Endometriosis is a condition in which the tissue that normally lines the inside of your uterus—the endometrium—grows outside of the uterus. This female condition is estimated to affect more than 11% of women in the United States between the ages of 15 and 44. When not treated, it can lead to fertility problems and ovarian cancer.
Fortunately, endometriosis can be effectively managed so you can feel more comfortable during menstrual periods and reduce your risk for related complications.
Symptoms of Endometriosis
Pain is the most common symptom of endometriosis. This condition can cause the following types of pain:
- Painful menstrual cramps that grow worse over time
- Chronic pain in the pelvis and lower back
- Intestinal pain
- Pain during or after sexual intercourse
- Pain when urinating or when having bowel movements during your period
- Blood in the stool or urine
In addition to pain, endometriosis may cause the following symptoms:
- Bleeding or spotting between menstrual periods
- Heavy menstrual periods
- Inability to get pregnant
- Gastrointestinal problems (constipation, diarrhea, nausea, and abdominal bloating are common digestive issues connected with endometriosis)
Causes and Risk Factors of Endometriosis
The exact cause of endometriosis remains unknown. Researchers are studying several potential causes, which include:
- Retrograde menstruation. This type of menstruation occurs when some of your menstrual blood flows back through the fallopian tube instead of out of your body through your vagina.
- Genetics. You may be at greater risk for endometriosis if it runs in your family.
- Hormonal imbalances. Endometriosis is thought to be driven by estrogen and may be caused by problems with the body’s hormone system.
- Immune system problems. A faulty or weakened immune system may have problems finding and destroying endometrial tissue outside of the uterus.
- Abdominal surgery. Endometrial tissue that is accidentally displaced during an abdominal surgery could lead to endometriosis.
Certain factors may also increase your risk for endometriosis. These risk factors include:
- Age. Endometriosis is more common among women in their 30s and 40s.
- Age during the first menstrual period. Girls who had their first period before the age of 11 are at greater risk for endometriosis later in life.
- Menstrual cycle length. Endometriosis is more common in women whose cycles last under 27 days.
- Menstrual period length. It is more common in women whose periods last longer than seven days.
- Birthing status. Having never given birth can increase your risk for endometriosis.
- Body mass index (BMI). Having a low BMI or being lean may increase your risk.
How Is Endometriosis Diagnosed?
Endometriosis is usually diagnosed using a pelvic exam and ultrasound. This condition may be diagnosed and treated by your general physician or by a gynecologist.
If you think you have endometriosis, your doctor will talk to you in greater detail about your symptoms and feel your pelvic area for signs of endometriosis, including cysts and scar tissue behind the uterus. If no abnormalities are detected, your doctor may perform an ultrasound to get a better view of your reproductive organs and check for smaller cysts that weren’t detected during the pelvic exam.
MRI and laparoscopy are other tests your doctor may use to diagnose endometriosis. Laparoscopy is a procedure in which a surgeon makes a tiny incision in your pelvic area and inserts a tiny viewing instrument called a laparoscope into the incision to look for signs of endometrial tissue that has grown outside the uterus. A biopsy, the removal of a small tissue sample that can be evaluated for endometriosis, may also be performed at the same time.
Treatments for Endometriosis
There is no medical cure for endometriosis. Medications and surgery are the most common treatments for endometriosis that can reduce symptoms and make the condition more manageable.
Medications
Over-the-counter (OTC) pain relievers such as ibuprofen and naproxen may be recommended if you frequently experience painful menstrual cramps or other types of pain associated with endometriosis.
Hormone therapies may be recommended if OTC pain relievers are not effective at controlling your symptoms. Birth control pills, gonadotropin-releasing hormone (Gn-RH) agonists and antagonists, progestin therapy, and aromatase inhibitors can all manipulate your body’s estrogen levels and production to treat endometriosis. If you plan on becoming pregnant, your doctor can prescribe the right medication to manage the condition while enhancing fertility.
Surgery
Surgery for endometriosis is typically only recommended if your condition does not respond to medication. Surgery involves removing the endometrial tissues that have grown outside the uterus while keeping your uterus and ovaries intact (and maintaining fertility).
If your symptoms haven’t improved after having these tissues removed, your doctor can talk to you about other surgical options such as a hysterectomy (in which the entire uterus is removed to treat symptoms such as heavy and painful menstrual bleeding).
Acupuncture, herbal supplementation, and chiropractic care are alternative treatments that may reduce your symptoms. Consult with specialists who offer these treatments to learn more about how they can improve your symptoms—especially if you want a second opinion or want to avoid medications and surgery.
Resource Links
- “Endometriosis” via U.S. Department of Health and Human Services
- “What are the risk factors for endometriosis?” via National Institutes of Health