If you have painful periods, pain during sex and excessive bleeding, it’s possible that you’re suffering from a pelvic disorder.
While these can be signs of a number of conditions, you might be wondering do you have endometriosis?
Let’s look into this chronic disease that impacts quality of life, including symptoms, diagnosis, and treatment.
What is Endometriosis?
Tissue called endometrium lines inside of your uterus, forming layers of tissue that build up along the inner lining. This tissue is what you shed during a menstrual period, when it falls away from the walls of your uterus and leaves your body. The endometrium is also the tissue that supports early development when you get pregnant.1
The condition known as endometriosis is caused when tissue that’s similar to the inner lining of the uterus grows outside your uterus. It can impact your ovaries, fallopian tubes and the tissue lining the pelvis, and in rare instances even grows beyond the area of your pelvic organs.2
That tissue is also like your endometrium in that it thickens, breaks down and bleeds with each menstrual cycle. But since it is growing outside the uterus, it has nowhere to go and can’t leave your body in the way that the lining of the uterus does each cycle. The result can be cysts, scar tissue and adhesions, and can even cause the pelvic tissues and organs to stick to each other.2
Here are the possible impacts:2
- when endometriosis involves the ovaries, cysts called endometriomas may form
- surrounding tissue can become irritated and form scar tissue
- bands of fibrous tissue called adhesions also may form
- endometriosis can cause pain, especially during menstrual periods
- endometriosis can also cause fertility problems
If you find out you have endometriosis, you’re not alone. It’s estimated that this condition affects roughly 10%—or 190 million—of reproductive age women and girls globally.3
Symptoms of Endometriosis
Pain is not the only signal of endometriosis. In fact, some women have no symptoms. If you do have pain, the seriousness of it may not be a sign of the number or extent of endometriosis growths in your body—you could have a small amount of tissue with bad pain, or you could have lots of endometriosis tissue with little or no pain.2
For some women, endometriosis is a chronic disease associated with severe, life-impacting pain that can occur at various times: during periods, during sex, or during bowel movements.3
Here are the common side effects of endometriosis:
- Painful periods, including lower back and stomach pain. Painful periods are often referred to as dysmenorrhea.2
- Chronic pelvic pain and abdominal bloating.3
- Pain during or after sex.2
- Pain with bowel movements or urination, most commonly before or during a menstrual period.2
- Heavy bleeding during menstrual periods or bleeding between periods.2
- Infertility. In fact, endometriosis is often diagnosed during tests for infertility.2
- Other symptoms such as fatigue, diarrhea, constipation, or nausea, especially before or during menstrual periods.2
- Some women suffer from depression and anxiety due to the condition.3
Do You Have Endometriosis?
Since some women with endometriosis have no symptoms, it’s not always easy to diagnose. The condition also has side effects similar to other pelvic conditions, like pelvic inflammatory disease, or ovarian cysts, leading to confusion about the cause of the symptoms.2
It is sometimes mis-diagnosed as irritable bowel syndrome (IBS), since it can cause diarrhea, constipation and stomach cramps. In fact, IBS can happen along with endometriosis, making it more difficult to pinpoint.2
Women sometimes find out they have endometriosis when they can’t get pregnant or after they have surgery for another reason.2 As a result, being infertile is often considered a risk factor that causes doctors to look for endometriosis.4
There are other risk factors that could point to a diagnosis of endometriosis:
- if you have a mother, sister, or daughter with endometriosis4
- If you started your periods early, before the age of 11 years old4
- if you have short monthly cycles, such as those less than 27 days4
- if you have heavy menstrual periods that last more than 7 days4
- if you have never given birth2
- if you go through menopause at an older age2
- if you have higher levels of estrogen in your body2
- if you have a low body mass index2
Diagnosis often starts with a review of your symptoms, your personal medical history and whether any people in your family have endometriosis. You may undergo a pelvic exam, or an ultrasound. Further examination may require an MRI or even a laparoscopy for definitive diagnosis and treatment. A laparoscope is a small camera that looks inside your body and can confirm endometriosis as well as take a tissue sample to confirm the diagnosis.1
Sometimes endometriosis is discovered by accident. If you don’t have symptoms, your doctor might discover the condition during a different procedure.1
Treatment of Endometriosis
There is currently no known cure for endometriosis, so the goal of treatment is typically focused on controlling symptoms.3 It’s also good to remember that endometriosis is not cancer, and it isn’t an infection or contagious either.5
Your treatment plan will be based on a few factors, such as:1
- the severity of your endometriosis
- the severity of your symptoms, in particular pain
- your age
- your plans for future pregnancies
For instance, if you plan on getting pregnant, your doctor will look at improving your fertility; if your pain is severe, treatment will focus on managing pain.1
Here are some of the options for treating endometriosis.
