Endometrium cells get outside the uterus where they are not supposed to be, and they cause havoc by gluing together internal organs. They are living cells and there is no way really to get rid of them all. These are a natural part of the body, so the natural defense systems of the body will not attack them. They multiply each hormone cycle. Surgery can only get some of it. Drugs like Lupron can hold the condition at bay for a while, or being pregnant can stop the spread of the cells. The only permanent end to the condition is a full hysterectomy including removal of the ovaries where they also remove as many of the lesions as possible.
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