Everything You Need to Know About Endometriosis: Symptoms, Causes, Treatment Options, and More

Published May 10th, 2022 by Chris Riley
Fact Checked by
Jacqueline Hensler
Medically Reviewed:
Erik Rivera

Endometriosis is a chronic disease that affects millions of women all over the world.

It is a condition where the endometrium, or lining of your uterus, grows outside of the uterus.

In this article, we will discuss everything you need to know about endometriosis from symptoms and causes to treatment options.

Provided with the information here, you can consult with your doctor to help make informed decisions about your health and improve your quality of life.

What is endometriosis?

Endometriosis is a chronic, often painful disorder in which your endometrium, the tissue that normally lines the inside of your uterus, grows outside of the uterus.

The endometrium is the layer of tissue that sheds each month during menstruation.

If your endometriosis involves ovaries, fallopian tubes, and other pelvic tissues, it is known as pelvic endometriosis.

When your endometrium grows outside of the uterus, it still responds to hormonal signals from your brain, thickening and then breaking down and bleeding just as it does inside your uterus each month.

But because this tissue has no way to exit your body, it becomes trapped and the surrounding tissue can become irritated, eventually forming scar tissue, which is also called adhesions.

endometriosis image

Due to the trapped tissue, you become more at risk for other medical problems such as endometriosis cysts, endometriosis adhesions, endometriosis fibroids, and endometriosis nodules.

There are four types of endometriosis: minimal, mild, moderate, and severe.

Determining the stage is based on the size, depth, and location of endometrial implants as well as the presence and severity of endometriosis-related scar tissue.

Whether or not your fallopian tubes are blocked also plays a factor.

What are the symptoms of endometriosis?

Endometriosis can cause a variety of symptoms which can range from mild to severe symptoms.

The most common endometriosis symptom is pelvic pain which can cause painful periods that can feel like severe menstrual pain, also called dysmenorrhea, that can interrupt your daily life.

The onset of symptoms of endometriosis may not take place for years after your first menstrual period. Other symptoms of endometriosis that you may experience include:

  • Pain with intercourse
  • Pain with bowel movements or urination
  • Excessive bleeding during your menstrual period
  • Spotting or bleeding between your menstrual flow
  • Bloating
  • Infertility
  • Fatigue
  • Diarrhea
  • Constipation
  • Nausea
  • Abdominal pain or lower back pain that can feel like menstrual cramps

If you are experiencing these symptoms, especially pelvic pain or any of the other painful symptoms, it is important to see your doctor or health care provider so they can properly diagnose and treat you.

Where can you get endometriosis?

There are many places in your body you may experience endometriosis outside of your uterus, usually around your reproductive organs and abdominal cavity, and these places include:

  • Fallopian tubes
  • Ovaries
  • Pelvic ligaments and tissues that support the uterus
  • The pelvic floor
  • Intestines
  • Rectum
  • Bladder
  • The lining of the pelvic cavity
  • Abdominal scars
  • The outside of the uterus
  • Vagina
  • Vulva
  • Cervix

What causes endometriosis?

The exact cause of endometriosis is unknown, but there are several theories that have been proposed that we will detail below.

Retrograde menstruation

One theory is that during menstruation, some of the endometrial tissue flows backward through your fallopian tubes and into the pelvis, which is called retrograde menstruation.

Endometrial cell transport

Another theory is that endometrial tissue is distributed to other parts of the body through your blood or lymph vessels.

Coelomic metaplasia theory

The coelomic metaplasia theory states that endometrial-like cells, called coelomic cells, or peritoneal cells, which are cells that line the inside of your abdomen, undergo metaplasia, which means they transform into endometrial cells in areas outside of the uterus.

Stem cell metaplasia theory

The stem cell metaplasia theory suggests that endometriosis is caused by the transformation of embryonic cells or adult stem cells into endometrial-like cells in areas outside of your uterus.

Autoimmune disorder theory

Autoimmune disorder theory suggests that endometriosis is caused by an autoimmune disease, such as Graves' disease, in which your autoimmune system fails to destroy endometrial cells outside of the uterus.

Surgical scar implantation theory

The surgical scar implantation theory states that endometrial cells are implanted in areas outside of your uterus after an abdominal surgery such as a hysterectomy or C-section.

There are other theories about the cause of endometriosis but these are some of the most common.

What are the risk factors of endometriosis?

