Endometriosis is a condition where cell tissue that lines the uterus forms in other pelvic organs like the ovaries and fallopian tubes and the outside of the uterus. It can also occur in the abdomen and bowels, and although rare, other organs like the lungs. This tissue acts just like the uterine tissue during your menstrual cycle, meaning that it bleeds during you period. Because it has no way out of your body, it forms lesions and can cause severe pain and often infertility. Endometriosis affects up to 11% of menstruating women but is more common for women in their 30s to early 40s. It’s estimated that over six and a half million women in the United States alone suffer from the condition.
There are four stages of endometriosis from mild to severe based on the size of the lesions and how deep. Pain can range from none to extreme in any of the stages and is not an indication of severity.
Symptoms of Endometriosis
Although the majority of women with endometriosis have no symptoms at all, below are the most common symptoms and usually what brings them to the doctor for a diagnosis or treatment.
- Mild to severe pain in or around the pelvic region up to the abdomen, especially near or during menstruation
- Chronic back or pelvic pain
- Digestive issues which can mimic IBS (Irritable Bowel Syndrome)
- Pain moving your bowels
- Longer and more painful periods
- Painful intercourse
- Bleeding in between periods
- Inflammation and swelling
- Infertility is a complication of endometriosis and while there are many causes of infertility, if you are having trouble getting pregnant, your physician can rule out endometriosis. And, if that is the case, treating the lesions with surgery may improve your fertility.
- Ovarian Cancer rate is higher among women with endometriosis, although it’s still very low, only around 1%.
- Ovarian cysts can happen when blood gets trapped in the ovaries, called endometrioma.
Symptoms can worsen over time, so if you suspect endometriosis, or you’re having any symptoms, talk to your doctor, especially if you plan on getting pregnant. They may recommend you do it sooner rather than waiting as fertility issues may increase over time.
Possible Causes of Endometriosis
Although there is no known cause of endometriosis, there are several theories that explain the condition.
- Retrograde menstruation is where the endometrial cells during your period escape the fallopian tubes and fall into the pelvis and lower abdominal cavity instead of leaving your body. These cells stick to the walls of the pelvic organs where they grow. Sometimes in severe cases, the cells cause organs to stick together.
- Cell Transformation is where the peritoneal (lining of the abdomen) transform into endometrial cells.
- Hormonal cell transformation – Estrogen transforms early cells (embryonic) into endometrial cells, meaning that as a baby, you grow endometrial cells which respond to hormones during puberty.
- Surgical transplant – After a hysterectomy or cesarean birth (c-section), endometrial cells attach to the incision, causing scar tissue.
- Blood vessel transplant – the lymphatic system carries endometrial cells to other organs in the body
- Immune disorders – Immune systems diseases where your body attacks itself like MS and Lupus, and allergies.
Risk Factors of Endometriosis
- High Levels of Estrogen promote the growth of endometrial tissue
- Never given birth
- Started their periods before the age of 12
- Reached menopause later in life
- Short menstrual cycles (less than 27 days)
- Long periods (7 or more days)
- Family history of endometriosis
How is Endometriosis Diagnosed?
The only way to accurately diagnose endometriosis is through a surgical procedure called laparoscopy where they place a small camera inside your abdomen to view the lesions. Sometimes they will take a sample of the tissue to confirm endometriosis. Your surgeon may remove the lesions at the same time, avoiding a second surgery.
What Are My Treatment Options?
Laparoscopy surgery is not usually the first line of treatment for endometriosis. You doctor may recommend treatment based on your symptoms and whether or not you desire to get pregnant.
Nearly 40% of women having trouble conceiving also have endometriosis, so talk to your doctor if you are having difficulties getting pregnant and ask if endometriosis may be the cause. A laparoscopy used to detect fertility issues like fibroids or blocked fallopian tubes will also detect endometriosis.
For extreme cases, a hysterectomy may be the best option if you no longer want to have children. Removing the ovaries will stop estrogen production and by removing the uterus you’ll no longer have periods. Either of these options should lessen endometriosis symptoms.
Other ways to manage endometriosis besides surgery is through medication. However, this will not improve fertility and there’s no way to confirm endometriosis if the medication relieves your symptoms.
For mild pain, your doctor may recommend ibuprofen or other NSAID (nonsteroidal anti-inflammatory drug), or prescription pain medicine for more severe pain.
Hormonal therapy like birth control contraceptives helps as it lowers estrogen production as long as you continue the treatment.
Other medicines which stop your period or block estrogen production may also relieve symptoms.
Your physician can help you find the proper diagnosis and treatment plan.
How Can I Lower My Risk?
- You can’t prevent endometriosis, but because it’s promoted by estrogen production, lowering your estrogen production may also lower your risk of developing it.
- Hormone therapy (not HRT for menopause) or low estrogen birth control pills
- Exercise is good for the body in so many ways but lowering body fat through exercise decreases estrogen production.
- Limiting caffeine and alcohol also keeps estrogen levels low.
- Consuming a healthy diet of fruits and vegetables and limiting foods that increase estrogen like soy products.
Tying it All Together
Endometriosis is a very common disorder among women between puberty and menopause. Although many who have it don’t have any symptoms, the most commonly reported symptom is pain.
If endometriosis runs in your family, or you suspect you have it, speak with your doctor about your risks and any symptoms, especially if you’re dealing with infertility.
Although it’s common and there’s no cure, you can treat the symptoms, so don’t wait. Get relief now and get on with your life.