So, WordPress shows me a lot of the searches that people run that lead them to my site. One has recently come up again and again. “Cervical Endometriosis” and “Endometriosis on Cervix.”
Seeing as I’ve never touched up on that particular location, I figured I would today!
What are the symptoms? How are you diagnosed? What’s the treatment?
Some people with cervical Endometriosis don’t have any symptoms and they’re diagnosed during a visual cervical examination (if the lesions are visible). Others may develop spotting and/or bleeding after sex…and in some cases, severe vaginal bleeding. Pelvic or cervical pain may be indicative of Endometriosis in the pelvis, but from what I’m reading, cervical Endo isn’t painful. Women may be misdiagnosed with cervical myoma, masses, cysts, polyps, melanoma, or cervical cancer; only to receive the Endometriosis diagnosis once the tissue is biopsied. There are several studies that state proper diagnosis must take place. Get a second or third opinion, even. With that being said, though, it’s been written that cervical Endometriosis is very rare…and there are definitely other causes for spotting/bleeding. This isn’t meant to scare you.
Some physicians believe that cervical Endometriosis may be one of the leading causes of abnormal bleeding. Some also believe that cervical Endometriosis may develop after cervical procedures, such as a punch biopsy, loop/leep procedures, and laser treatments. That being said, some patients are diagnosed with cervical Endo after never having received any of the aforementioned procedures.
As far as treatment? A 2011 publication stated that if women with cervical Endometriosis have symptoms, the lesions should be excised (can be done using the loop/leep procedure and local anesthesia).
If you’d like to see examples of what cervical Endometriosis looks like, feel free to watch this video:
An article published in 2004 identifies two women who both had pelvic Endometriosis and each had undergone hysterectomies (removing the uterus and the ovaries, but leaving the cervix). Both women underwent hormone replacement therapy (HRT) and received estrogen treatment. AND both women developed cervical Endometriosis. As many of us EndoSisters are aware, estrogen tends to feed Endometriosis…as well as a hysterectomy may not cure you of your symptoms.
A 2005 study discusses a 32-year-old woman had been spotting for the past 8 months, although she did not have any painful periods or painful sex. She had gone to three gynecologists before one thought to thoroughly examine her cervix. She had been on a birth control pill, prescribed by her two prior gynos, to control her bleeding; it didn’t work. The last gyno found two lesions on her cervix, one of which was slightly bleeding. These two lesions were punch biopsied, found to be Endometriosis lesions, and they were then burnt off. Three years after the procedure, she had no relapse or recurrence. The authors stress that more physicians must become familiar with examining the cervix, and have a full understanding of the different appearances of Endometriosis lesions.
In 2008, a study was published about a 37-year-old woman who had been spotting since her last period for about 15 days. A week later, she began to have “severe vaginal hemorrhage” – she was bleeding A LOT. An examination found a small laceration on the inside of her cervix; and an ultrasound found she had a cyst which was bleeding. A pelvic MRI confirmed the 2cm cervical cyst, as well as Adenomyosis of her uterine wall. A biopsy of the cyst’s tissue revealed Endometriosis. They could not stop the bleeding with sutures or tamponade (what? Google says it’s “the surgical use of a plug of absorbent material;” guess we know where “tampon” came from), so they had to do what’s called a uterine artery embolization, where they block the artery, cutting off the blood supply to the laceration. After the procedure, the woman continued to “have Endometriosis,” but her vaginal hemorrhaging had stopped.
A 2010 report reviewed the literature of several cervical Endo cases from 1970 to 1999:
- One 48-year-old woman complained of vaginal bleeding and she had uterine fibroids. She underwent a hysterectomy and removal of a Fallopian and ovary. Her biopsy revealed fibroids, Adenomyosis, and cervical Endometriosis.
- A 41-year-old woman had a longstanding history of pelvic and abdominal pain. She had a previous surgery for uterine fibroids. Upon an exploratory laparoscopy, they found “dense adhesions,” ovarian cysts, and her ovary was stuck to her Pouch of Douglas and rectum. They performed a total hysterectomy and removed both her ovaries and Fallopian tubes. They also found, upon biopsy, that she had Endometriosis deep in her cervix.
