anesthesiology Clinics
  16. Prostaglandins and Inflammation — Arteriosclerosis, Thrombosis, and Vascular Biology
  17. In Vitro Fertilization (IVF) — Mayo Clinic
  18. Colostomy — Johns Hopkins Medicine
  19. Rectovaginal Fistula — Mayo Clinic
  20. Endometriosis and the Urinary Tract: From Diagnosis to Surgical Treatment — Diagnostics
  21. Endometriosis and the Bladder — Endometriosis UK
  22. Mechanisms of Pain in Endometriosis — European Journal of Obstetrics & Gynecology and Reproductive Biology
  23. Pain in Endometriosis — Frontiers in Cellular Neuroscience
  24. Anxiety and Depression in Patients with Endometriosis: Impact and Management Challenges — International Journal of Women’s Health
  25. Cognitive Behavioral Therapy — Mayo Clinic
  26. Pelvic Adhesions (Scar Tissue) — UNC School of Medicine
  27. The Role of Gnrh Analogues in Improving Outcome in Women Undergoing Superovulation and Intrauterine Insemination After Surgical Correction of Mild Endometriosis: A Randomized Controlled Trial — The Eurasian Journal of Medicine
  28. Endometriosis Symptoms: Gastrointestinal Distress — Endometriosis Foundation of America
  29. Abdominal Adhesions: A Practical Review of an Often Overlooked Entity — Annals of Medicine and Surgery
  30. Bowel Endometriosis: Colorectal Surgeon’s Perspective in a Multidisciplinary Surgical Team
Dan Martin, M.D. is the scientific and medical director of the Endometriosis Foundation of America. Learn more about him here.
Kristopher Bunting, M.D. studied chemistry and life sciences at the U.S. Military Academy, West Point, and received his doctor of medicine degree from Tulane University. Learn more about him here.

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