stylistic:style_transfer, quality:corruption, stylistic:tone
Endometriosis is a disease in which cells like those in the endometrium, the layer of tissue that normally covers the inside of the uterus, grow outside the uterus. It occurs in humans and a limited number of menstruating mammals. Lesions can be found on ovaries, fallopian tubes, tissue around the uterus and ovaries (peritoneum), intestines, bladder, and diaphragm; and may also occur in other parts of the body. Symptoms include pelvic pain, heavy and painful periods, pain with bowel movements, painful urination, pain during sexual intercourse and infertility. Nearly half of those affected have chronic pelvic pain, while 70% feel pain during menstruation. Up to half of affected individuals are infertile. About 25% of individuals have no symptoms and 85% of those seen with infertility in a tertiary center have no pain. Endometriosis can have both social and psychological effects. Diagnosis is usually based on symptoms and medical imaging; however, a definitive diagnosis is made through laparoscopy and biopsy. Other causes of similar symptoms include pelvic inflammatory disease, irritable bowel syndrome, interstitial cystitis, and fibromyalgia. Endometriosis is often misdiagnosed and many patients report being incorrectly told their symptoms are trivial or normal. Patients with endometriosis see an average of seven physicians before receiving a correct diagnosis, with an average delay of 6.7 years between the onset of symptoms and surgically obtained biopsies, the gold standard for diagnosing the condition. This places endometriosis at the extreme end of diagnostic inefficiency. Nearly 11 million women were affected by endometriosis, globally, in 2015. Other sources estimate 6 to 10% of the general female population might have endometriosis. Ethnic differences have been observed in endometriosis, as Southeast Asian and East Asian women are significantly more likely than White women to be diagnosed with endometriosis. The main cause of endometriosis is exposure to elevated levels of the female sex hormone estrogen, as well as estrogen receptor sensitivity. Estrogen exposure worsens the inflammatory symptoms of endometriosis by stimulating an immune response. While there is no cure for endometriosis, several treatments may improve symptoms. This may include pain medication, hormonal treatments or surgery. The recommended pain medication is usually a non-steroidal anti-inflammatory drug (NSAID), such as naproxen. Taking the active component of the birth control pill continuously or using an intrauterine device with progestogen may also be useful. Gonadotropin-releasing hormone agonist may improve the ability of those who are infertile to conceive. Surgical removal of endometriosis may be used to treat those whose symptoms are not manageable with other treatments.