Endometriosis: Symptoms, diagnosis and treatment

Endometriosis is a common disease where extra tissue grows outside the uterus. It impacts more than 6.5 million women ages 15 to 44 in the United States. Any woman who has a menstrual period can have endometriosis, with women in their 30s and 40s the likeliest to be diagnosed.

Although endometriosis is named after endometrium, which is the tissue that lines the uterus, the tissue that causes endometriosis is not the same. It is similar but it typically grows in the outer part of the uterus, the ovaries, and the fallopian tubes. The tissue may also grow in the cervix, bladder, or rectum. Although rare, it can even be found in other parts of the body, like the lungs or brain.

During menstrual periods, endometriosis tissue swells, breaks down, and bleeds with the lining of the uterus. But unlike the uterine lining, there is nowhere for this tissue to go. The symptoms of endometriosis include pain and swelling, and it may create scar tissue or adhesions (bands of tissue that connect organs that are not usually connected). Endometriosis can cause infertility and bladder or bowel problems.

Endometriosis is not life-threatening, but symptoms like chronic pain can have a big impact on quality of life. Knowing the symptoms of endometriosis, getting diagnosed, and starting treatment are key to living well with this condition.

Symptoms of endometriosis

Symptoms of endometriosis can vary, but there are some common ones to watch for. Pain is the most frequent one and might include:

• Painful periods that may get worse over time
• Pain in the lower back or pelvic area
• Pain during bowel movements or urinating, especially during your period
• Pain during or after sex, often described as being deep inside the body

Other symptoms of endometriosis include:

• Heavy periods
• Bleeding or spotting between periods
• Bloating that is worse during your period
• Nausea, diarrhea, or constipation, particularly when you have your period
• Fatigue
• Depression
• Infertility or difficulty getting pregnant

Symptoms often stop during pregnancy and menopause.

Cause of endometriosis

The cause of endometriosis is unknown, but many possibilities are being studied.

Endometriosis may be caused by tissue moving from the uterus into other parts of the body. This could happen during certain surgeries, such as a C-section or hysterectomy. Problems with period flow that causes tissue to go up into the body instead of coming out through the cervix and vagina are other possible causes.

Additional research is looking to see if endometriosis is tied to immunity. People with endometriosis are more likely than others to have an autoimmune disorder in which the body's immune system attacks healthy tissue. Inherited genes may also play a part, as studies show endometriosis can run in families.

Risk factors for endometriosis

These risk factors increase the chance of having endometriosis:

• Having a family member with endometriosis
• Short menstrual cycles (27 days or less)
• Periods that last more than seven days
• Heavy periods
• Getting your first period before age 11
• Having a health condition that stops period blood from leaving the body

There is no way to prevent endometriosis, but these factors may lower your risk:

• Avoiding alcohol and caffeine
• Getting your first period later in adolescence
• Low body fat
• Pregnancy
• Regular exercise

How to diagnosis endometriosis

Your medical provider will start by asking you about your symptoms and medical history. Additional ways to make a diagnosis include:

● Pelvic exam. During the exam, your medical provider will check for lumps of tissue or other signs of disease inside the vagina.

● Imaging (diagnostic screening). Magnetic resonance imaging (MRI) or ultrasound takes pictures of the inside of your body to find any areas with extra tissue or adhesions.

● Laparoscopic surgery. A small cut is made in the skin and a thin tube with a camera and light is inserted. The image from the camera lets the surgeon see any unusual tissue growth. They may diagnose endometriosis based on what they see or take a small tissue sample (a process referred to as a biopsy) to examine further.

● Medication. Medication may be prescribed to decrease symptoms of endometriosis. If your symptoms lessen after starting the medicine, you likely have the disease.

Treatment of endometriosis

There is no cure for endometriosis, but there are treatment options to help manage it.

Hormonal birth control is usually the first treatment option used. This includes birth control pills, shots, and hormonal intrauterine devices (IUDs). Endometriosis symptoms often return if you stop hormonal treatment.

If you are trying to get pregnant or want to avoid birth control, your provider might suggest a gonadotropin-releasing hormone (GnRH) agonist. This medication causes temporary menopause and works to control the growth of endometriosis tissue. You may have an increased chance of pregnancy once you stop this medication.

Surgery may be an option if other treatments have not worked. During surgery, extra endometrial tissue is removed. Nerves in the pelvic area might also be cut to decrease pain. Staying on medication after surgery may help to prevent symptoms from coming back.

A hysterectomy (surgery to remove the uterus) might be an option for the most severe cases of endometriosis.

Pelvic floor physical therapy is often helpful in managing endometriosis. This therapy strengthens the muscles in the pelvic area. It also helps decrease pain and lessen bowel and bladder symptoms.

Learn more about how Reid Health OB/GYN services can help keep you healthy.