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https://www.mayoclinic.org/diseases-conditions/endometriosis/diagnosis-treatment/drc-20354661

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Diagnosis

Endometriosis FAQs

Get answers to the most frequently asked questions about endometriosis from Megan Wasson, D.O., a minimally invasive gynecologic surgeon at Mayo Clinic.

Hi, I'm Dr. Megan Wasson, a minimally invasive gynecologic surgeon at Mayo Clinic. I'm here to answer some of the important questions that you might have about endometriosis.

What causes endometriosis?

I wish I could tell you the answer to that, but unfortunately, we don't know. Currently, we think that the likely source of endometriosis is actually occurring during development as a fetus. So when a baby is developing inside the uterus of its mother, that's when we think endometriosis actually starts.

How do I know if I have endometriosis?

That's a really great question. So endometriosis is something that can be a little bit elusive, but we can suspect it based on symptoms that you might be experiencing. If you're having pain with your periods, pain in your pelvis in general pain with intercourse, urination, bowel movements, all of that may point us to a suspicion of endometriosis. But unfortunately, the only way to say 100% If you do or do not have endometriosis is to do surgery. Because during surgery we can remove tissue, look at it underneath the microscope, and definitively be able to say whether you do or do not have endometriosis.

Can endometriosis be seen on imaging?

Unfortunately, most of the time, no. The vast majority of endometriosis is superficial endometriosis, meaning that it's almost like paint spackling on a wall, that we can't see it unless we actually go in and take a look surgically. The exception to that is if there's endometriosis actually growing into organs in the pelvis or the abdomen like the bowel or the bladder. That's called deep-infiltrating endometriosis. In those scenarios, we can frequently see that disease either on ultrasound or on MRI.

If I have endometriosis, should I have a hysterectomy?

Not necessarily. So endometriosis, it's cells similar to the lining of the uterus that are growing outside of the uterus. So it's truly not an issue with the uterus at all, which is what we treat with hysterectomy. That being said, there is a sister condition to endometriosis called adenomyosis and that occurs concurrently in 80 to 90% of patients, and so with adenomyosis, the uterus itself can be a source of problems, including pain. In those scenarios, sometimes we do consider a hysterectomy at the time that we're treating endometriosis.

What happens if my endometriosis is left untreated?

The key thing to remember here is that endometriosis is a progressive condition, and it will continue to grow and may cause progressive symptoms. So for some patients, that means that initially the pain was only with the menstrual cycle. But over time with that progression of disease, the pain can start to occur outside of the cycle, so throughout different times of the month, with urination, with bowel movements, with intercourse. So that can prompt us to need to intervene and do treatment if we hadn't done anything previously. But that being said, even though we know endometriosis is progressive, for some patients, it doesn't ever progress to the point that we would need to do any treatment because it's more of a quality of life issue. And if it's not impacting the quality of life, we don't really need to do anything.

Can I become pregnant if I have endometriosis?

100%. You can absolutely have children if you have endometriosis. When we talk about infertility, those are patients who are struggling with pregnancy already. But if we look at all patients with endometriosis, everyone with that diagnosis, the vast majority are able to achieve pregnancy without any problem whatsoever. They can get pregnant, they can carry the pregnancy. They walk home from the hospital with a beautiful baby in their arms. So, yes, unfortunately, infertility can be associated with endometriosis. But the vast majority of the time, it's truly not a problem.

How can I be the best partner to my medical team?

Being a partner for the medical team is truly key. A lot of individuals with endometriosis have been in pain for a prolonged period of time, which unfortunately means that the body has changed in response. And pain has almost become like an onion with endometriosis at the core of that onion. So we need to work not only to treat the endometriosis, but treat other potential sources of pain that have arisen. And so I encourage you to educate yourself, not only so that you can come in to your health care provider and have a dialogue and a conversation as to what you need and what you're experiencing. But also so you can be an advocate and make sure that you are getting the health care that you need and that you deserve. Also talk about it. Know women have, for years and decades, been told that a period is supposed to be painful and we just have to unfortunately suck it up and deal with it. That's not the reality. The reality is we should not be laying on the bathroom floor when we have our period. We should not be crying during intercourse. That is not normal. If you're experiencing it, speak up. Talk to your family, Talk to your friends. Talk to your health care provider. Let them know what's going on. Because truly, we are here to help and together we can start to make a impact not only on endometriosis for you, but endometriosis in society as a whole. Never hesitate to ask your medical team any questions or concerns you have. Being informed truly makes all the difference. Thanks for your time and we wish you well.

To find out if you have endometriosis, your doctor will likely start by giving you a physical exam. You'll be asked to describe your symptoms, including where and when you feel pain.

Tests to check for clues of endometriosis include:

Pelvic exam. Your health care professional feels areas in your pelvis with one or two gloved fingers to check for any unusual changes. These changes can include cysts on the reproductive organs, painful spots, irregular growths called nodules and scars behind the uterus. Often, small areas of endometriosis can't be felt unless a cyst has formed.

Ultrasound. This test uses sound waves to make pictures of the inside of the body. To capture the images, a device called a transducer might be pressed against the stomach area. Or it may be placed into the vagina in a version of the exam called transvaginal ultrasound. Both types of the test may be done to get the best view of the reproductive organs. A standard ultrasound won't confirm whether you have endometriosis. But it can find cysts linked with the condition called endometriomas.

Magnetic resonance imaging (MRI). This exam uses a magnetic field and radio waves to make images of the organs and tissues within the body. For some, an MRI helps with surgical planning. It gives your surgeon detailed information about the location and size of endometriosis growths.

Laparoscopy. In some cases, you may be referred to a surgeon for this procedure. Laparoscopy lets the surgeon check inside your abdomen for signs of endometriosis tissue. Before the surgery, you receive medicine that puts you a sleep-like state and prevents pain. Then your surgeon makes a tiny cut near your navel and inserts a slender viewing instrument called a laparoscope.

A laparoscopy can provide information about the location, extent and size of the endometriosis growths. Your surgeon may take a tissue sample called biopsy for more testing. With proper planning, a surgeon can often treat endometriosis during the laparoscopy so that you need only one surgery.

Treatment

Treatment for endometriosis often involves medicine or surgery. The approach you and your health care team choose will depend on how serious your symptoms are and whether you hope to become pregnant.

Typically, medicine is recommended first. If it doesn't help enough, surgery becomes an option.

Pain medicines

Your health care team may recommend pain relievers that you can buy without a prescription. These medicines include the nonsteroidal anti-inflammatory drugs (NSAIDs) ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve). They can help ease painful menstrual cramps.

Your care team may recommend hormone therapy along with pain relievers if you're not trying to get pregnant.

Hormone therapy

Sometimes, hormone medicine help ease or get rid of endometriosis pain. The rise and fall of hormones during the menstrual cycle causes endometriosis tissue to thicken, break down and bleed. Lab-made versions of hormones may slow the growth of this tissue and prevent new tissue from forming.

Hormone therapy isn't a permanent fix for endometriosis. The symptoms could come back after you stop treatment.