- A 29-year-old woman had a routine pap smear with the result of abnormal cells on her cervix. She had no other symptoms. The cells were removed via the loop procedure. Once the cells were removed and biopsied they discovered hemorrhagic Endometriosis glands.
- A 40-year-old woman had been diagnosed with Endometriosis in 2000 and went to her physician for ongoing abdominal pain. She had undergone several unsuccessful IVF treatments, as well as a loop procedure to remove some abnormal cervical cells for post-coital bleeding. She continued to bleed after the loop procedure. So, in 2008 she underwent a speculum examination of her cervix. Her physician saw several brownish spots on her cervix, which were removed via the loop procedure. Upon biopsy, cervical Endometriosis was confirmed.
A January 2017 published article was about a 41-year-old woman who had an abnormal pap smear: the presence of clusters of glandular cells. She had a colposcopy and endocervical biopsy performed – the colopsocopy was normal, but the biopsy revealed tissues surrounded by endometriosis. She received her cervical Endometriosis diagnosis. The authors warn that come cervical biopsies may be diagnosed as atypical or glandular neoplasia, when it is in face Endometriosis. Always pursue a biopsy.
A 2019 article published in Modern Medicine discusses a 24-year-old Romanian woman who was seeking a second opinion. Two months prior, she was diagnosed with glandular cervical dysplasia. A pap smear biopsy revealed possible cervical endometriosis and she was referred to a specialist. She had a history of painful periods, chronic pelvic pain, and infertility. They took a peek inside at her cervix via speculum and found “2 violet macular [small blisters] lesions” on her cervix’s surface. The pelvic examination revealed diminished uterine mobility, a shortened vaginal cul-de-sac, and their probing and pushing caused her pain. A colposcopy was normal, as was the transvaginal ultrasound. A laparoscopic surgery was performed and found her rectum was adhered to her uterus and cervix. Once they shifted the rectum back to its normal positioning, a large endometriosis nodule was found on the cervix and rectum and was and was excised. Pathology confirmed Endometriosis. There was no other Endometriosis located within her pelvic cavity.
But what causes it? Just like everything else we’ve heard : they don’t know. There are theories: it could be a transfer from other surgical procedures or examinations, it could transfer from menstrual discharge, it could develop from cellular changes. Nobody knows.
Before recently, I’d not heard of cervical Endometriosis, nor its symptoms. I’m fascinated, as usual. And if YOU have been diagnosed with cervical Endometriosis, what was your experience? Did you have the lesions removed? Did your symptoms return? ALL THE THINGS…! Let us know in the comments below.
Concerned about your cervix? Talk to your gynecologist. That’s the first step…
*Updated September 3, 2020*
American Journal of Obstetrics & Gynecology – (Abstract; July 2008) A Severe Vaginal Hemorrhage Caused by Cervical Endometriosis
American Journal of Obstetrics & Gynecology – (Abstract; Nov. 2011) Cervical Endometriosis: Clinical Character and Management Experience in a 27-Year Span
Archives of Gynecology and Obstetrics – (Abstract; Dec. 2005) Cervical Endometriosis: a Diagnostic and Management Dilemma
Journal of Cytology – (Abstract; Jan. 2017) Endometriosis Mimiking Glandular Atypia in a Cervical Cytology
Journal of Gynecologic Surgery – (Abstract; July 2004) Cervical Endometriosis Stimulated by Estrogen Therapy Following Supracervical Hysterectomy
Journal of Obstetrics and Gynaecology Research – (Article; July 2010) Cervical Endometriosis: Case Series and Review of Literature
Medscape General Medicine – (Article; April 2005) Cervical Endometriosis, a Case Presenting with Intractable Spotting
Modern Medicine – (Article 2019) Cervical Endometriosis – Case Report and Review of Literature
The Global Library of Women’s Medicine – (Article; Nov. 2015) Diagnosis and Therapy of Benign and Preinvasive Disease of the Cervix
~ Again, I am a layman. I do not hold any college degrees, nor mastery of knowledge. Please take what I say with a grain of salt. If curious, do your own research Validate my writings. Or challenge them. And ALWAYS feel free to consult with your physician. Always. Yours ~ Lisa