Key points to remember:

• Endometriosis is a condition where tissue similar to the lining of the uterus grows in other areas of the body.
• Endometriosis can cause pelvic pain and painful sexual activity.
• Currently, there is no cure for endometriosis, so treatment focuses on managing symptoms.
• Treatment options may include medication, surgery, and changes to lifestyle.

What is endometriosis?

Endometriosis is a health condition in which tissue similar to the lining of the uterus grows in other areas of the body, usually in the pelvic region. This tissue acts like the tissue in the uterus, thickening and shedding during the menstrual cycle. However, because the tissue has no way to exit the body, it can cause inflammation and scarring, leading to pain and possibly fertility issues. The prevalence of endometriosis is difficult to estimate, but it is thought to affect about 1 in 10 women of reproductive age, with some populations having lower rates of incidence.

Symptoms of endometriosis may not appear in the early stages of the condition, and a surgical procedure is often required for a definite diagnosis. Tracking symptoms and discussing them with a healthcare provider may help with early detection and treatment of endometriosis. Early treatment can reduce the risk of complications.

Symptoms of endometriosis

Endometriosis can cause symptoms in women at any age, and the severity of the symptoms may not necessarily correspond to the stage of the condition. Symptoms of endometriosis may appear consistently or only during certain times of the menstrual cycle. Common symptoms include severe menstrual cramps, pain during or after sexual activity, painful urination or bowel movements, abdominal or lower back pain that may last throughout the menstrual cycle, heavy periods, and difficulty getting pregnant. If you are experiencing unusual menstrual pain, it is important to speak with a healthcare provider to determine if endometriosis may be a contributing factor

Causes of endometriosis

The causes of endometriosis are not fully understood. It was once believed that the condition was caused by uterine tissue flowing back through the fallopian tubes and into the pelvic region (a process called retrograde menstruation), but this theory does not explain why only a small percentage of people with retrograde menstruation develop endometriosis. Other theories suggest that endometrial cells may travel through the blood vessels or lymphatic system, or that cells outside of the uterus may transform into endometrial cells.

Some research suggests that hormonal, genetic, and immune system factors may play a role in the development of endometriosis, and the condition may be more likely to occur in people with a family history of the disorder, later or no childbirth, early or late onset of menstruation, or short menstrual cycles. Some studies also show that people with endometriosis may have higher levels of inflammation, imbalanced blood fats, and oxidative stress in the body. The exact reasons for these associations are not yet known.

Why should you get it checked out?

Endometriosis is typically a progressive condition, meaning it can get worse over time. Infertility is a common complication of endometriosis that may be avoidable with early treatment. Up to half of those with endometriosis have decreased fertility. Recent research has also found that people with endometriosis may be at higher risk of cardiovascular problems including heart disease and heart attacks. This could be due to the levels of inflammation, fats, and oxidative stress seen in many people with endometriosis. Early diagnosis can improve outcomes down the road. Early management can help reduce progression of the condition, reduce complications, and keep symptoms under control.

How endometriosis is diagnosed

Endometriosis is often treated based on symptoms without a formal diagnosis being made. However, a diagnosis can be confirmed through a laparoscopy, a minor surgical procedure in which a camera is inserted through a small incision in the abdomen to examine the pelvic region and possibly collect tissue samples for biopsy. A healthcare provider may ask about your medical and menstrual history, perform a physical exam, and recommend additional tests such as a pelvic exam, pelvic ultrasound, or laparoscopy to assess for the presence of endometriosis. It can be helpful to track your pain levels and share this information with your healthcare provider.

While some discomfort during menstruation is normal, pain associated with endometriosis can be severe and it is important to communicate your symptoms to your healthcare provider. Seeking out specialized care from a gynecologist or endometriosis specialist may also help speed up the diagnosis process, which can take an average of 5 years after the onset of symptoms.

Treatments for endometriosis

Endometriosis is a long-term condition that can be managed with treatment, although currently there is no cure for the underlying causes of the disorder. Treatment options depend on the individual's symptoms and goals, which may include reducing pain or improving fertility. Some people may choose not to undergo treatment if their symptoms are mild, but it is important to continue monitoring the condition as it can lead to complications in the future. Medications, such as over-the-counter pain relievers and hormonal medications, may be recommended to manage pain and other symptoms. In more severe cases, surgery such as laparoscopy to remove or destroy endometrial tissue may be recommended.

However, surgery is not always effective and may need to be repeated, and carries its own risks. In some cases, a hysterectomy (removal of the uterus, fallopian tubes, and sometimes the ovaries) may be considered as a last resort. Alternative treatment options such as exercise, dietary changes, and acupuncture are not well-studied and their effectiveness is uncertain.