What is endometriosis?

What Is Endometriosis?

Endometriosis is a common yet often misunderstood condition in which tissue similar to the lining of the uterus (the endometrium) grows outside the uterine cavity. It affects roughly 1 in 10 women of reproductive age worldwide and can cause significant pain, fertility issues, and a reduced quality of life (Giudice 2010; Zondervan et al. 2018).

How Endometriosis Develops
• Retrograde menstruation: Menstrual blood flows backward through the fallopian tubes into the pelvic cavity, depositing endometrial-like cells that implant and grow.
• Coelomic metaplasia: Cells lining the pelvic organs transform into endometrial-type cells under certain triggers.
• Immune dysfunction: A weakened immune system may fail to clear displaced endometrial cells, allowing them to implant and proliferate.
• Genetic and hormonal factors: Family history increases risk, and estrogen promotes lesion growth.

Common Locations of Lesions
• Ovaries (endometriomas or “chocolate cysts”)
• Pelvic peritoneum (lining of the pelvic walls)
• Uterosacral ligaments and pelvic ligaments
• Fallopian tubes
• Less commonly: bladder, bowel, diaphragm

Symptoms to Watch For
Symptoms vary widely. Some women have mild discomfort, while others experience debilitating pain. Key red-flag signs include:
• Dysmenorrhea (painful periods, often worsening over time)
• Chronic pelvic pain (non-cyclical pain lasting longer than six months)
• Dyspareunia (pain during or after sexual intercourse)
• Infertility (up to 30–50% of women with endometriosis may struggle to conceive)
• Bowel or bladder symptoms (pain with bowel movements or urination, especially during menstruation)
• Fatigue, bloating, mood changes

Because symptoms overlap with other conditions (e.g., irritable bowel syndrome, pelvic inflammatory disease), endometriosis can be misdiagnosed or diagnosed late. If you’re concerned, you might consider doing a free, online symptom check for endometriosis.

How Endometriosis Is Diagnosed

1. Clinical evaluation
   – Detailed medical and menstrual history
   – Pelvic exam to feel for nodules or tender areas
2. Imaging tests
   – Transvaginal ultrasound: May detect ovarian endometriomas
   – MRI: Useful for deep infiltrating endometriosis
3. Laparoscopy (gold standard)
   – Minimally invasive surgery to visualize lesions
   – Allows biopsy for definitive confirmation
4. Lab tests
   – No blood test can definitively diagnose endometriosis, but CA-125 levels may be elevated in some cases

Classification (Revised American Society for Reproductive Medicine)
• Stage I (minimal): Superficial lesions, few adhesions
• Stage II (mild): More lesions, mild adhesions
• Stage III (moderate): Endometriomas on one or both ovaries, more adhesions
• Stage IV (severe): Large endometriomas, dense adhesions, extensive lesions

Treatment Options
No cure exists, but treatments aim to relieve pain, slow lesion growth, and preserve fertility. Often a combination of approaches is needed.

Medical Management
• Nonsteroidal anti-inflammatory drugs (NSAIDs): First-line for pain relief (e.g., ibuprofen, naproxen)
• Hormonal therapies:
– Combined oral contraceptives (estrogen–progestin) to suppress menstruation
– Progestin-only methods (pills, injections, intrauterine devices)
– GnRH agonists/antagonists: Lower estrogen levels, induce a temporary menopausal state
– Aromatase inhibitors (less common): Block estrogen production in lesions
• Add-back therapy: Low-dose hormones to reduce side effects of GnRH analogs

Surgical Management
• Conservative (fertility-preserving): Removal or ablation of lesions, lysis of adhesions
• Definitive (for women who do not desire future fertility): Hysterectomy with or without removal of ovaries and fallopian tubes
• Laparoscopic approach is preferred for less invasiveness and quicker recovery

Fertility Treatments
• Assisted reproductive technologies (ART) such as in vitro fertilization (IVF)
• Surgical removal of endometriomas may improve chances of pregnancy in some cases

Living Well with Endometriosis
Endometriosis is a chronic condition, but many women learn to manage symptoms and maintain an active life. Strategies include:
• Pain-management techniques: Heat packs, gentle exercise (yoga, walking), relaxation and breathing exercises
• Diet and nutrition: Anti-inflammatory diet rich in omega-3 fatty acids, fruits, vegetables; limit processed foods and trans fats
• Physical therapy: Pelvic floor therapy to relieve muscle tension and pain
• Support groups and counseling: Emotional support can reduce stress, anxiety, and feelings of isolation

When to Seek Urgent Care
While endometriosis itself isn’t life-threatening, complications or severe symptoms warrant prompt medical attention. Seek care if you experience:
• Uncontrollable pelvic or abdominal pain
• Signs of infection after surgery (fever, chills, wound redness)
• Severe gastrointestinal or urinary symptoms
• Symptoms affecting daily functioning that can’t be managed with outpatient care

Speak to a doctor about any concerning or life-threatening symptoms. Only a healthcare professional can determine the best course of action for your individual situation.

Key Takeaways
• Endometriosis is a chronic condition where endometrial-like tissue grows outside the uterus, causing pain and potential fertility issues.
• Symptoms vary widely; common signs include painful periods, pelvic pain, painful intercourse, and infertility.
• Diagnosis relies on clinical evaluation, imaging, and laparoscopy (gold standard).
• Treatments range from pain relief and hormonal therapies to surgery; fertility treatments may be needed for those trying to conceive.
• Lifestyle adjustments and support can significantly improve quality of life.
• If you suspect endometriosis or have severe symptoms, consider a free, online symptom check for guidance—and discuss all findings with your doctor.

Remember: early recognition and a tailored treatment plan can help manage endometriosis effectively. If you have persistent or severe symptoms, please speak to a healthcare professional without delay.