Therapies used to treat endometriosis include:

Hormonal contraceptives. Birth control pills, shots, patches and vaginal rings help control the hormones that stimulate endometriosis. Many have lighter and shorter menstrual flow when they use hormonal birth control. Using hormonal contraceptives may ease or get rid of pain in some cases. The chances of relief seem to go up if you use birth control pills for a year or more with no breaks.

Gonadotropin-releasing hormone (Gn-RH) agonists and antagonists. These medicines block the menstrual cycle and lower estrogen levels. This causes endometriosis tissue to shrink. These medicines create an artificial menopause. Taking a low dose of estrogen or progestin along with Gn-RH agonists and antagonists may ease menopausal side effects. Those include hot flashes, vaginal dryness and bone loss. Menstrual periods and the ability to get pregnant return when you stop taking the medicine.

Progestin therapy. Progestin is a lab-made version of a hormone that plays a role in the menstrual cycle and pregnancy. A variety of progestin treatments can stop menstrual periods and the growth of endometriosis tissue, which may relieve symptoms. Progestin therapies include a tiny device placed in the uterus that releases levonorgestrel (Mirena, Skyla, others), a contraceptive rod placed under the skin of the arm (Nexplanon), birth control shots (Depo-Provera) or a progestin-only birth control pill (Camila, Slynd).

Aromatase inhibitors. These are a class of medicines that lower the amount of estrogen in the body. Your health care team may recommend an aromatase inhibitor along with a progestin or combination birth control pills to treat endometriosis.

Conservative surgery

Conservative surgery removes endometriosis tissue. It aims to preserve the uterus and the ovaries. If you have endometriosis and you're trying to become pregnant, this type of surgery may boost your chances of success. It also may help if the condition causes you terrible pain - but endometriosis and pain may come back over time after surgery.

Your surgeon may do this procedure with small cuts, also called laparoscopic surgery. Less often, surgery that involves a larger cut in the abdomen is needed to remove thick bands of scar tissue. But even in severe cases of endometriosis, most can be treated with the laparoscopic method.

During laparoscopic surgery, your surgeon places a slender viewing instrument called a laparoscope through a small cut near your navel. Surgical tools are inserted to remove endometriosis tissue through another small cut. Some surgeons do laparoscopy with help from robotic devices that they control. After surgery, your health care team may recommend taking hormone medicine to help improve pain.

Fertility treatment

Endometriosis can lead to trouble getting pregnant. If you have a hard time conceiving, your health care team may recommend fertility treatment. You might be referred to a doctor who treats infertility, called a reproductive endocrinologist. Fertility treatment can include medicine that helps ovaries make more eggs. It also can include a series of procedures that mix eggs and sperm outside the body, called in vitro fertilization. The treatment that's right for you depends on your personal situation.

Hysterectomy with removal of the ovaries

Hysterectomy is surgery to remove the uterus. Taking out the uterus and ovaries was once thought to be the most effective treatment for endometriosis. Today, some experts consider it to be a last resort to ease pain when other treatments haven't worked. Other experts instead recommend surgery that focuses on the careful and thorough removal of all endometriosis tissue.

Having the ovaries removed, also called oophorectomy, causes early menopause. The lack of hormones made by the ovaries may improve endometriosis pain for some. But for others, endometriosis that remains after surgery continues to cause symptoms. Early menopause also carries a risk of heart and blood vessel diseases, certain metabolic conditions and early death.

In people who don't want to get pregnant, hysterectomy sometimes can be used to treat symptoms linked with endometriosis. These include heavy menstrual bleeding and painful menses due to uterine cramping. Even when the ovaries are left in place, a hysterectomy may still have a long-term effect on your health. That's especially true if you have the surgery before age 35.

To manage and treat endometriosis, it's key to find a health care professional with whom you feel comfortable. You may want to get a second opinion before you start any treatment. That way, you can be sure you know all of your options and the pros and cons of each.

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Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.

Lifestyle and home remedies

It may take time to find a treatment that works. Until then, you can try some things at home to ease your pain.

Warm baths and a heating pad can help relax pelvic muscles. This lessens cramping and pain.

Nonsteroidal anti-inflammatory drugs (NSAIDs) can help ease painful menstrual cramps. NSAIDs include ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve).

You also can ask your health care team if physical therapy might help. A therapist can teach you how to relax muscles that support the uterus, called the pelvic floor. Relaxing these tight muscles may help pelvic pain linked with endometriosis feel less intense.

Alternative medicine

Alternative medicine involves treatments that aren't part of standard medical care. Some people with endometriosis say they get pain relief from alternative therapies such as:

Acupuncture, in which a trained practitioner places fine needs into the skin.

Chiropractic care, in which a licensed professional adjusts the spine or other body parts.

Herbs such as cinnamon trig or licorice root.

Supplements including vitamin B1, magnesium or omega-3 fatty acids.

Acupuncture has shown some promise at easing endometriosis pain. But overall, there's little research on much relief people with the condition might get from alternative medicine. Always check with your health care team before you try a new alternative therapy to find out if it's safe for you. For example, supplements and herbs can affect standard treatments such as medicines. If you're interested in trying acupuncture or chiropractic care, ask your care team to recommend reputable professionals. Check with your insurance company to see if the expense will be covered.

Coping and support

Think about joining a support group if you have endometriosis or a complication such as fertility trouble. Sometimes it helps simply to talk to other people who can relate to your feelings and experiences. If you can't find a support group in your community, look for one online.

Preparing for your appointment

Your first appointment will likely be with either your primary care doctor or a gynecologist. If you're seeking treatment for infertility, you may be referred to a doctor called a reproductive endocrinologist.

Appointments can be brief, and it can be hard to remember everything you want to discuss. So it's a good idea to plan ahead for your appointment.

What you can do

Make a list of any symptoms you have. Include all of your symptoms, even if you don't think they're related to the reason for your appointment.

Make a list of any medicines, herbs or vitamin supplements you take. Include how often you take them and how much you take, called the dose.

Have a family member or close friend join you, if possible. You may get a lot of information at your visit, and it can be hard to recall everything.

Take a notepad or electronic device with you. Use it to make notes of important information during your visit.

Prepare a list of questions to ask your doctor. List your most important questions first, to be sure you bring up those points.

For endometriosis, some basic questions to ask your doctor include:

How is endometriosis diagnosed?

What medicines treat endometriosis? Is there a medicine that can ease my symptoms?

What side effects can I expect from medicine?

Do you recommend surgery?

Will endometriosis affect my ability to become pregnant?

Can treatment of endometriosis improve my fertility?

Can you recommend any alternative treatments I might try?

Make sure that you understand everything your health care team tells you. It's fine to ask your team to repeat information or to ask follow-up questions.

What to expect from your doctor

Some questions your doctor might ask include:

How often do you have these symptoms?

How long have you had these symptoms?

How bad are your symptoms?

Do your symptoms seem to be related to your menstrual cycle?

Does anything improve your symptoms?

Does anything make your symptoms worse?

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Learn about endometriosis, including possible treatments for this condition that can cause pain and sometimes infertility.

