Endometriosis is a condition where the tissue that lines the uterus — the endometrium — grows elsewhere in the body, leading to chronic pain, heavy periods and even infertility, significantly impacting quality of life. It’s estimated that 6.5 million women (about one in 10) in the United States have endometriosis.
In females with endometriosis, the endometrial lining can grow in places like the:
Back and outer surface of the uterus
Ovaries
Fallopian tubes
Bladder
Ureters (the ducts where urine passes from the kidneys to the bladder)
Lining of the pelvis and abdomen (peritoneum)
Cervix
Vagina
Intestines
Rectum
In rare cases, endometriosis can grow in the brain, lungs or skin.
What are the symptoms of endometriosis?
The following can be signs of endometriosis:
Intensely painful menstrual cramps
Pain during or after sex
Chronic pain in the pelvis and lower back
Intestinal pain
Pain during bowel movements or urination during periods
Bleeding or spotting between periods
Infertility
Constipation, bloating, nausea or diarrhea, particularly during periods
Fatigue
Depression or anxiety
“Many symptoms of endometriosis are similar to other issues women face, and therefore can sometimes be difficult to diagnose,” said Dr. R. Edward Betcher, OB-GYN department chair for Atrium Health Navicent and a specialist in minimally invasive gynecological surgery. “There’s also a hereditary component and some women think that what they are experiencing is normal because that’s what their mother or aunts experience. This may lead to hesitation to talk to their doctors about it.”
Physicians urge women to speak to their provider if they are experiencing these symptoms.
“We encourage women experiencing any endometriosis symptoms to speak up and tell their health care provider. Just because you may know other women with these symptoms, it doesn’t mean that it’s normal. You don’t have to suffer through painful periods. There are things we can do to help,” Betcher said.
With a complete exam and imaging of the affected area, a gynecologist can help develop a treatment plan. While there is no cure for endometriosis, successful treatment options include pain relievers and hormone therapy. If a patient’s condition is not responding well to treatment, laparoscopy or surgery may be performed.
“The important thing to know is that we believe you. If you tell us you’re having these issues, we will evaluate you and treat the issues,” Betcher said. “Atrium Health Navicent is invested in women’s health, and there are many ways to improve quality of life for women with endometriosis, and that all starts by talking to your doctor.”
Who’s at risk of endometriosis?
Endometriosis is most common in women between ages 25 and 40, though it can also occur in teenagers. Some people experience relief from endometriosis symptoms once they are in menopause.
You may be at higher risk of having endometriosis if you:
Have a family history of endometriosis
Have defects in your fallopian tubes or uterus
Began your period before age 11
Never had children
Have menstrual periods that are longer than seven days
Have short menstrual cycles (27 days or fewer)
What causes endometriosis?
The cause of endometriosis is still unknown, though researchers are exploring the following possible factors:
Menstrual flow problems
Hormonal issues
Genetics
Surgery to the abdominal area, such as a hysterectomy or cesarean section (C-section)
How does endometriosis affect fertility?
It’s still possible to get pregnant if you have endometriosis, but it may be more difficult. Researchers estimate one in two women with infertility may have endometriosis.
Can endometriosis be prevented?
Currently, there are no known ways to prevent endometriosis. However, you may be able to lower your risk by reducing estrogen levels in your body. The following can help you maintain lower estrogen levels:
Avoiding large amounts of caffeinated and alcoholic beverages
Exercising regularly (ideally more than four hours per week)
Maintaining a low percentage of body fat
How is endometriosis diagnosed?
The following can be used to diagnose endometriosis:
A pelvic exam
An ultrasound
An MRI
Laparoscopic surgery
How is endometriosis treated?
While there’s no cure for endometriosis at this time, there are several ways to treat endometriosis, including:
Hormonal birth control pill or shot to help reduce or eliminate pain and stop bleeding (if you’re not trying to become pregnant).
Intrauterine device (IUD) to help with pain and bleeding (if you’re not trying to become pregnant).
Gonadotropin-releasing hormone (GnRH) medications, which can cause temporary menopause, but also helps control the growth of the condition. Once you stop taking the medicine and your menstrual cycle returns to normal, you may have an increased chance of getting pregnant.
Pain medications, like naproxen and ibuprofen, to help manage pain.
Surgery to remove endometriosis patches. This is usually only used for severe symptoms or those with fertility issues.
Surgical removal of the uterus (hysterectomy). This is usually reserved for severe cases.
When to see your health care provider?
You should see your health care provider if you experience any of the symptoms above, particularly if they interfere with your daily activities, or if you’ve been trying to conceive for more than 12 months (or more than six months if you’re 35 or older). Left untreated, endometriosis can cause scar tissue, cysts and adhesions in the body.
Learn more about Atrium Health Navicent Women’s Care and how to find an OB-GYN.