Endometriosis: Causes, Symptoms, & Treatment

By Zina Semenovskaya, MD
Medically reviewed checkmarkMedically reviewed
November 2, 2019

Are you experiencing severe pelvic pain or cramping that gets worse during your period? Are you also having difficulty getting pregnant, or do you feel pain during sexual intercourse? You may be suffering from endometriosis. Endometriosis is a painful condition that occurs when cells similar to those that form the lining of the uterus (womb) begin to grow outside of the uterus. Usually, these cells spread to the ovaries, fallopian tubes, and the lining of the pelvis, but they can also spread to other parts of the body such as the vagina, cervix, bowel, bladder, and in rare cases, the lungs.

Endometriosis is a relatively common condition, affecting more than 11% of American women between the ages of 15 and 44. Fortunately, there are effective treatments available to help you cope with your symptoms, as we will explain in this article.

What Is Endometriosis?

If you have endometriosis, the tissue that usually lines the inside of your uterus (the endometrium) begins to spread and grow outside the uterus as well. These growths are called endometrial implants. Although the tissue is now outside your uterus, it still behaves as it would during a regular menstrual cycle. Just like with tissue lining the uterus, towards the end of your cycle it breaks down and bleeds, and you can develop pain and cramping.

Endometriosis pain can be more severe than regular period pain. In a regular period, the discarded uterine lining exits the body via the vagina. Because endometrial tissue is not situated in the uterus, it can not leave the body in this way. Over time, trapped tissue builds up, causing swelling and inflammation in the surrounding areas. Scar tissue, cysts, and adhesions can also develop and lead to significant pain and discomfort.

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The Stages of Endometriosis

The severity of endometriosis is classified in stages (formulated by the American Society of Reproductive Medicine) based on the location of the implanted tissue in the body, its depth, size, and the amount of affected tissue. This classification system is helpful as it can help determine what kind of treatment you need.

The stages of endometriosis are as follows:

  • Stage 1 (minimal endometriosis): You have a few small implants, small wounds or lesions mostly on the tissue lining your pelvis or abdomen. You have little or no scar tissue.
  • Stage 2 (mild endometriosis): You have more implants than typically found in stage 1. The implants reach deeper into the tissue, and there may be some scarring.
  • Stage 3 (moderate endometriosis): You have several deep implants and some small cysts on one or both ovaries. You also have some thick bands of scar tissue called adhesions.
  • Stage 4 (severe endometriosis): You have many deep implants and thick adhesions. You also have large cysts on one or both ovaries.

The stage and symptoms of endometriosis are not always directly proportional. It is entirely possible to have stage 1 endometriosis, yet have more severe pain than someone with stage 4. This, however, is not the case with infertility. If you have stage 3 or 4 endometriosis, you are more likely to have difficulty getting pregnant than if you have stage 1 or 2.

Causes of Endometriosis

There are different theories as to what causes endometriosis.

  • Retrograde menstruation: Menstrual blood containing endometrial cells may travel back through the fallopian tubes into the pelvic cavity where it sticks to the organs and begins reproducing.
  • Genetics: There may be a hereditary cause of the disease. If a close family member, such as your mother or sister, has endometriosis, you are at increased risk.
  • Immune system disorder: It is common to have endometriosis alongside immune system disorders such as multiple sclerosis, lupus, an underactive thyroid, and rheumatoid arthritis. This leads some researchers to conclude that there is a link between the conditions. Confusion still exists, however, as to whether the immune condition is a cause or effect of endometriosis.

Endometriosis Symptoms

The most common symptom of endometriosis is pelvic pain, usually occurring during your menstrual period or during ovulation. If you have endometriosis, you will likely have pain that is worse than the cramping associated with regular periods. You may also find that the pain worsens over time. If you experience any of the following symptoms, it is a good idea to visit your gynecologist to discover whether endometriosis is the cause:

  • Painful periods (dysmenorrhea): You have severe or unusual pelvic pain and cramping that begins before, and extends several days into, your menstrual period. This may or may not be accompanied by lower back and abdominal pain.
  • Painful sex: You find sexual intercourse painful.
  • Going to the bathroom is painful: You feel pain when you try to have a bowel movement or urinate. The pain may be worse during your period.
  • Excessive bleeding: You have very heavy menstrual periods or bleed between periods (intermenstrual bleeding).
  • Infertility: You have been trying to get pregnant without success. Some women discover they have endometriosis when they seek treatment for infertility but do not experience other classic symptoms.
  • Other signs and symptoms: You feel more tired than usual or have diarrhea, constipation, bloating or nausea, especially during menstrual periods.

Risk Factors for Endometriosis

While endometriosis can develop during any stage of life, it is most common in your 20s 30s. Endometriosis usually develops several years after you started your menstrual periods and worsens over time. Symptoms may temporarily resolve during pregnancy and then disappear completely at the onset of menopause (unless you are taking estrogen supplements).

You are more likely to get endometriosis if you:

  • Never had children
  • Started your period at an early age
  • Have heavy menstrual periods that last > 7 days
  • Have a short menstrual cycle (27 days or fewer)
  • Have a family member with endometriosis
  • Have a low body mass index (BMI)
  • Have reproductive tract abnormalities

How Is Endometriosis Diagnosed?