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https://www.mayoclinic.org/diseases-conditions/erectile-dysfunction/diagnosis-treatment/drc-20355782

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Diagnosis

Erectile dysfunction FAQs

Urologist Tobias Kohler, M.D., answers the most frequently asked questions about erectile dysfunction.

Hi. I'm Dr. Kohler, a urologist at Mayo Clinic. I'm here to answer some of the important questions you may have about erectile dysfunction.

Problems with erectile dysfunction are super common. If you look at the decade of life, that predicts what percent of men will have problems. So, for example, 50% of 50-year-olds, 60% of 60-year-olds, so on and so forth, will have problems with erections. But that does not necessarily mean that as you get older, you have to have problems of the penis. There are plenty of men in their 60s, 70s and 80s and 90s with great sex lives. In other words, if you take great care your penis, your penis will take great care of you.

So the things that you can do to take care of yourself to help with erections include exercising, eating well, including a diet high in fruits and vegetables, having a slimmer waistline, sleeping well, quitting smoking. A lot of these things I mentioned are as powerful as medications in helping with erections and improving your sex life.

The penis and overall health is so strongly connected, it's really important to remember that the penis is one of the most powerful predictors we have, especially in young men, for heart attacks. The blood vessels that feed the penis are relatively small. Blood vessels in the heart and the neck are a little bit bigger. So therefore, the penis can predict heart attacks or strokes years in advance when they may occur.

Yes and no. So when we talk about what truly is a problem with erectile dysfunction, the definition is a problem that lasts greater than three months and is a consistent inability to obtain or maintain an erection adequate for intercourse. So when young men get problems with erections, which is very, very common because it's normal to have bad nights here and there. And so, if it happens occasionally, you don't need to be as worried about that. But if you have consistent problems, you absolutely should and must get checked out by a doctor to figure out what's going on, not only because there are great treatments available, but because we may discover underlying medical problems.

When young men have problems with erections, most of the time it's a confidence issue. And so, there are different ways to deal with that. One way is to give medications to get the confidence back. Another way is to use specialists trained in behavioral techniques to get confidence back, so sexual counselors or therapists can really help with this problem.

Modern day, we have several new, exciting, experimental things, such as shockwave therapy of the penis or platelet-rich plasma or stem cell therapy. These are not ready for prime time, and so you should not, as a patient, have to spend your hard-earned money to see whether or not this works for you. It's better to be part of a clinical trial to see if that works or to go with more traditional therapies at this point.

If you want to be a great partner for your medical team to help solve problems with erections, the number one thing you can do is book an appointment. Just like anything else in life, you have to take the initiative, set up an appointment for your physician, say, "Doc, I have a problem with sex." Never hesitate to ask your medical team any questions or concerns you have. Being informed makes all the difference. Thanks for your time and we wish you well.

For many people, a physical exam and answering questions (medical history) are all that's needed for a doctor to diagnose erectile dysfunction and recommend a treatment. If you have chronic health conditions or your doctor suspects that an underlying condition might be involved, you might need further tests or a consultation with a specialist.

Tests for underlying conditions might include:

Physical exam. This might include careful examination of your penis and testicles and checking your nerves for sensation.

Blood tests. A sample of your blood might be sent to a lab to check for signs of heart disease, diabetes, low testosterone levels and other health conditions.

Urine tests (urinalysis). Like blood tests, urine tests are used to look for signs of diabetes and other underlying health conditions.

Ultrasound. This test is usually performed by a specialist in an office. It involves using a wandlike device (transducer) held over the blood vessels that supply the penis. It creates a video image to let your doctor see if you have blood flow problems.

This test is sometimes done in combination with an injection of medications into the penis to stimulate blood flow and produce an erection.

Psychological exam. Your doctor might ask questions to screen for depression and other possible psychological causes of erectile dysfunction.

Treatment

The first thing your doctor will do is to make sure you're getting the right treatment for any health conditions that could be causing or worsening your erectile dysfunction.

Depending on the cause and severity of your erectile dysfunction and any underlying health conditions, you might have various treatment options. Your doctor can explain the risks and benefits of each treatment and will consider your preferences. Your partner's preferences also might play a role in your treatment choices.

Oral medications

Oral medications are a successful erectile dysfunction treatment for many men. They include:

Sildenafil (Viagra)

Tadalafil (Adcirca, Cialis)

Vardenafil (Levitra, Staxyn)

Avanafil (Stendra)

All four medications enhance the effects of nitric oxide - a natural chemical your body produces that relaxes muscles in the penis. This increases blood flow and allows you to get an erection in response to sexual stimulation.

Taking one of these tablets will not automatically produce an erection. Sexual stimulation is needed first to cause the release of nitric oxide from your penile nerves. These medications amplify that signal, allowing normal penile function in some people. Oral erectile dysfunction medications are not aphrodisiacs, will not cause excitement and are not needed in people who get normal erections.

The medications vary in dosage, how long they work and side effects. Possible side effects include flushing, nasal congestion, headache, visual changes, backache and stomach upset.

Your doctor will consider your particular situation to determine which medication might work best. These medications might not treat your erectile dysfunction immediately. You might need to work with your doctor to find the right medication and dosage for you.

Before taking any medication for erectile dysfunction, including over-the-counter supplements and herbal remedies, get your doctor's OK. Medications for erectile dysfunction do not work in everyone and might be less effective in certain conditions, such as after prostate surgery or if you have diabetes. Some medications might also be dangerous if you:

Take nitrate drugs - commonly prescribed for chest pain (angina) - such as nitroglycerin (Nitro-Dur, Nitrostat, others), isosorbide mononitrate (Monoket) and isosorbide dinitrate (Isordil, Bidil)

Have heart disease or heart failure

Have very low blood pressure (hypotension)

Other medications

Other medications for erectile dysfunction include:

Alprostadil self-injection. With this method, you use a fine needle to inject alprostadil (Caverject, Edex) into the base or side of your penis. In some cases, medications generally used for other conditions are used for penile injections on their own or in combination. Examples include alprostadil and phentolamine. Often these combination medications are known as bimix (if two medications are included) or trimix (if three are included).

Each injection is dosed to create an erection lasting no longer than an hour. Because the needle used is very fine, pain from the injection site is usually minor.

Side effects can include mild bleeding from the injection, prolonged erection (priapism) and, rarely, formation of fibrous tissue at the injection site.

Alprostadil urethral suppository. Alprostadil (Muse) intraurethral therapy involves placing a tiny alprostadil suppository inside your penis in the penile urethra. You use a special applicator to insert the suppository into your penile urethra.

The erection usually starts within 10 minutes and, when effective, lasts between 30 and 60 minutes. Side effects can include a burning feeling in the penis, minor bleeding in the urethra and formation of fibrous tissue inside your penis.

Testosterone replacement. Some people have erectile dysfunction that might be complicated by low levels of the hormone testosterone. In this case, testosterone replacement therapy might be recommended as the first step or given in combination with other therapies.

Penis pumps, surgery and implants

If medications aren't effective or appropriate in your case, your doctor might recommend a different treatment. Other treatments include:

Penis pumps. A penis pump (vacuum erection device) is a hollow tube with a hand-powered or battery-powered pump. The tube is placed over your penis, and then the pump is used to suck out the air inside the tube. This creates a vacuum that pulls blood into your penis.

