Introduction to Endometriosis

Endometriosis affects the endometrium–the lining of the uterus sheds during a menstrual period. Imagine that the lining of your uterus decided to take a vacation and grow outside its designated area. This causes the endometrial lining to act as an unwanted guest in a place where it isn’t supposed to be. 

Women who have endometriosis are usually found to have high levels of estrogen [2]. For this reason, endometriosis symptoms typically go away after menopause, but in some rare cases, they can persist even after menopause. As one of the most common women’s health issues, endometriosis affects approximately 10 – 15% of women of reproductive age, but many cannot recognize symptoms. The displaced endometrial tissue can cause severe pain and menstrual cramps during menstruation and intercourse. You may also experience nausea, fatigue, and infertility. 

One of the most common symptoms of endometriosis is painful period cramps and cramping around the cervix, uterus, and pelvic region. Endometriosis-related pain can be triggered by any activity that involves the abdominal organs, such as urination and bowel movements.

Photo by Yuris Alhumaydy on Unsplash
Photo by Yuris Alhumaydy on Unsplash

Understanding the Symptoms of Endometriosis

Symptoms of endometriosis vary. Understanding the symptoms can help you know what’s happening in your body and when there is a cause for concern. Common symptoms of endometriosis include pelvic pain, heavy periods, infertility, pain during sex, and heavy bleeding.

Pelvic Pain

Pelvic pain is the most common symptom of endometriosis. Pelvic pain from endometriosis is commonly described as a cramping or stabbing sensation in the lower abdomen, pelvis, or lower back [3]. In addition, many people describe pelvic pain from endometriosis as cyclical, meaning that it occurs around the same time as menstruation–it can happen at other times of the month. However, the exact cause of endometriosis is not entirely known. 

The endometrial tissue can sometimes become inflamed and irritated, leading to pain and discomfort. A gynecology expert can diagnose an underlying cause for the pain and offer treatment options. They may order a biopsy to look for any lesions that would confirm a diagnosis of endometriosis. 

Painful Periods

Because endometriosis affects the uterine lining, one common symptom is dysmenorrhea or painful periods [4]. Some discomfort during your period is normal, but when the pain excruciates or interferes with everyday life, there may be a more significant issue. 

Women with endometriosis typically have more painful periods than women without endometriosis. The pain may start a few days before your period begins and continue for several days into the period. Sometimes the pain can be so severe that it interferes with your ability to perform daily activities–in this case, it may require medication. In addition, unlike the uterus lining, the endometrial tissue has nowhere to go when it breaks down and bleeds during menstruation; this can cause inflammation, scarring, and pain. 

If you have symptoms that line up with a potential diagnosis of endometriosis, your provider may order a pelvic exam to look for any signs of the disease. When left untreated, endometriosis can lead to other conditions, such as endometrioma. It can also easily be confused with other conditions like adenomyosis, so seeking medical treatment for an accurate diagnosis is vital.

Infertility

Endometriosis can sometimes make it difficult for a woman to get pregnant or carry a pregnancy to term. One study shows up to 30 – 50% of infertile women have endometriosis. 

Because endometriosis causes the endometrial tissue to grow outside of the uterus, this can affect the reproductive organs such as the ovaries, fallopian tubes, and uterus [6]. The endometrial tissue can also grow adhesions and abnormal attachments to the tissues that cause organs to stick together. Adhesions can interfere with the release of the egg from the ovary, which makes it difficult for sperm to reach the fertilized egg.

The same factors that cause endometriosis pain (inflammation and scarring of the reproductive organs) can also affect fertility. When there is scarring present, it can make it difficult for an egg to implant in the uterus or for a uterus to support a pregnancy. If you hope to conceive soon, it might be worth considering your risk factors for developing endometriosis to know whether you can expect it to be complicated. Some endometriosis treatment approaches, such as surgery and IVF, may be recommended for women with endometriosis-associated infertility. These approaches may help to encourage a healthy pregnancy and improve the quality of life for women who struggle with this diagnosis. 

Photo by Womanizer on Unsplash

Pain During Sex

Another common symptom of endometriosis is pain during sex, also known as dyspareunia. Up to 43% of women with endometriosis report this symptom [7]. Endometriosis tissue outside the uterus can become inflamed and irritated, leading to pain during sex. 

Some women also develop ovarian cysts from endometriosis, which can cause pain. This symptom of endometriosis can also be related to adhesions. As mentioned earlier, adhesions are scar tissue that forms between organs, and they can pull on organs during sex, causing pain. 

Women with endometriosis and trying to get pregnant may need to use invitro fertilization (IVF). However, due to the hormonal changes, IVF causes, pain during sex can also be one of the side effects. 

Heavy Bleeding

Heavier or more extended menstrual periods affect about 50% of women with an endometriosis diagnosis [8]. If your menstrual bleeding is more severe than average, it may require you to change pads or tampons more frequently, including clots. 

Heavy bleeding in women with endometriosis occurs because the endometrial tissue that grows outside the uterus responds to hormonal changes like the tissue inside the uterus does. This means that rather than just having blood coming from the inside of the uterus, it is also coming from any of the endometrial tissue that has extended outside of it. In addition, other conditions, such as fibroids or hormonal imbalances, can cause heavy menstrual bleeding. Treatment of endometriosis, such as hormonal therapy, can help to improve this symptom and make period bleeding lighter. 

If you’re experiencing any of the symptoms mentioned above, it is important to see your doctor or OBGYN as soon as possible to figure out what’s happening. It’s scary when something seems “off,” and you’re unsure why. But try not to panic; getting a diagnosis and beginning treatment promptly will provide answers and ensure that symptoms don’t worsen. 