If you are experiencing symptoms of endometriosis, particularly if you are having difficulty getting pregnant, there’s a chance that you have the condition. Endometriosis is sometimes mistaken for other conditions that cause pelvic and lower abdominal pain, such as pelvic inflammatory disease (PID), ovarian cysts or irritable bowel syndrome (IBS). Your doctor may perform some of the following tests to determine if you have endometriosis:

  • Pelvic exam: Your doctor will examine your pelvic area for large cysts or scars. As it is difficult to manually detect smaller endometriosis lesions, further tests may be needed to verify the diagnosis.
  • Ultrasound: Your gynecologist may order an ultrasound to check for ovarian cysts or other findings related to endometriosis.
  • Magnetic resonance imaging (MRI): This is another common and painless imaging test that allows your doctor to view the inside of your body and try to determine whether you have endometrial tissue.
  • Laparoscopy: If the results of the other tests are inconclusive, your doctor may need to perform surgery to know for sure if you have endometriosis tissue. Laparoscopy is a minimally invasive type of surgery that can be used for investigative and treatment purposes.
  • Biopsy: In order to confirm your endometriosis diagnosis, your doctor may need to take a small sample of tissue to send to a lab for further study under a microscope. The procedure takes just a few minutes and can usually be done in the doctor’s office with local anesthesia.

Treatment Options for Endometriosis

While there is no cure for endometriosis, there are many treatment options to help you manage your symptoms and achieve a better quality of life.

Hormonal Therapies For Endometriosis

Your doctor may recommend starting one of the following hormonal treatments to manage your endometriosis symptoms:

  • Birth control: Birth control can offer significant relief from endometriosis symptoms by regulating your hormones. With milder cases, your doctor may advise that you take the pill, or use a patch or vaginal ring. Taking the pill continuously, without any breaks–or with less frequent breaks between cycles–can also offer longer-lasting relief.
  • GnRH analogs (agonists): If you have severe endometriosis, your doctor may prescribe hormone drugs known as GnRH (gonadotropin-releasing hormone) analogs or GnRH agonists. These work very well to relieve symptoms but have can have significant side effects. GnRH agonists work by lowering the levels of female sex hormones that are produced and can therefore cause estrogen deficiency as a side effect. This can lead to issues such as hot flashes, sleep problems, vaginal dryness, and mood swings.
  • Progestins and the LNG-IUS – Your doctor might also prescribe you drugs containing the hormone progestin. These drugs suppress the growth of abnormal endometrial tissue and may also reduce endometriosis-induced inflammation in the pelvic cavity.
  • Danazol (Danocrine)Danazol belongs to class of medications called androgenic hormones. Acting like the male hormone testosterone, it works to decrease the level of hormones made by the ovaries, thereby shrinking areas of abnormal endometrial tissue and relieving pain and symptoms.

Pain Medication for Endometriosis

Pain is one of the most challenging symptoms of endometriosis and, in severe cases, it can disrupt your daily life. Fortunately, many over-the-counter NSAID medications, such as ibuprofen (Advil, Motrin) or naproxen (Aleve) can offer significant pain relief. If these do not prove effective in treating your pain, speak to your doctor about stronger medications or try some of the other treatments detailed below.

Endometriosis Surgery

In some cases, medications simply cannot provide enough relief from pain, and your doctor may recommend surgery. If you have been trying unsuccessfully to get pregnant, surgery may also be the best option for you. Your doctor can discuss the various surgical options and help you decide on the best treatment for you. Here is an outline of the main options:

  • Laparoscopy: This minimally invasive surgical procedure requires only a very small incision. A laparoscope is inserted close to the affected area and this allows the doctor to see what is going on and also to remove any implanted endometrial tissue using a laser or an electric current.
  • Laparotomy: This is a more invasive procedure that involves cutting through the wall of the abdomen. As with laparoscopy, it allows the doctor to see what is going on inside your and remove any abnormal endometrial tissue.

It is worth noting that for all the types of surgery mentioned above, there is about a 20 in 100 chance that the endometrial implants will recur within five years post-surgery.

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Endometriosis Natural Treatments

There are many natural and alternative treatments you can try at home to help control your symptoms.

  • Heat therapy: Heat therapy is a safe, complementary therapy that you can use in conjunction with medications to provide relief from endometriosis pain. Try a warm bath, or applying a heat pack or heating pad to the affected area.
  • TENS machine: A Transcutaneous Electrical Nerve Stimulation (TENS) unit is a device you can buy over the counter and use at home. TENS units can provide pain relief by stimulating the nerves and intercepting the body’s pain signals.
  • Stress management: Severe endometriosis pain can lead to stress, which further exacerbates the symptoms and makes it harder to handle the pain. Anything you can do to keep stress in check can also help you better cope with your symptoms. Make sure you get enough sleep and exercise regularly. Adopting a meditation practice or taking a workshop on mindfulness or positive thinking techniques can also help. If you are feeling very low and struggling to cope, connect with a therapist, counselor or a support group. You can also try self-guided treatments for anxiety.
  • Relaxation techniques: Learning to relax properly can be enormously beneficial. You could try classes in yoga or tai chi, which can give you tools to help you relax.
  • Alternative therapies: Some people with chronic pain from endometriosis have found that acupuncture and homeopathy can provide relief from endometriosis symptoms.

While the underlying causes are still unknown, there is evidence to suggest that having endometriosis puts you at a higher risk for several diseases:

Older research from the National Institute of Child Health and Human Development (NICHHD) also reported findings that people with endometriosis are more likely to have:

When to See a Doctor

You should see your doctor if you have any of the signs and symptoms of endometriosis, including pelvic pain and infertility. While endometriosis can be a challenging condition to manage, getting the correct diagnosis and initiating treatment greatly increases your chances of controlling and coping with the condition. If you are trying to get pregnant, it is even more important to seek medical care as this will greatly increase your chances of conceiving and enjoying a healthy pregnancy.

K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

Zina Semenovskaya, MD

Dr. Semenovskaya specializes in emergency medicine, and received her medical degree from Weill Cornell Medical College. She is currently the medical director at Remote Emergency Medicine Consulting, LLC and splits her time working clinically as an emergency medicine attending in California and Alaska. She is the first of our doctors to be fluent in Russian.

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