Once you get an erection, you slip a tension ring around the base of your penis to hold in the blood and keep it firm. You then remove the vacuum device.

The erection typically lasts long enough for a couple to have sex. You remove the tension ring after intercourse. Bruising of the penis is a possible side effect, and ejaculation will be restricted by the band. Your penis might feel cold to the touch.

If a penis pump is a good treatment choice for you, your doctor might recommend or prescribe a specific model. That way, you can be sure it suits your needs and that it's made by a reputable manufacturer.

Penile implants. This treatment involves surgically placing devices into both sides of the penis. These implants consist of either inflatable or malleable (bendable) rods. Inflatable devices allow you to control when and how long you have an erection. The malleable rods keep your penis firm but bendable.

Penile implants are usually not recommended until other methods have been tried first. Implants have a high degree of satisfaction among those who have tried and failed more-conservative therapies. As with any surgery, there's a risk of complications, such as infection. Penile implant surgery is not recommended if you currently have a urinary tract infection.

Exercise

Recent studies have found that exercise, especially moderate to vigorous aerobic activity, can improve erectile dysfunction.

Even less strenuous, regular exercise might reduce the risk of erectile dysfunction. Increasing your level of activity might also further reduce your risk.

Discuss an exercise plan with your doctor.

Psychological counseling

If your erectile dysfunction is caused by stress, anxiety or depression - or the condition is creating stress and relationship tension - your doctor might suggest that you, or you and your partner, visit a psychologist or counselor.

More Information

Show more related information

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.

Lifestyle and home remedies

For many people, erectile dysfunction is caused or worsened by lifestyle choices. Here are some steps that might help:

If you smoke, quit. If you have trouble quitting, get help. Try nicotine replacement, such as over-the-counter gum or lozenges, or ask your doctor about a prescription medication that can help you quit.

Lose excess pounds. Being overweight can cause - or worsen - erectile dysfunction.

Include physical activity in your daily routine. Exercise can help with underlying conditions that play a part in erectile dysfunction in a number of ways, including reducing stress, helping you lose weight and increasing blood flow.

Get treatment for alcohol or drug problems. Drinking too much or taking certain illegal drugs can worsen erectile dysfunction directly or by causing long-term health problems.

Work through relationship issues. Consider couples counseling if you're having trouble improving communication with your partner or working through problems on your own.

Alternative medicine

Before using any supplement, check with your doctor to make sure it's safe for you - especially if you have chronic health conditions. Some alternative products that claim to work for erectile dysfunction can be dangerous.

The Food and Drug Administration (FDA) has issued warnings about several types of "herbal viagra" because they contain potentially harmful drugs not listed on the label. The dosages might also be unknown, or they might have been contaminated during formulation.

Some of these drugs can interact with prescription drugs and cause dangerously low blood pressure. These products are especially dangerous for anyone who takes nitrates.

Coping and support

Whether the cause is physical, psychological or a combination of both, erectile dysfunction can become a source of mental and emotional stress for you and your partner. Here are some steps you can take:

Don't assume you have a long-term problem. Don't view occasional erection problems as a reflection on your health or masculinity, and don't automatically expect to have erection trouble again during your next sexual encounter. This can cause anxiety, which might make erectile dysfunction worse.

Involve your sexual partner. Your partner might see your inability to have an erection as a sign of diminished sexual interest. Your reassurance that this isn't the case can help. Communicate openly and honestly about your condition. Treatment can be more successful for you when you involve your partner.

Don't ignore stress, anxiety or other mental health concerns. Talk to your doctor or consult a mental health provider to address these issues.

Preparing for your appointment

You're likely to start by seeing your family doctor. Depending on your particular health concerns, you might go directly to a specialist - such as a doctor who specializes in male genital problems (urologist) or a doctor who specializes in the hormonal systems (endocrinologist).

Because appointments can be brief and there's often a lot of ground to cover, it's a good idea to be well prepared. Here's some information to help you get ready and know what to expect from your doctor.

What you can do

Take these steps to prepare for your appointment:

Ask what you need to do ahead of time. When you make the appointment, be sure to ask if there's anything you need to do in advance. For example, your doctor might ask you not to eat before having a blood test.

Write down any symptoms you've had, including any that might seem unrelated to erectile dysfunction.

Write down key personal information, including any major stresses or recent life changes.

Make a list of all medications, vitamins, herbal remedies and supplements you take.

Take your partner along, if possible. Your partner can help you remember something that you missed or forgot during the appointment.

Write down questions to ask your doctor.

For erectile dysfunction, some basic questions to ask your doctor include:

What's the most likely cause of my erection problems?

What are other possible causes?

What kinds of tests do I need?

Is my erectile dysfunction most likely temporary or chronic?

What's the best treatment?

What are the alternatives to the primary approach that you're suggesting?

How can I best manage other health conditions with my erectile dysfunction?

Are there any restrictions that I need to follow?

Should I see a specialist? What will that cost, and will the visit be covered by my insurance?

If medication is prescribed, is there a generic alternative?

Are there any brochures or other printed material that I can take home with me? What websites do you recommend?

In addition to your prepared questions, don't hesitate to ask additional questions during your appointment.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Be prepared for questions such as these:

What other health concerns or chronic conditions do you have?

Have you had any other sexual problems?

Have you had any changes in sexual desire?

Do you get erections during masturbation, with a partner or while you sleep?

Are there any problems in your relationship with your sexual partner?

Does your partner have any sexual problems?

Are you anxious, depressed or under stress?

Have you ever been diagnosed with a mental health condition? If so, do you currently take any medications or get psychological counseling (psychotherapy) for it?

When did you first begin noticing sexual problems?

Do your erectile problems occur only sometimes, often or all of the time?

What medications do you take, including any herbal remedies or supplements?

Do you drink alcohol? If so, how much?

Do you use any illegal drugs?

What, if anything, seems to improve your symptoms?

What, if anything, seems to worsen your symptoms?

Our caring team of Mayo Clinic experts can help you with your health concerns. Visit Mayo Clinic Men's Health to get started.

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Erectile dysfunction FAQs Urologist Tobias Kohler, M.D., answers the most frequently asked questions about erectile dysfunction. Hi. I'm Dr. Kohler, a urologist at Mayo Clinic. I'm here to answer some of the important questions you may have about erectile dysfunction. Problems with erectile dysfunction are super common.

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https://my.clevelandclinic.org/health/diseases/10035-erectile-dysfunction#:~:text=Erectile%20dysfunction%2C%20commonly%20referred%20to,on%20a%20long%2Dterm%20basis.

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Overview

Dr. Drogo Montague discusses treatment options for erectile dysfunction.

What is erectile dysfunction (ED)?

Erectile dysfunction (ED) is the inability to get and keep an erection firm enough for sexual intercourse. Estimates suggest that one of every 10 men will suffer from ED at some point during his lifetime. It is important to understand that in most cases, ED is a symptom of another, underlying problem. ED is not considered normal at any age, and may be associated with other problems that interfere with sexual intercourse, such as lack of desire and problems with orgasm and ejaculation.

