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Endometriosis Nursing Guide

Content Writer: Cassandra Shine RN, BSN

Overview: Endometriosis

This content is intended as a Quick Reference for Endometriosis and will cover an overview and nursing considerations utilizing the nursing process.

Endometriosis Etiology and Epidemiology

Endometriosis is defined as the presence of normal endometrial tissue, or mucosa, outside of the uterine cavity. It is characterized by pain associated with menstruation and affects an estimated 2 to 10% of American women between the ages of 25 and 40. It is more common in women of reproductive age in their 30s and 40s and may make it harder for them to get pregnant. Up to 95% of individuals respond to initial treatment, but as many as 50% will return within five years with symptoms of endometriosis, which is one of the three major causes of female infertility.

During menstruation ectopic tissue bleeds may cause inflammation, neovascularization, and fibrosis formation, leading to the clinical signs and symptoms of endometriosis.

  • Endometriosis is commonly found in the following locations:
    • Ovaries
    • Fallopian tubes
    • Outer surface of the uterus
    • Tissues that hold the uterus in place
  • Other sites for growths may include:
    • Vagina
    • Cervix
    • Vulva
    • Bowel
    • Bladder
    • Rectum
  • Endometrial cells proliferate in response to estrogen and progesterone secretion.

Endometriosis Causes

While the exact causes of endometriosis are unknown, possible explanations include:

  • Retrograde menstruation
  • Transformation of peritoneal cells
  • Embryonic cell transformation
  • Surgical scar implantation
  • Endometrial cell transport
  • Immune system disorder

Endometriosis Complications include:

  • Anemia
  • Infertility
  • Ovarian cyst
  • Ovarian cancer
  • Pelvic adhesions
  • Ectopic pregnancy
  • Chronic pelvic pain
  • Spontaneous abortion
  • Bleeding or spotting between menstruation periods
  • Painful menstrual cramps in abdomen or lower back
  • Intestinal or bladder complications during menstruation
    • Painful urination
    • Painful bowel movements

Endometriosis Risk factors include:

  • Hypoxia
  • Iron deficiency
  • Familial tendency
  • Alcohol consumption
  • Uterine abnormalities
  • Menopause at older age
  • Compromised immune system
  • Starting menstruation at early age
  • Defects in fallopian tubes or uterus
  • Short menstrual cycles (less than 27 days)
  • Menstrual periods lasting more than 7 days
  • Never giving birth or giving birth after the age of 30
  • Hormonal or endocrine disorders
    • Higher levels of estrogen
    • Greater lifetime exposure to estrogen body products

Endometriosis Diagnosis

The stages of progression for the diagnosis of endometriosis are measured according to size, character, and location of endometrial lesions:

  • Stage I: minimal disease (1 to 5 points)
  • Stage II: mild disease (6 to 15 points)
  • Stage III: moderate disease (16 to 40 points)
  • Stage IV: severe disease (over 40 points)

Endometriosis Management

  • Administer medications as ordered.
  • Administer pain medications and nonpharmacological pain relief measures.
  • Encourage individual to express feelings and communicate.
  • Follow infection precautions.
  • Give emotional support.
  • Initiate comfort measures.
  • Maintain calm environment.

Monitor for:

  • Adverse reactions or complications
  • Treatment response
  • Vital signs

Administer self-care as tolerated and utilize surgical wound care as needed.

Endometriosis Nursing Care Plan

Nursing Considerations

Use the nursing process to develop a plan of care for individuals. The nursing assessment (with common findings listed), diagnosis, interventions, expected outcomes, and patient education for individuals with endometriosis are listed below.


