Endometriosis: Everything You Need to Know About the Gynecological Condition

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Endometriosis is a gynecological condition that affects approximately 11% of individuals between the ages of 15 to 44 in the United States. For these individuals, endometrial tissue grows outside of the uterus onto other surrounding structures including the ovaries, fallopian tubes, outer surface of the uterus, pelvic floor, vagina, or cervix.

In someone who does not have endometriosis, endometrial tissue normally builds up within the uterine wall and is shed during menstruation, or one’s period. Because endometriosis leads to a buildup of this type of tissue outside of the uterus, it is not as easily shed and can instead become trapped within the abdomen. This causes pain that ranges in severity, and in some cases may interfere with the reproductive process.

The typical onset for endometriosis is several years after an individual’s first menstrual cycle. There is no cure for endometriosis, but there are treatment options that offer symptom relief and support reproductive function. 

Symptoms of Endometriosis

Menstrual cramps, or pain during one’s period, can occur for many different reasons, so it is important to be evaluated by a healthcare professional if monthly cramping is disruptive. If associated with endometriosis, your symptoms will likely include:

  • Pelvic, lower back, and/or abdominal pain
  • Dysmenorrhea (painful periods or excessive cramping) that may worsen over time
  • Pain during sex, especially with penetration, and/or after sex
  • Painful bowel movements or urination during your period
  • Diarrhea, constipation or bloating during your period
  • Excessive bleeding or bleeding between periods (“spotting”)
  • Diarrhea, constipation, bloating, nausea, or fatigue that gets worse around your period
  • Difficulty getting pregnant

Because symptoms of endometriosis commonly involve the digestive system and the entire pelvic region, they can be mistaken for other conditions like irritable bowel syndrome (IBS) or pelvic inflammatory disease (PID). In addition, the severity of pain experienced does not always align with the severity of tissue spread within the body. For these reasons, it’s important to be evaluated by a specialized healthcare professional if endometriosis is suspected.

A Note on Infertility

A diagnosis of endometriosis does not guarantee that a successful pregnancy cannot occur; approximately one third to one half of those who are diagnosed with endometriosis have difficulty getting pregnant. This may have to do with endometrial tissue physically obstructing the path for sperm to join with an egg, or underdevelopment of the uterine lining needed to support implantation. In many cases, healthcare professionals can recommend treatments that may address these barriers to support a safe pregnancy.

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What Causes Endometriosis?

There are several factors that may lead to the development of endometriosis. Individuals with a family history of endometriosis, heavy menstrual periods, low body mass index, and those who have not given birth may be at higher risk for developing this condition. Currently, experts posit that the following can cause excessive endometrial tissue buildup:

  • Retrograde Menstruation: Sometimes menstrual blood flows “backwards” into the fallopian tubes and pelvic region, and it is possible for endometrial cells to attach to other surfaces and thicken over time.
  • Transformation of Cells: Certain hormones may have the ability to actually transform other cell types into endometrial cells, so that cells meant to line other body parts begin behaving differently.
  • Surgical Scars: Surgeries that involve reproductive organs, including C-sections, may lead to the spread of endometrial cells in that area.
  • Immune System Dysfunction: Spread of endometrial tissue outside of the uterus may have to do with the immune system not appropriately recognizing this type of tissue.

Because hormone levels influence the cyclical growth and behavior of endometrial cells in the uterus, changes in these hormones can often lead to changes in symptoms. For example, symptoms may temporarily improve during a pregnancy, and can go away entirely when a person reaches menopause. 

Diagnosis of Endometriosis

After discussing your symptoms with you — and learning more about the location, timing, and severity of your pain — a healthcare professional may order one or more of the following tests to help identify whether or not you are experiencing endometriosis:

  • Pelvic Exam: A manual assessment of the interior pelvis that allows a healthcare professional to feel for any physical abnormalities, like cysts or scarring in the reproductive organs.
  • Ultrasound: Imaging of the reproductive organs using a device that may either be placed on the outside of the abdomen or inserted through the vagina.
  • MRI (magnetic resonance imaging): Imaging of the reproductive organs using a magnetic field. This may help locate endometrial tissue that is outside of the uterus.
  • Laparoscopy: Performed by a surgeon, this procedure requires a small incision to be made near the belly button allows the provider to insert a small camera to help visualize internal tissues. It is also possible to biopsy, or take a small sample of the tissue, during this procedure.

Treatment for Endometriosis

Treatment approaches for endometriosis will depend on severity of symptoms and whether or not an individual is planning to become pregnant in the future. Some options include:

  • Pain Relief Medications: Over-the-counter or prescription pain medication will likely be recommended to manage pain and menstrual cramping.
  • Hormone Therapy: Oral contraceptives (birth control pills), medications that alter gonadotropin-releasing hormone, progestin, or aromatase inhibitors are some examples of ways to adjust hormone levels in the body to slow the spread of endometrial tissue and reduce pain, especially if pregnancy is a goal.
  • Fertility Treatment: If a person with endometriosis is having difficulty conceiving, they may consult with a fertility specialist to discuss options to either stimulate the ovaries or attempt in vitro fertilization.
  • Surgical Intervention: It is possible to surgically remove excess endometrial tissue, though this is often a temporary solution and the tissue spreads again over time. This surgery can typically be done using a small laparoscopic incision in the abdomen. Surgery may be the best choice for patients with widespread endometriosis, and, since laparoscopic surgery is less invasive than other abdominal surgeries, it allows surgeons to access and remove more areas of endometriosis without necessarily impacting one’s ability to become pregnant. However, as a last resort — and only for patients who aren’t trying to get pregnant — a hysterectomy, or the surgical removal of the uterus and, sometimes, the ovaries, can be performed.

Next Steps for Folks With Endometriosis

Assuming that cramps are just a normal part of the menstrual cycle may prevent one from receiving an important diagnosis. With this in mind, if you are regularly experiencing any symptoms of endometriosis, discuss them with your healthcare provider.