How common is erectile dysfunction?

Approximately one in 10 adult males will suffer from ED on a long-term basis.

Many men do experience occasional failure to achieve erection, which can occur for a variety of reasons, such as drinking too much alcohol, stress, relationship problems, or from being extremely tired.

The failure to get an erection less than 20% of the time is not unusual and typically does not require treatment. However, the failure to achieve an erection more than 50% of the time generally means that there is a problem and treatment is needed.

ED does not have to be a part of getting older. While it is true that some older men may need more stimulation, they should still be able to achieve an erection and enjoy intercourse.

Symptoms and Causes

What causes erectile dysfunction (ED)?

ED can be caused by a number of factors, including:

Vascular disease: Blood supply to the penis can become blocked or narrowed as a result of vascular disease such as atherosclerosis (hardening of the arteries).

Neurological disorders (such as multiple sclerosis): Nerves that send impulses to the penis can become damaged from stroke, diabetes, or other causes.

Psychological states: These include stress, depression, lack of stimulus from the brain and performance anxiety.

Trauma: An injury could contribute to symptoms of ED.

Chronic illness, certain medications, and a condition called Peyronie's disease can also cause ED. Operations for the prostate, bladder, and colon cancer may also be contributing factors.

What medications could cause erectile dysfunction (ED)?

Erectile dysfunction (ED) is a common side effect of a number of prescription drugs. While these medications may treat a disease or condition, in doing so they can affect a man's hormones, nerves or blood circulation, resulting in ED or increasing the risk of ED.

If you experience ED and think that it may be a result of the medication you are using, do not stop taking the medication. If the problem persists, contact your doctor and he or she may be able to prescribe a different medication. Common medications that may list ED as a potential side effect include:

Diuretics (pills that cause increase urine flow).

Antihypertensives (high blood pressure drugs).

Antihistamines.

Antidepressants.

Parkinson's disease drugs.

Antiarrhythmics (drug for irregular heart action).

Tranquilizers.

Muscle relaxants.

Nonsteroidal anti-inflammatory drugs.

Histamine H2-receptor antagonists.

Hormones.

Chemotherapy medications.

Prostate cancer drugs.

Anti-seizure medications.

Other substances or drugs that can cause or lead to ED include these recreational and frequently abused drugs:

These drugs not only affect and often suppress the central nervous system, but can also cause serious damage to the blood vessels, leading to permanent ED.

What prescription drugs may cause erectile dysfunction?

Erectile dysfunction (ED) is a common side effect of a number of prescription drugs. While these medications may treat a disease or condition, in doing so they can affect a man's hormones, nerves or blood circulation. The result may be ED or an increase in the risk of ED.

If you have ED and think that it may be a result of the medication you are using, do not stop taking the medication. If the problem persists, contact your doctor and he or she may be able to prescribe a different medication. Common medications that may list ED as a potential side effect include:

Diuretics (pills that cause an increase in urine flow).

Antihypertensives (medication for high blood pressure).

Antihistamines.

Antidepressants.

Parkinson's disease drugs.

Antiarrhythmics (medication for irregular heart action).

Tranquilizers.

Muscle relaxants.

Non-steroidal anti-inflammatory drugs.

Histamine H2-receptor antagonists.

Hormones.

Chemotherapy medications.

Prostate cancer drugs.

Anti-seizure medications.

What other substances or drugs may cause erectile dysfunction?

Other substances or drugs that can cause or lead to ED include these recreational and frequently abused drugs:

Aside from the well-known complications that the use and abuse of these drugs can cause, ED is not often mentioned. However, use of these drugs is a risk factor for ED. These drugs not only affect and often times slow down the central nervous system, but can also cause serious damage to the blood vessels, leading to permanent ED.

For some men, depression can accompany the condition of erectile dysfunction (ED). It is common for men with ED to feel angry, frustrated, sad, unsure of themselves, or even less "manly." Such feelings may lead to a lack of self-esteem and, in severe cases, to depression.

Depression that accompanies ED is treatable. The first step in addressing your concerns about ED-related depression is to be honest with yourself, your partner, and your doctor. After depression has been brought out into the open, coping with it will be easier and less stressful.

Diagnosis and Tests

How is erectile dysfunction (ED) diagnosed?

Because there are a variety of causes for ED, there are several different tests your doctor may use to diagnose the condition and determine its cause. Only after the cause of ED is determined can it be effectively treated.

Before ordering any tests, your doctor will review your medical history and perform a thorough physical examination. The doctor will also "interview" you about your personal and sexual history. Some of these questions will be very personal and may feel intrusive. However, it is important that you answer these questions honestly. The questions asked may include:

What medications or drugs are you currently using? This includes prescription drugs, over-the-counter drugs, herbals, dietary supplements and illegal drugs.

Have you had any psychological problems such as stress, anxiety and depression?

When did you first notice symptoms of ED?

What are the frequency, quality and duration of any erections you have had?

What are the specifics of the circumstances under which ED first occurred?

Do/did you experience erections at night or during the morning?

What sexual techniques do you use?

Are there problems in your current relationship?

The doctor may also wish to interview your sexual partner since your partner may be able to offer in sight about the underlying causes.

After your physical examination and discussion, your doctor may then order any one of the following tests to further diagnose your condition:

Complete blood count (CBC): This is a set of blood tests that, among other things, can detect the presence of anemia. Anemia is caused by a low red blood cell count and can cause fatigue, which in turn can cause ED.

Liver and kidney function tests: These blood tests may indicate whether ED may be due to your kidneys or liver functioning improperly.

Lipid profile: This blood test measures the level of lipids (fats), like cholesterol. High levels may indicate atherosclerosis (hardening of the arteries), which can affect blood circulation in the penis.

Thyroid function test: One of the thyroid hormones' functions is to regulate the production of sex hormones, and a deficiency in these hormones may contribute to or cause ED.

Blood hormone studies: Testosterone and/or prolactin levels in the blood may be measured to see if abnormalities in either of these sex hormones are present.

Urinalysis: Analysis of urine can provide a wealth of information, including information on protein, sugar and testosterone levels. Abnormal measurements of these substances can indicate diabetes, kidney disease or a testosterone deficiency, all which can cause ED.

Duplex ultrasound: This is perhaps the best test for evaluating ED. An ultrasound uses high-frequency sound waves to take "pictures" of the body's tissues. For people with ED, an ultrasound may be used to evaluate blood flow and check for signs of a venous leak, atherosclerosis (hardening of arteries) or tissue scarring. This test is performed both while the penis is erect (usually induced by an injection of a drug that stimulates erection) and also while it is soft.

Bulbocavernosus reflex: This test evaluates nerve sensation in the penis. During the test, your doctor will squeeze the head of your penis, which should immediately cause your anus to contract. If nerve function is abnormal, there will be a delay in response time.