There are several risk factors that have been linked to endometriosis, which include:

  • Starting your period at a young age
  • Short menstrual cycles, usually 27 days or less
  • Longer periods with heavy menstruation, usually 7 days or more
  • Never giving birth
  • Family history of endometriosis
  • Certain medical conditions of the reproductive tract
  • Experiencing menopause at a later age
  • Higher levels of estrogen or exposure to higher levels of estrogen
  • Low body weight
  • Having an abnormal uterus
  • Conditions that prevent you from bleeding during menstruation

These are some of the most common risk factors linked to endometriosis but it is important to note that you can still develop endometriosis even if you do not have any of these risk factors.

What are the complications of endometriosis?

Endometriosis can cause a variety of complications, which include:

Infertility

If you have had endometriosis for a long time, it can damage your fallopian tubes or ovaries, which can lead to infertility.

In fact, endometriosis is one of the three leading causes of infertility. Your doctor may encourage you to try for children soon after discovering your mild or moderate endometriosis, as the symptoms may become worse over time. Endometriosis can cause you to become temporarily infertile, but in some cases, you become permanently infertile.

Please talk to your doctor about fertility options as in vitro fertilization and fertility treatments may help you.

Chronic pain

Endometriosis can cause chronic pain in the pelvic area that can range from mild to severe.

The pain is usually worse during your period and can get in the way of your everyday activities. It can also radiate to other parts of your body, such as your lower back, thighs, and rectum.

Cancer

There is a link between endometriosis and some types of cancer, such as ovarian cancer.

However, it is important to note that the link is still being researched and the risk of endometriosis-related cancer is very low. Endometriosis-associated adenocarcinoma, which is a rare type of cancer, can also occur due to endometriosis.

From around the web: endometriosis

Reddit Community - endometriosis

Reddit Community - What makes endometriosis so har to diagnose

How do doctors diagnose endometriosis?

If you are experiencing symptoms of endometriosis, it is important to see your doctor who will ask about your medical history and symptoms.

They may also perform a physical examination, called a pelvic exam, which can help them rule out other conditions.

In order to confirm a diagnosis of endometriosis, your doctor may recommend one or more of the following tests:

  • Ultrasound examinations
  • Magnetic resonance imaging (MRI)
  • Laparoscopy

During a laparoscopy, your doctor will make a small incision in your abdomen and insert a thin, lighted tube called a laparoscope which allows them to look for endometrial tissue outside of the uterus and your surgeon may also take a small sample for a biopsy.

When the tissue is viewed under a microscope, your doctor can confirm if you have endometriosis.

What are the treatment options for endometriosis?

Your treatment options will depend on the severity of your endometriosis, your symptoms, your age, and if you want to have children in the future.

The goal of the treatment of endometriosis is to relieve pain and improve fertility.

Your doctor may recommend one or more of the following treatments:

  • Pain medication
  • Hormone therapy such as hormonal birth control helps control your hormones, which can be a cause of endometriosis
  • Gonadotropin-releasing hormone (GnRH) agonists and antagonists are another hormonal therapy that lowers your estrogen level
  • Progestin therapy helps to stop your periods
  • Aromatase inhibitors lower your estrogen levels
  • Fertility treatments such as in vitro fertilization or trying to make your ovaries produce more eggs

You may need a surgical procedure as an endometriosis treatment. As noted above, what type of surgery for endometriosis you have may be dependent on the severity of your endometriosis or your plans for children in the future.

The two common surgeries for endometriosis include:

  • Laparoscopic surgery, also called conservative surgery, involves your doctor using the same laparoscope that could be used in diagnosis to help remove endometriosis tissue
  • Hysterectomy, which can involve removing the uterus and, in some cases, even your ovaries

Please note that unless you have a hysterectomy there may be a recurrence of endometriosis.

Summary

Endometriosis is a condition where uterine cells, called endometrium, grow outside your uterus, usually around your pelvic organs.

There are several theories to its cause, yet the actual cause or causes still remain unknown.

The most common symptom of endometriosis is mild to severe pain in your pelvis among many others and it can cause infertility and several other complications.

While there is no cure for endometriosis there are treatments that can help with the management of endometriosis symptoms although factors such as if you plan to have children in the future may affect your options.

If you think you may have a suspicion of endometriosis or have more questions, it is important to see your doctor to determine the most effective treatment option for you.

References and Sources:

Oxford Academic

Karger

NIH

American Journal of Obstetrics & Gynecology

Medicine

The Lancet

UpToDate

Mayo Clinic

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