  • History
    • Abdominal cramps
    • Blood in urine and/or stool
    • Chronic pelvic pain
    • Diarrhea
    • Heavy periods
    • Infertility
    • Lower back pain
    • Nausea and vomiting
    • Pain with menstruation
    • Pain with ovulation
    • Pain with sex, exercise, or bowel movements
    • Pain with urination
    • Premenstrual spotting
  • Physical Examination
    • Adnexal tenderness and/or adnexal mass/fullness
    • Dyschezia
    • Dysmenorrhea
    • Dyspareunia
    • Dysuria
    • Flank pain (costovertebral angle tenderness)
    • Hematuria
    • Hypermenorrhea
    • Uterosacral ligament nodularity and tenderness
  • Laboratory Tests
    • Cancer antigen 125 test
    • Detection and measurement of newer markers, including Thomsen Friedenreich antigen and CCRI marker
  • Radiological and Imaging Studies
    • IV pyelography and colonic studies if clinical presentation suggests extragenital involvement of these organ systems.
    • Pelvic ultrasonography, CT and MRI
  • Other Studies
    • Laparoscopy and biopsy are the diagnostic modalities to confirm endometriosis.

Endometriosis Nursing Diagnosis/Risk For

  • Pain related to sexual intercourse
  • Anxiety related to alteration in body image
  • Knowledge deficit related to risk for infection
  • Depression related to decreased sexual activity
  • Decreased sexual function related to severe pain and/or excessive bleeding
  • Risk for hypovolemic related to blood loss

Endometriosis Interventions

  • General
    • Individuals with classic symptoms of endometriosis and no reason to suspect another cause should be started on continuous oral contraceptives or progesterone.
    • Then send individual for pelvic ultrasound, CT and/or MRI to rule out other causes.
    • If individual fails to respond to treatment within 4 to 6 months, consider diagnostic laparoscopy.
  • Activity
    • Normal as tolerated
    • Diet
    • Well balanced
  • Medications
    • Analgesics or NSAIDs
    • Gonadotropin­releasing hormone analogs
    • Leuprolide acetate (Lupron®, Lupron Depot®)
    • Oral contraceptive pills (high progesterone and low estrogen
    • Danazol (Danocrine®)
    • Progestins (Camila®, Errin®)
    • Medroxyprogesterone acetate (Amen®, Cycrin®, Provera®, Depo-Provera®)
  • Surgery
    • Diagnosis only can be determined through direct visualization via laparoscopy or laparotomy.
    • Total hysterectomy with or without a bilateral salpingo-oophorectomy

Expected Outcomes

  • Decreased anxiety and fear
  • Pain relief
  • Remain free of infection
  • Use coping strategies effectively

Individual/Caregiver Education

  • General Education
    • Aggressive treatment increases fertility rates.
    • Discuss diagnosis and further treatment.
    • Discuss medications and potential side effects.
    • Pregnancy, breastfeeding, and both early and prolonged use of oral contraceptive pills give some protection against endometriosis progression.
    • If taking leuprolide acetate, individual should increase daily intake of calcium and/or take a calcium supplement of 1,200 mg and exercise.
    • Stress the importance of compliance for treatment to be effective.
    • The best treatment for relieving pain is surgical treatment (total hysterectomy with bilateral salpingo-oophorectomy and peritoneal stripping).
  • Discharge Planning/Instructions
    • Follow up with private physician or surgeon as directed.
    • Reoccurrence of symptoms requires follow-up.
  • Prevention
    • There is no prevention of endometriosis.
    • Reduction in estrogen levels in your body will help.
    • Hormonal birth control methods (patches, pills, or rings with lower doses of estrogen) may help.

Women's Health Nursing CEU Courses

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Additional Information

Release Date

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Content Contributor
Cassandra Shine RN, BSN
Cassandra earned her Bachelor of Science Degree in Nursing from Winston-Salem State University. She has worked as a registered nurse for more than 20 years and has clinical experience, specializing in Nephrology Research, Critical Care with Cardiothoracic Surgery and Trauma, Med/Surg, Community Health Outreach, and Education.

  • Disclosures
    Cassandra Shine RN, BSN has no relevant financial or non-financial relationship(s) with ineligible companies to disclose.
  • Reference herein to any specific commercial product, process, or service by trade name, trademark, service mark, manufacturer or otherwise does not constitute or imply any endorsement, recommendation, or favoring of, or affiliation with, Relias, LLC.
  • All characteristics and organizations referenced in the following training are fictional. Any resemblance to any actual organizations or persons living or dead, is purely coincidental.



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