Nocturnal penile tumescence (NPT): This test measures a man's erectile function while he is sleeping. Normally, a man will have five or six erections while asleep. A lack of these erections may indicate there is a problem with nerve function or circulation to the penis. The test uses two methods, the snap gauge method and the strain gauge method. The snap gauge method is performed by wrapping three plastic bands of varying strength around the penis. Erectile function is then measured based on which of the three bands breaks. The strain gauge method works by placing elastic bands around the tip and base of the penis. If the penis becomes erect during the night, the bands stretch, measuring the changes in penile circumference.

Penile biothesiometry: This test involves the use of electromagnetic vibration to determine sensitivity and nerve function. A decreased sensitivity to these vibrations may indicate nerve damage.

Vasoactive injection: During this test, an erection is produced by injecting special solutions that cause the blood vessels to dilate (enlarge) allowing blood to enter the penis.

Dynamic infusion cavernosometry: This test is used for men with ED who have a venous leak. During this test, fluid is pumped into the penis at a predetermined rate. By measuring the rate at which fluid must be pumped to attain a rigid erection, doctors can determine the severity of the venous leak.

Cavernosography: Used in conjunction with the dynamic infusion cavernosometry, this test involves injecting a dye into the penis. The penis is then X-rayed so that the venous leak can be seen.

Arteriography: This test is given to people who are candidates for vascular reconstructive surgery. A dye is injected into the artery believed to be damaged and X-rays will be taken.

Before you are given any of these tests, your doctor will explain what is involved. If you have any questions, do not hesitate to ask your doctor.

Management and Treatment

What doctors treat erectile dysfunction?

The type of medical specialist who treats ED will depend on the cause of the problem. Based on your family's medical history, as well as your own medical history and current health, your doctor may treat you with oral medications (Viagra®, Levitra®, Cialis®).

If these options fail, you may be referred to a urologist who can assist with other non-surgical options such as vacuum device or injections or surgical treatment options. If needed, your doctor may also refer you to a psychologist specializing in sexual dysfunction.

How is erectile dysfunction treated?

ED can be treated in many ways, including:

Oral medications.

Sex therapy.

Penile injections.

Vacuum devices.

Intraurethral medication.

Surgery (penile implant).

Each type has its own pros and cons. Discuss your options with your doctor to determine the best treatment for you.

The first step to treating ED is to find the underlying cause. Then the appropriate treatment can begin. There are a number of non-surgical and surgical options that can help a man regain normal sexual function.

What non-surgical treatments are there for erectile dysfunction (ED)?
Education and communication
Education about sex, sexual behaviors, and sexual responses may help a man overcome his anxieties about sexual dysfunction.

Talking honestly with your partner about your needs and concerns may also help to overcome many barriers to a healthy sex life.
Medication
Medications such as sildenafil (Viagra®), vardenafil (Levitra®), or tadalafil (Cialis®) may help improve sexual function in men by increasing blood flow to the penis. Men who are on medicines that contain nitrates such as nitroglycerine should not take oral ED medications. The combination of nitrates and these specific medications can cause low blood pressure (hypotension).

The most common side effects of these medications are indigestion, nasal congestion, flushing, headaches and a temporary visual disturbance.
Mechanical aids
Aids such as vacuum devices and penile constriction rings serve as erectile aids for some men.

A vacuum constriction device (above) is a cylinder that is placed over the penis. The air is pumped out of the cylinder, which draws blood into the penis and causes an erection. The erection is maintained by slipping a band off of the base of the cylinder and onto the base of the penis. The band can stay in place for up to 30 minutes. The vacuum device can be safely used to treat most causes of erectile failure. Lack of spontaneity, discomfort, and cumbersomeness of the device seem to be the biggest concerns of patients.
Penile injection therapy (intracavernosal injection therapy)
Men are taught how to inject medications directly into the erection chambers of the penis to create an erection. Injection therapy is effective in treating a wide variety of erection issues caused by blood vessel, nerve and psychological conditions.

Using a tiny needle and syringe, the man injects a small amount of medicine into the side of his penis. The medicine relaxes the blood vessels, allowing blood to flow into the penis. This treatment has been widely used and accepted since the early 1980s. The three most common medicines are prostaglandin E1 (alprostadil), papaverine (Papacon®), and phentolamine (Regitine®).

The most common side effects are pain and penile scarring (fibrosis). In extremely rare cases, patients with cerebral and vascular disease or severe cardiovascular diseases might not be able to tolerate the dizziness and high blood pressure occasionally caused by injection therapy.

A painful erection that lasts longer than two to three hours is called priapism and may occur with injection therapy. This can be lessened with proper dosing and by following the treatment guidelines.
Psychology and sex therapies
Psychological causes may contribute to erectile failure even when there is a clear organic cause.

Therapy with a trained counselor can help a person address feelings of anxiety, fear or guilt that may have an impact on sexual dysfunction.

Sex therapy can be beneficial to most men when counseling is provided by a skilled sex therapist. Sex therapy also helps a man's partner accept and cope with the problems.

A patient whose ED has a clear psychological cause should receive sex therapy counseling before any invasive treatments are pursued.
Hormone
Low hormone levels may play a role in ED. Hormone replacement in the form of topical gels, creams, patches, injections and pellets are only used after physician evaluation.

What are surgical treatment options for erectile dysfunction (ED)?
Penile prosthesis surgery
Inflatable penile prostheses are implanted during outpatient surgery. Once they are part of a man's body, they enable him to have an erection whenever he desires. The use of a prosthesis preserves penile sensation, orgasm and ejaculation for most men.

The most commonly used penile implant consists of a pair of inflatable cylinders that are surgically implanted in the erection chambers of the penis. The cylinders are connected through tubing to a reservoir of fluid under the lower abdominal muscles, and to a pump inside the scrotal sac.

To inflate the penile prosthesis, the man compresses the pump a number of times to transfer fluid from the reservoir to the cylinders. This causes the penis to become erect. When inflated, the prosthesis makes the penis stiff and thick, which is very similar to a natural erection.

A penile prosthesis does not change the sensation on the skin of the penis or a man's ability to achieve orgasm or ejaculate. Pressing on a deflation valve attached to the pump returns the fluid to the reservoir, which returns the penis to a flaccid state.

The surgical procedure is performed through one or two small incisions that are generally well hidden. Other people will be unable to tell that a man has an inflatable penile prosthesis. Complications following surgery are not common, but primarily include infection and mechanical device failure.

Approximately 95% of penile implant surgeries are successful in producing erections that enable men to have sexual intercourse. Moreover, patient satisfaction questionnaires show that up to 90% of men who have undergone penile implants say they would choose the surgery again, and overall satisfaction ratings are higher than those reported by men using oral medication or penile injection therapy.

Prevention

Can erectile dysfunction (ED) be prevented?

For people who are at risk of developing ED due to personal behavior, steps may be taken to try to prevent its occurrence. However, other causes may not be preventable.

A number of studies now suggest a link between ED and obesity, high cholesterol, hypertension, diabetes and heart disease.

The following recommendations may help prevent ED or improve the problem if it is already present:

Eat a healthy diet. A diet that limits saturated fat intake and includes several portions of fruits, vegetables and whole grains can benefit men with ED.

Reduce cholesterol. High cholesterol can harden, narrow or block the arteries (atherosclerosis) leading to the penis. Men can lower cholesterol through diet, exercise and medication.

