Endometriosis: Symptoms, Causes, and Treatments

|   September 20, 2019   |   Gynecology

Endometriosis: Symptoms, Causes, and Treatments

It is estimated that endometriosis affects 1 in 10 women during their reproductive years in their lifetime. Worldwide, that means it affects roughly 175 million women per year. Endometriosis can have onset at any time, from a girl’s first period in her preteen or teen years to a woman that is in the stages of premenopause. Endometriosis can be painful and debilitating in addition to causing fertility problems, negatively affecting women’s health. Read on to learn more about endometriosis, what causes it, what the symptoms are, and what treatments are available.

What Is Endometriosis?


In every woman’s uterus is a lining known as endometrium, or endometrial tissue. In some women, this endometrial tissue grows abnormally outside of the uterus. This expansion, in what is known as an endometrial implant, can spread and grow to nearby areas, such as the ovaries and bowels. It is less likely that endometrial tissue will grow in the pelvis, but it is not unheard of. This additional growth is not harmful by itself, but the hormonal changes experienced during a menstrual cycle can cause these areas to become irritated and painful. The growth can grow larger over time, simply because it has nowhere else to go. The buildup of endometrial tissue outside of the uterus can become trapped in your pelvis, causing more pain and related problems, such as problems with fertility, severe pain during the menstrual cycle, and irritation. This can also cause scar tissue to form in the pelvis, as well as adhesion, which means parts of the pelvis will begin to fuse together. 

What Causes Endometriosis?


Doctors are not entirely sure what the cause of endometriosis is. There are several theories; however, nothing has been scientifically proven. Perhaps the oldest school of thought regards retrograde menstruation. During this process, menstrual blood does not leave the body via the vagina as it normally would. Instead, it flows back into the fallopian tubes and into the pelvic cavity. Another theory states that small abdominal areas may form endometrial tissue, thus displacing cells and causing them to travel into the pelvis and pelvic organs like the bladder, rectum, and ovaries. There are also other schools of thought regarding the causes of endometriosis, but nothing has been formally proven. If you have a family member who has endometriosis, you may be more at risk; however, genetics hasn’t been strongly correlated with the condition.

What Are the Signs and Symptoms of Endometriosis?


Women may not know at first that they have endometriosis. If they have a mild case, symptoms may also be mild. However, it’s also possible to have a severe form of endometriosis (see mild and severe in the stages listed below) and also have mild symptoms. This is why it is important to be evaluated by your gynecologist. The most common symptom associated with endometriosis is pain. This type of pain is usually pelvic pain, but can also manifest in the form of painful periods. You may also experience common symptoms such as:

  • Pain in the lower abdomen at any time (but especially before and during menstruation)
  • Lower back pain during the menstrual cycle 
  • Uncomfortable of painful bowel movements
  • Pain after engaging in sexual intercourse
  • Infertility
  • Heavy menstrual bleeding
  • Painful cramps leading up to menstruation

It is also possible to have endometriosis and have no symptoms at all. The best way to know for sure is to see your gynecologist regularly and have regular checkups and gynecological exams. It is much more common for women who are experiencing infertility problems to have an endometriosis diagnosis, and very commonly endometriosis is found after complaints of infertility. Knowing about endometriosis beforehand and receiving proper treatment can definitely help when it’s time to decide you want to try to conceive. 

What Are the Stages of Endometriosis?


Endometriosis is classified into four stages, but these are also referred to as types. It is unlike a cancer diagnosis, where a stage I cancer can easily progress to a stage IV, which is much more serious. You can have stage I endometriosis for your entire life without an increase in severity. However, it is important to point out that the severity can increase over time. Endometriosis is classified by the location of the endometrial tissue, its size, depth, and number. 

  • A minimal stage means that tissue is found on your ovary, and perhaps a small amount on your pelvic cavity. This is the mildest form of endometriosis. 
  • A mild stage may involve more tissue growth, but in the same areas: the ovary and the pelvic cavity. 
  • A moderate case of endometriosis means you have a fairly deep lining on your pelvic cavity and your ovary. There may also be more lesions than are found with milder cases.
  • A severe case of endometriosis involves growth on your ovaries and pelvis, but likely the condition has also spread to your bowels and fallopian tubes. 

Diagnosing endometriosis requires some testing so your doctor can be confident of the diagnosis. Testing is needed because the symptoms of endometriosis can be very similar to that of pelvic inflammatory disease (PID) or ovarian cysts. Your doctor will first ask for detailed health history. This can help them determine if there are any signs of long-term illness. Next, a pelvic exam is warranted. This is, of course, a routine part of any gynecological exam, but when confirming an endometriosis diagnosis, the doctor will look for scar tissue behind the uterus and feel the abdomen for possible signs. 

If initial questions and evidence shows there may be endometriosis, the physician will order more definitive tests, such as an abdominal ultrasound. A transvaginal ultrasound is inserted so that the gynecologist can get pictures of the abdomen as well as any cysts located there. However, this isn’t quite definitive enough in most cases to rule out endometriosis or to provide a diagnosis. The only way to be positive that the condition is endometriosis is to have a laparoscopy. This is a relatively non-invasive surgical procedure that involves making small cuts to see the endometrial tissue directly. Once this is completed, the doctor can provide a definitive diagnosis, including what stage the endometriosis is in (ranging from mild to severe). 

Treatments and Endometriosis Options


Most physicians will opt for non-invasive endometriosis treatments, such as hormonal treatments such as birth control or other options, before opting for more serious treatment directives like surgery. There is no cure for endometriosis, so it’s likely that your doctor will prescribe several different types of medications to help manage pain and tissue growth. Prescription pain medications for irregular and painful periods are common, such as a prescription-strength nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen. 

Hormones are the most common treatment when it comes to managing tissue growth. Your doctor may recommend different types of birth control, including an intrauterine device or hormonal birth control. Gonadotropin-releasing hormone (GnRH) antagonists and agonists may both also be recommended, depending on the severity of your case. For those trying to conceive, fertility treatments may be necessary.

One of the complications when it comes to using surgery as a viable treatment for endometriosis is the unfortunate fact that a full hysterectomy may need to be performed in order to remove the excess endometrial tissue. This is not a viable option for women of childbearing age who wish to conceive, so other treatments are recommended instead. Those who wish to conceive with fertility treatments would have to cease taking hormonal birth control to conceive, however, so the fertility specialist and the gynecologist would have to work closely together to ensure the best possible outcome.  

If you need more information about endometriosis and its symptoms or would like to be evaluated by a physician, request an appointment with The Woman’s Clinic today. We offer Care At Every Life Stage, with two convenient locations with individual and specialized care.


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