Common Treatments for Endometriosis

Some experts consider endometriosis a “mystery disease” since the cause is unknown, making it difficult to pinpoint a cure. Although there is no definite cure for endometriosis, some common treatments can help alleviate symptoms. 

One of the most common treatments used for endometriosis is hormone therapy. Hormones such as birth control pills, progesterone-only oral contraceptive pills, and gonadotropin-releasing hormone (GnRH) agonists can help to regulate the menstrual cycle and reduce pain. 

Another common treatment for endometriosis is surgery. Typically, surgery for endometriosis involves a minimally invasive or laparoscopic procedure. The surgery involves removing endometrial tissue that has grown outside where it should be. In more severe cases, a hysterectomy may be recommended by your gynecologist, which involves the removal of the uterus and some of the ovaries. Although surgery tends to be a practical approach to relieving symptoms, it is not a permanent solution since endometriosis can return even after surgery. 

Another important aspect of treating endometriosis is pain management. Over-the-counter pain relievers such as ibuprofen or naproxen can help to reduce pain and inflammation caused by endometriosis. However, prescription pain medications or nerve blockers are sometimes used when pain is severe and over-the-counter medications are not helpful. 

A 2014 review article titled “Endometriosis and Pain Management: An Updated Review” by Sinaii et al. provides an overview of different treatment options for endometriosis and their success rates. Here is a summary of the treatments mentioned in the article:

Nonsteroidal Anti-inflammatory Drugs (NSAIDs): NSAIDs are often the first line of treatment for endometriosis-associated pain. These drugs effectively relieve pain for some women, but their success rate varies among individuals.

Hormonal therapies: Hormone treatments and therapies, such as oral contraceptives, progestins, and GnRH agonists, are often prescribed for endometriosis. These treatments can help reduce pain and inflammation by suppressing the growth of endometrial tissue. The success rate for hormonal therapies in managing endometriosis pain ranges from 70% to 90%.

Laparoscopic surgery: Laparoscopic surgery, aka laparoscopy, can effectively reduce pain in women with endometriosis, with success rates ranging from 60% to 80%. However, recurrence rates can be as high as 20% to 40% within five years after surgery. This procedure involves the placement of long instruments into the pelvic cavity to give doctors a view inside of your body without having to make a large incision. 

Hysterectomy: A hysterectomy (removal of the uterus) may be necessary in severe cases of endometriosis. The success rate for pain relief after a hysterectomy is generally high. Still, this option is typically reserved for women who have exhausted other treatment options or do not desire future fertility.

Assisted reproductive technologies (ART): For women with endometriosis-related infertility, ART, such as in vitro fertilization (IVF), can help increase pregnancy rates. Success rates vary depending on individual factors, but they can be as high as 50% per cycle for some women.

Living With Endometriosis

Managing endometriosis will require a comprehensive approach that involves several different approaches, such as medication, surgery, and lifestyle changes. Pain management is one of the most important aspects of treatment, and you may have to try a variety of different pain relievers as well as hormone therapy before finding what works for you. But don’t worry; your provider can help guide you through this process, and we have a number of tips listed below to help you move towards feeling your best. 

It is important to find a supportive group of friends, family, and a good team of healthcare providers to be on your side. With the proper treatment regimen and support system, many women with endometriosis can successfully manage symptoms and thrive. 

Some important steps to take to live to your fullest with an endometriosis diagnosis include:

  • Prioritizing self-care. Finding out you have a condition like endometriosis can be scary and overwhelming. You should take steps to take care of yourself while learning to navigate endometriosis. Take time to do things you enjoy to feel good and manage stress. Make sure you’re taking steps to live a healthy lifestyle by exercising, eating well, and taking the right supplements. 
  • Seeking appropriate medical care. If you notice any abnormal symptoms, it is important to seek medical care immediately to figure out what’s happening. A prompt diagnosis can ensure a proactive treatment approach and help treat the condition before it worsens. 
  • Advocating for yourself. Endometriosis is a chronic condition. To get the best care, it is important to always advocate for yourself in a healthcare setting. If you are unsure about something a doctor says to you, ask for clarification. Do your research and bring your questions to your doctor visits.

A 2013 study, “Quality of life in women with endometriosis: an Italian pilot study” by Fazioli et al. examined the importance of comprehensive care to help women manage an endometriosis diagnosis. The study concluded that endometriosis, including mental health, can seriously affect a woman’s quality of life. In addition, it found that a multidisciplinary approach to treatment and care can help manage symptoms. 

Endometriosis is only one of many common reproductive issues that can affect women. Other common issues that women may experience include:

For this reason, it is important to pay close attention and be aware of any unusual symptoms since it may be your body trying to communicate to you that something isn’t right. Take steps to stay healthy such as eating nutritious food and limiting unhealthy foods like processed sugar and fast food. Take some time to learn important aspects of your reproductive health, such as understanding your menstrual cycle and what your vaginal discharge should (and shouldn’t) look like.

Final Thoughts

Although common, endometriosis is a severe disease that has the potential to interfere with your everyday life. From uncomfortable symptoms to the need for regular doctor’s visits, an endometriosis diagnosis will absorb plenty of your attention and time. However, with a prompt diagnosis and a comprehensive treatment approach, symptoms can be managed and quality of life restored. If you think you may be experiencing symptoms of endometriosis, talk with your doctor as soon as possible to take steps toward figuring out a diagnosis.