Maintain a healthy weight.

Exercise regularly. Regular exercise may reduce the risk of ED. Choose exercises that you enjoy and will make a regular part of your day. In addition to reducing the risk of ED, exercise also can help you manage stress. Check with your doctor before starting any exercise program.

Living With

What should I do if I am having problems achieving/keeping an erection?

If you suspect you have erectile dysfunction, please see your primary care physician or a urologist. He or she can perform tests to find out what is causing your problem and refer you to a specialist if needed. Once the cause is identified, there are several treatment options to choose from.

Does insurance cover erectile dysfunction (ED) treatment?

Insurance coverage for ED depends on the type of treatment prescribed and whether your insurance covers sexual dysfunction at all. Speak with your insurance provider to determine if the option you are considering will be covered.

Resources

Download Our Free Treatment Guide

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Erectile Dysfunction (ED): Causes, Diagnosis & Treatment

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Erectile dysfunction (ED) is the inability to get and keep an erection firm enough for sexual intercourse. Estimates suggest that one of every 10 men will suffer from ED at some point during his lifetime. It is important to understand that in most cases, ED is a symptom of another, underlying problem.

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https://www.womenshealth.gov/a-z-topics/endometriosis#:~:text=Endometriosis%20is%20a%20common%20health,the%20United%20States%2C%20have%20endometriosis.

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Endometriosis happens when tissue similar to the lining of the uterus (womb) grows outside of the uterus. It may affect more than 11% of American women between 15 and 44.1 It is especially common among women in their 30s and 40s and may make it harder to get pregnant. Several different treatment options can help manage the symptoms and improve your chances of getting pregnant.

What is endometriosis?

Endometriosis, sometimes called "endo," is a common health problem in women. It gets its name from the word endometrium, the tissue that normally lines the uterus or womb. Endometriosis happens when tissue similar to the lining of the uterus grows outside of your uterus and on other areas in your body where it doesn't belong.

Most often, endometriosis is found on the:

Ovaries

Fallopian tubes

Tissues that hold the uterus in place

Outer surface of the uterus

Other sites 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.

What are the symptoms of endometriosis?

Symptoms of endometriosis can include:

Pain. This is the most common symptom. Women with endometriosis may have many different kinds of pain. These include:

Very painful menstrual cramps. The pain may get worse over time.

Chronic (long-term) pain in the lower back and pelvis

Pain during or after sex. This is usually described as a "deep" pain and is different from pain felt at the entrance to the vagina when penetration begins.

Intestinal pain

Painful bowel movements or pain when urinating during menstrual periods. In rare cases, you may also find blood in your stool or urine.

Bleeding or spotting between menstrual periods. This can be caused by something other than endometriosis. If it happens often, you should see your doctor.

Infertility, or not being able to get pregnant.

Stomach (digestive) problems. These include diarrhea, constipation, bloating, or nausea, especially during menstrual periods.

Why does endometriosis cause pain and health problems?

Endometriosis growths are benign (not cancerous). But they can still cause problems.

Endometriosis happens when tissue similar to the lining on the inside of your uterus or womb grows outside of your uterus or womb where it doesn't belong. Endometriosis growths may swell and bleed in the same way the lining inside of your uterus does every month - during your menstrual period. This can cause swelling and pain because the tissue grows and bleeds in an area where it cannot easily get out of your body.

The growths may also continue to expand and cause problems, such as:

Blocking your fallopian tubes when growths cover or grow into your ovaries. Trapped blood in the ovaries can form cysts.

Inflammation (swelling)

Forming scar tissue and adhesions (type of tissue that can bind your organs together). This scar tissue may cause pelvic pain and make it hard for you to get pregnant.

Problems in your intestines and bladder

How common is endometriosis?

Endometriosis is a common health problem for women. Researchers think that at least 11% of women, or more than 6 ½ million women in the United States, have endometriosis.1

Who gets endometriosis?

Endometriosis can happen in any girl or woman who has menstrual periods, but it is more common in women in their 30s and 40s.

You might be more likely to get endometriosis if you have:

Never had children

Menstrual periods that last more than seven days

Short menstrual cycles (27 days or fewer)

A family member (mother, aunt, sister) with endometriosis

A health problem that blocks the normal flow of menstrual blood from your body during your period

What causes endometriosis?

No one knows for sure what causes this disease. Researchers are studying possible causes:

Problems with menstrual period flow. Retrograde menstrual flow is the most likely cause of endometriosis. Some of the tissue shed during the period flows through the fallopian tube into other areas of the body, such as the pelvis.

Genetic factors. Because endometriosis runs in families, it may be inherited in the genes.

Immune system problems. A faulty immune system may fail to find and destroy endometrial tissue growing outside of the uterus. Immune system disorders and certain cancers are more common in women with endometriosis.

Hormones. The hormone estrogen appears to promote endometriosis. Research is looking at whether endometriosis is a problem with the body's hormone system.

Surgery. During a surgery to the abdominal area, such as a Cesarean (C-section) or hysterectomy, endometrial tissue could be picked up and moved by mistake. For instance, endometrial tissue has been found in abdominal scars.

How can I prevent endometriosis?

You can't prevent endometriosis. But you can reduce your chances of developing it by lowering the levels of the hormone estrogen in your body. Estrogen helps to thicken the lining of your uterus during your menstrual cycle.

To keep lower estrogen levels in your body, you can:

Talk to your doctor about hormonal birth control methods, such as pills, patches or rings with lower doses of estrogen.

Exercise regularly (more than 4 hours a week).2 This will also help you keep a low percentage of body fat. Regular exercise and a lower amount of body fat help decrease the amount of estrogen circulating through the body.

Avoid large amounts of alcohol. Alcohol raises estrogen levels.3 No more than one drink per day is recommended for women who choose to drink alcohol.

Avoid large amount of drinks with caffeine. Studies show that drinking more than one caffeinated drink a day, especially sodas and green tea, can raise estrogen levels.4

How is endometriosis diagnosed?

If you have symptoms of endometriosis, talk with your doctor. The doctor will talk to you about your symptoms and do or prescribe one or more of the following to find out if you have endometriosis:

Pelvic exam. During a pelvic exam, your doctor will feel for large cysts or scars behind your uterus. Smaller areas of endometriosis are harder to feel.

Imaging test. Your doctor may do an ultrasound to check for ovarian cysts from endometriosis. The doctor or technician may insert a wand-shaped scanner into your vagina or move a scanner across your abdomen. Both kinds of ultrasound tests use sound waves to make pictures of your reproductive organs. Magnetic resonance imaging (MRI) is another common imaging test that can make a picture of the inside of your body.

Medicine. If your doctor does not find signs of an ovarian cyst during an ultrasound, he or she may prescribe medicine:

Hormonal birth control can help lessen pelvic pain during your period.

Gonadotropin -releasing hormone (GnRH) agonists block the menstrual cycle and lower the amount of estrogen your body makes. GnRH agonists also may help pelvic pain.

If your pain gets better with hormonal medicine, you probably have endometriosis. But, these medicines work only as long as you take them. Once you stop taking them, your pain may come back.

