What Is Endometriosis?

Endometrial tissue behaves the same way when it grows outside the uterus, but there is nowhere for the tissue to go to exit the body. So, the tissue becomes trapped. Most often, endometriosis affects the ovaries, fallopian tubes, and tissue lining your pelvis. However, endometrial tissue can eventually spread beyond the pelvic organs—although this is rare. 

 

As endometrial tissue builds up in the pelvic area, cysts can form on the ovaries, and tissues surrounding the endometrial tissue can become irritated. Scar tissue will eventually develop, causing the primary symptom of endometriosis: Painful pelvic cramps.

Signs and Symptoms of Endometriosis

The most common and prevalent symptom of endometriosis is pelvic pain that worsens during menstrual periods. Because pain is generally worse during periods, some women will mistake endometriosis for simple menstrual cramps and do not consider that something else is wrong.

 

The level of pain associated with endometriosis may also vary, and for some it can get worse over time. However, the pain level for each patient is not necessarily correlated to the severity or stage of the condition. Along with pain during periods, women with endometriosis may experience: 

 

• Infertility – Endometriosis is one of the most common causes of infertility. However, there are many effective treatments available to facilitate a healthy pregnancy.

 

• Pain during intercourse – Some women may feel pain during intercourse due to endometriosis. It is often described as a deep pain different from any discomfort that may occur due to initial penetration.

 

• Chronic lower back pain – Pain from endometriosis may be more persistent, depending on the areas affected by this condition. For some women, endometriosis may cause chronic pelvic pain or lower back pain.

 

• Bleeding or spotting between periods – Endometriosis can cause spotting or heavy bleeding during periods. However, there are many possible causes for abnormal vaginal bleeding, so you should consult your gynecologist to confirm that endometriosis is the cause.

 

• Digestive problems – Digestive issues associated with endometriosis tend to worsen during menstrual periods. These symptoms can include diarrhea, bloating, constipation, or nausea.

Causes of Endometriosis

The cause of endometriosis is unclear. However, there are several known risk factors that can make an individual more susceptible to this disease.

 

• Age – Women of any age may develop endometriosis after their menstrual cycle begins, but it most commonly appears in women between the ages of 25 and 40.

 

• Heredity – Family history of endometriosis makes you more likely to have this disease.

 

• Pregnancy – During pregnancy, the symptoms of endometriosis may temporarily subside. In addition, women who have been pregnant are less likely to develop endometriosis. These facts support the hypothesis that endometriosis is affected by hormones. However, more research is needed to fully understand how hormones influence the development and progression of this disease.

 

• Menstrual History – If you have a history of menstrual problems, such as shorter cycles, heavy periods, or menstruation that began at a very young age, you may be more likely to develop endometriosis. One of the potential causes of endometriosis is a menstruation backflow wherein the endometrium is shed into the fallopian tube or other areas of the pelvis. 

 

• Immune Disorders – Certain immune system disorders and cancers are more common in women with endometriosis, indicating that a faulty immune system could be a potential cause for this disease.

 

• Surgery – Surgeries affecting the abdominal area, such as a Cesarean (C-section), can inadvertently move endometrial tissue to areas outside of the uterus.

Diagnosis of Endometriosis

Endometriosis is a complex medical condition. If you believe you are exhibiting symptoms of endometriosis, the first step in your diagnosis will be a pelvic exam. During this in-office exam, your doctor will feel for cysts behind the uterus. However, imaging tests may also be required, as smaller areas of endometriosis will be harder to feel and identify. Ultrasound tests and MRIs may both be utilized to diagnose endometrial cysts. In some cases, laparoscopic surgery may be appropriate.

 

There are four stages of endometriosis that may be diagnosed: Minimal, mild, moderate, and severe. The location, size, and number of endometrial tissue implants and related lesions will indicate the stage of the condition.

Treatment and Care

The treatment process for endometriosis will depend not only on the stage of the disease but also on the patient’s age and child-bearing goals. For all women with endometriosis, pain management will be a primary goal. Often, women will use over-the-counter pain medications to reduce pain and discomfort, but these medications are not effective in all cases. Prescription pain medications may be prescribed, or women may choose alternative pain management options such as acupuncture to alleviate their symptoms. Hormone therapy and hormonal contraceptives can be effective for reducing endometrial tissue growth outside the uterus, but these options are not ideal for women who are trying to have children. 

 

When fertility is a concern, treatment will likely be more aggressive. Women who know they have endometriosis or who have a family history of this disease might consider having children earlier in life, as endometriosis is likely to worsen over time. For women who are experiencing infertility caused by endometriosis, conservative surgery to remove endometrial tissue in the pelvic cavity may be recommended. Women with minimal to mild endometriosis may be able to successfully become pregnant and have a healthy pregnancy with no complications. In more severe stages, in-vitro fertilization and other infertility treatment options may be considered.

 

In addition to surgery and hormonal birth control, women may consider other medication options. GnRH therapy works by blocking estrogen production and stopping menstruation, but it will create artificial menopause and cause symptoms such as hot flashes and vaginal dryness. Danazol is another medication that can block menstruation, but it also has several possible adverse side effects, such as unwanted hair growth and acne.

 

In very rare cases, a hysterectomy will be recommended to treat very severe endometriosis. During a total hysterectomy, the surgeon will remove the cervix and the uterus as well as any visible lesions caused by endometrial tissue growth. This treatment option is only considered when other treatments have proven ineffective or when cooccurring conditions warrant this type of surgical care.

When to Talk to Your Doctor

If you feel any pelvic discomfort or experience abnormalities in your menstrual cycle, you should not wait to talk to your doctor. Even if these symptoms are not caused by endometriosis, they are treatable and should be addressed by a women’s health professional. In addition, symptoms like those of endometriosis can point to more serious, life-threatening conditions.

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Please note: If you are seeking care for Endometriosis online, it is a complex medical condition and may require the cooperation of your live, in-person/office primary care provider to complete the workup and to initiate and perform some of the required diagnostic and/or therapeutic procedures that may be required before treatment can begin.