Endometriosis is when uterine-like tissue forms in places other than the uterus. Painful periods and excessive bleeding are two symptoms of endometriosis, and pregnancy can also be challenging.

The inside of the uterus is lined with endometrium. This is the tissue that sheds when a woman has a period.

An estimated 10%-15% of reproductive-aged women have endometriosis. However, the percentage of women who experience persistent pelvic discomfort increases to as high as 70%. Up to half of the infertile women have endometriosis. Further, it has been found in 47% of teenage girls who had a laparoscopy for pelvic pain.

The cause of endometriosis remains unclear. However, experts propose some explanations, including retrograde menstruation. In retrograde menstruation, endometrial-rich menstrual blood flows back through the fallopian tubes and into the pelvis. Endometrial cells adhere to pelvic organs and walls, thickening and bleeding during menstruation. Scientists also proposed an immune system disorder as a possible explanation for endometriosis.

Endometriosis causes many symptoms, but the pain is the main sign. This pain can be mild or severe. Most women feel it in their stomach, pelvis, and lower back. Even though endometriosis is a common problem, not everyone will have symptoms. Sometimes women don’t know they have endometriosis until it’s found during another procedure or while looking into why they can’t have children.

Women with endometriosis may have the following:

• Cramps from the period that hurt a lot;
• Back or stomach pain during a period or when there is no period;
• Pain when having sex;
• Heavy bleeding during a period or light bleeding (spotting) between periods;
• Infertility (difficulty becoming pregnant);
• Bowel movements that hurt.

Your doctor will ask about the location and timing of discomfort to diagnose endometriosis and other pelvic pain issues. Endometriosis tests include:

• Pelvic exam. The doctor palpates the pelvis for abnormalities, such as cysts on the reproductive organs or scars behind the uterus. Small regions of endometriosis can’t be felt until cyst forms.
• Ultrasound. A probe (transducer) is placed on the abdomen or vagina to record uterus images (transvaginal ultrasound).
• Magnetic Resonance Imaging (MRI). MRIs assist surgeons in planning surgeries by revealing the placement and size of endometrial implants.
• Laparoscopy. A surgeon makes a small incision around the navel and inserts a laparoscope to examine for endometrial tissue outside the uterus. Laparoscopy can reveal the endometrial implant site, size, and extent. From there, the surgeon may do a biopsy.

Treatment

Physicians will base the plan on several criteria, including:

• Endometriosis severity;
• Pregnancy planning;
• Age;
• Symptoms’ severity (often pain).

The approach focuses on pain management and fertility which can be done via medications and surgery.

Endometriosis medications help manage symptoms. Painkillers and hormone treatments are examples.

Hormonal options to prevent endometriosis include:

• Birth control alternatives include estrogen- and progesterone-combination and progesterone-only.
• GnRH drugs, which stops menstruation hormones and halts reproduction to ease the pain. 
• Danazol, which is a hormonal medicine that prevents menstruation. Taking this drug may cause irregular or controlled periods.

A hysterectomy is a surgical option. In severe cases, removing the uterus may be best. The amount of endometriosis, scar tissue, other uterine diseases like adenomyosis, and your desire for future fertility are among the considerations for pursuing hysterectomy.

Endometriosis is not always preventable. Some things can make it less likely that a woman will get endometriosis. Endometriosis could happen to some women because of their genes. Some things that makes a woman less likely to get endometriosis are:

• Pregnancy;
• Breastfeeding;
• Keeping the weight at a normal level;
• Starting their period at a later age.

Endometriosis can also cause problems with the bowels or the bladder. Pain during voiding, bowel movements, or blood in urine or stool are examples. With severe ureter endometriosis, the kidney can enlarge. Endometriosis can sometimes affect the lungs or diaphragm, making it hard to breathe, have chest pains, or causing the lungs to collapse.  

References

Tsamantioti ES, Mahdy H. Endometriosis. [Updated 2022 Sep 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK567777/

The American College of Obstetricians and Gynecologist (2022). Endometriosis. Retrieved November 1, 2022, from https://www.acog.org/womens-health/faqs/endometriosis

Mayo Clinic (2022). Endometriosis. Retrieved November 1, 2022, from https://www.mayoclinic.org/diseases-conditions/endometriosis/diagnosis-treatment/drc-20354661

Cleveland Clinic (2022). Endometriosis. Retrieved November 1, 2022, from https://my.clevelandclinic.org/health/diseases/10857-endometriosis