Laparoscopy. Laparoscopy is a type of surgery that doctors can use to look inside your pelvic area to see endometriosis tissue. Surgery is the only way to be sure you have endometriosis. Sometimes doctors can diagnose endometriosis just by seeing the growths. Other times, they need to take a small sample of tissue and study it under a microscope to confirm this.

How is endometriosis treated?

There is no cure for endometriosis, but treatments are available for the symptoms and problems it causes. Talk to your doctor about your treatment options.

Medicine

If you are not trying to get pregnant, hormonal birth control is generally the first step in treatment. This may include:

Extended-cycle (you have only a few periods a year) or continuous cycle (you have no periods) birth control. These types of hormonal birth control are available in the pill or the shot and help stop bleeding and reduce or eliminate pain.

Intrauterine device (IUD) to help reduce pain and bleeding. The hormonal IUD protects against pregnancy for up to 7 years. But the hormonal IUD may not help your pain and bleeding due to endometriosis for that long.

Hormonal treatment works only as long as it is taken and is best for women who do not have severe pain or symptoms.

If you are trying to get pregnant, your doctor may prescribe a gonadotropin-releasing hormone (GnRH) agonist. This medicine stops the body from making the hormones responsible for ovulation, the menstrual cycle, and the growth of endometriosis. This treatment causes a temporary menopause, but it also helps control the growth of endometriosis. Once you stop taking the medicine, your menstrual cycle returns, but you may have a better chance of getting pregnant.

Surgery

Surgery is usually chosen for severe symptoms, when hormones are not providing relief or if you are having fertility problems. During the operation, the surgeon can locate any areas of endometriosis and may remove the endometriosis patches. After surgery, hormone treatment is often restarted unless you are trying to get pregnant.

Other treatments you can try, alone or with any of the treatments listed above, include:

Pain medicine. For mild symptoms, your doctor may suggest taking over-the-counter medicines for pain. These include ibuprofen (Advil and Motrin) or naproxen (Aleve).

Complementary and alternative medicine (CAM) therapies. Some women report relief from pain with therapies such as acupuncture, chiropractic care, herbs like cinnamon twig or licorice root, or supplements, such as thiamine (vitamin B1), magnesium, or omega-3 fatty acids.5

Learn more about endometriosis treatments.

Does endometriosis go away after menopause?

For some women, the painful symptoms of endometriosis improve after menopause. As the body stops making the hormone estrogen, the growths shrink slowly. However, some women who take menopausal hormone therapy may still have symptoms of endometriosis.

If you are having symptoms of endometriosis after menopause, talk to your doctor about treatment options.

Can I get pregnant if I have endometriosis?

Yes. Many women with endometriosis get pregnant. But, you may find it harder to get pregnant. Researchers think endometriosis may affect as many as one in every two women with infertility.6

No one knows exactly how endometriosis might cause infertility. Some possible reasons include:7

Patches of endometriosis block off or change the shape of the pelvis and reproductive organs. This can make it harder for the sperm to find the egg.

The immune system, which normally helps defend the body against disease, attacks the embryo.

The endometrium (the layer of the uterine lining where implantation happens) does not develop as it should.

If you have endometriosis and are having trouble getting pregnant, talk to your doctor. He or she can recommend treatments, such as surgery to remove the endometrial growths.7

What other health conditions are linked to endometriosis?

Research shows a link between endometriosis and other health problems in women and their families. Some of these include:

Did we answer your question about endometriosis?

For more information about endometriosis, call the OWH Helpline at 1-800-994-9662 or contact the following organizations:

Sources

1. Buck, L.G.M., Hediger, M.L., Peterson, C.M., Croughan, M., Sundaram, R., Stanford, J., Chen, Z., et al. (2011). Incidence of endometriosis by study population and diagnostic method: the ENDO study. Fertility and Sterility; 96(2): 360-5.

2. American College of Obstetricians and Gynecologists. (2010). Management of endometriosis (Practice Bulletin No. 114): News release. Obstetrics & Gynecology, 116(1), 223-236

3. National Institute on Alcohol Abuse and Alcoholism. (2003). Alcohol's Effects on Female Reproductive Function.

4. Schliep, K., et al. (2012). Caffeinated beverage intake and reproductive hormones among premenopausal women in the BioCycle Study. American Journal of Clinical Nutrition; 95(2): 488-497.

5. Roshni, P., et al. (2012). Complementary and Alternative Medicine (CAM) Therapies for Management of Pain Related to Endometriosis. International Research Journal of Pharmacy; 3(3): 30-34.

6. Macer, M.L., Taylor, H.S. (2012). Endometriosis and Infertility: A review of the pathogenesis and treatment of endometriosis-associated infertility. Obstetrics and Gynecology Clinics of North America; 39(4): 535-549.

7. NICHD. (2013). Endometriosis

8. Matalliotakis, I. et al. (2012). High rate of allergies among women with endometriosis. Journal of Obstetrics and Gynaecology; 32(3): 291-293.

9. Sinaii, N. et al. (2002). High rates of autoimmune and endocrine disorders, fibromyalgia, chronic fatigue syndrome, and atopic diseases among women with endometriosis: A survey analysis. Human Reproduction; 17(10): 2715-2724.

10. Sayasneh, A. et al (2011). Endometriosis and ovarian cancer: A systematic review. ISRN Obstetrics and Gynecology.

11. Munksgaard, P. S., & Blaakaer, J. (2011). The association between endometriosis and gynecological cancers and breast cancer: A review of epidemiological data. Gynecologic Oncology, 123, 157-163.

# data[].attributes.attachment_link.description
Endometriosis happens when tissue similar to the lining of the uterus (womb) grows outside of the uterus. It may affect more than 11% of American women between 15 and 44.1 It is especially common among women in their 30s and 40s and may make it harder to get pregnant.

# data[].attributes.body
Erectile Dysfunction affects about 30 million men in the United States.

# data[].attributes.body
At least 11% of women, or more than 6 ½ million women in the United States, have endometriosis

# data[].attributes.body
-Oral Medications:
^Sildenafil (Viagra)
^Tadalafil (Adcirca, Cialis)
^Vardenafil (Levitra, Staxyn)
^Avanafil (Stendra)

-Penis Pumps

-Exercise

-Psychological Counseling

# data[].attributes.body
-Pain Medication

-Hormone Therapy

-Conservative Surgery

-Fertility Treatment

-Hysterectomy (Including Ovaries)

# data[].attributes.body
-Trouble getting an erection
-Trouble keeping an erection
-Reduced sexual desire.

# data[].attributes.body
-Pain during period
-Pain during intercourse
-Abnormal or heavy menstrual flow
-Infertility.

# data[].attributes.body
Erectile Dysfunction is the inability to achieve and/or sustain an erection suitable for sexual intercourse

Organ Affected - Penis

# data[].attributes.body
Endometriosis is an often painful disorder in which tissue similar to the tissue that normally lines the inside of your uterus, the endometrium, grows outside your uterus

Organs Affected: Ovaries, Fallopian tubes and the Tissue lining your pelvis