1. Pain medication: Such as over-the-counter pain relief or non-steroidal anti-inflammatory drugs (NSAIDs).
2. Hormone therapy: Which can suppress endometriosis. Options include birth control, to suppress hormones; Gonadotropin-releasing hormone (GnRH) medications that will stop the hormones that cause your menstrual cycle; or Danazol, another hormonal medication that stops your period.1 These can be taken in various forms, including pills, hormonal intrauterine devices (IUDs), vaginal rings, implants, injections and patches.3
These are obviously not an option—and not recommended—for women who want to become pregnant, and with any of these choices, symptoms can come back if you stop taking the medication.
3. Fertility treatment: A choice that may be suggested if you’re having trouble getting pregnant. You may be referred to a doctor who treats infertility, or suggested fertility treatment like medicine that helps your ovaries make more eggs; or a procedure called in vitro fertilization.6
4. Surgery: Which is the only way to positively confirm a diagnosis of endometriosis. 4 While there are always risks in any type of surgery, it can be effective to treat pain and improve your chances of getting pregnant.1
Surgical Options for Endometriosis
The type of surgery will also depend on several factors, in particular whether you want to get pregnant. A conservative surgery will remove endometriosis tissue while preserving the uterus and the ovaries, allowing you to become pregnant. It may help with pain, but both the endometriosis and the pain may come back over time after surgery.6
Here are the surgical options for endometriosis:
1. Laparoscopy: This procedure involves making a very small cut in your abdomen into which a thin tube-like tool called a laparoscope is inserted. The laparoscope allows the doctor to see inside your body with a camera to identify endometriosis. Additional small instruments can then be inserted into another small cut and used to remove the lesions.1 Some surgeons do laparoscopy with help from robotic devices that they control.6
2. Abdominal surgery: Less often, surgery that involves a larger cut in the abdomen is needed to remove the tissue.6 Also known as laparotomy, this more major abdominal procedure allows the surgeon to remove larger endometriosis patches.4
3. Hysterectomy: This major surgery involves removing your uterus, and is sometimes suggested based on the amount of endometriosis present, if you have other uterine conditions, and if you don’t want to get pregnant. Even with removal of the uterus, other areas of endometriosis should still be removed.1
A hysterectomy used to be considered the most effective way to treat endometriosis, but some doctors now consider it to be a last resort used only if other treatments don’t work. These experts instead recommend a less invasive surgery that focuses on the careful and thorough removal of all endometriosis tissue.6
After all, there are other important considerations about having a hysterectomy—it means you can no longer get pregnant, it could bring on early menopause, and it may have a long-term effect on your health, especially if you have the surgery before age 35.6
Endometriosis is considered a chronic disease. While many women receive relief from pain after surgery, the symptoms may return within a few years. If you do have surgery, it may also be recommended that you take medications, or look to pelvic floor physical therapy to supplement your treatment plan, and improve your overall pelvic health.1
See a Doctor
Endometriosis can decrease your quality of life, with its side effects of severe pain, and sometimes fatigue, depression, anxiety and infertility. Some women experience such severe pain that they can’t go to work or school, or are unable to have sex. It has significant social, public health and economic implications.3 Don’t suffer in silence. Use our Physician Finder to find a doctor near you with expertise in women’s health, to find out if you have endometriosis, and receive a treatment plan to ease or eliminate your symptoms.