Endometriosis is a condition related to a woman’s uterus and reproductive system. For many, it can cause severe pain, fertility problems or various other symptoms, while some women have no symptoms at all.
The problem is especially common among women in their 30s and 40s. It affects about 5 million American women. Symptoms usually develop several years after the onset of menstruation.
Endometriosis occurs when endometrial tissue, which lines the inside of the uterus, grows outside of the uterus. The tissue then gets ‘trapped’ in the pelvic area and lower abdomen and, in rare cases, in other areas in the body.
The exact cause of endometriosis is not clear. Experts have found some possible explanations, including retrograde menstruation, transformation of peritoneal cells into endometrial cells, embryonic cell transformation into endometrial cell implants during puberty, endometrial cells attaching to surgical incisions and implanting in the scar tissue, endometrial cells carried by blood or lymphatic fluid to other parts of the body and immune system disorders.
Certain risk factors also can put you at greater risk of developing endometriosis. Such risk factors include:
- never giving birth
- starting your period at an early age
- menopause at an older age
- short menstrual cycles
- higher levels of estrogen in the body
- low body mass index
- high alcohol intake
- one or more relatives with endometriosis
- any condition that prevents the normal passage of menstrual flow out of the body
- uterine abnormalities
Being a woman, it is important to know the signs and symptoms of endometriosis, so that timely diagnosis can be made and proper treatment planned.
Here are some of the signs and symptoms that mean you could have endometriosis.
1. Abdominal Pain
Abdominal pain is the most obvious symptom of endometriosis. Some women may experience chronic abdominal pain that never goes away.
The pain occurs as endometrial tissue bleeds outside the uterus, in places from which the blood can’t exit your body, leading to swelling and extreme pain. The abdominal pain is often accompanied by lower back or pelvic pain.
Usually, the pain gets particularly bad right before the period and typically lasts the duration of the period. However, the pain is different from normal period pain, and it can be bad enough that it is hard to stand up from the bed.
In severe cases, some women may develop blood-filled cysts, called endometriomas. If a cyst ruptures, the pain may be very extreme. This may require a visit to your doctor for help.
2. Pain During or After Intercourse
Pain associated with intercourse is another common symptom of endometriosis. This type of pain is typically felt deep inside the body. The pain can arise during sex or right after. It can last for several hours and even continue into the next day.
A 2013 study by the World Endometriosis Research Foundation analyzed survey responses from 931 females who had been treated for endometriosis regarding symptoms and their quality of life. Half of the participants stated that endometriosis had a profound impact on their relationships, 56 percent reported painful intercourse (dyspareunia), and 60 percent reported chronic pelvic pain.
As women have a difficult time talking about the issue with their partners or even doctors, the problem becomes more frustrating. This also prevents early diagnosis. Do not hesitate to talk with your doctor about pain related to intercourse.
3. Heavy or Irregular Menstrual Bleeding
Heavy bleeding, with or without clots, during menstruation is another common sign of endometriosis. When you get your period, the endometrial growths react to menstrual hormones from your ovaries just like the lining of uterus does, resulting in bleeding. As the endometrial growths get bigger over time, the bleeding also increases.
Along with heavy bleeding, irregular bleeding (with or without a regular cycle), bleeding or spotting between menstrual periods, bleeding longer than normal and bleeding before a period is due can also indicate endometriosis.
Many women tend to overlook heavy bleeding, but it is important to know that it can indicate other health issues along with endometriosis. So, if you experience heavy bleeding, consult your doctor immediately to determine if there’s an underlying cause.
4. Reduced Fertility
Suffering from endometriosis can make some women less fertile, and they might have trouble getting pregnant.
Scarring is the reason behind the reduced fertility rate. Scarring prevents movement of the egg from the ovary through the fallopian tube, as well as inhibiting the movement of sperm.
In some cases, the eggs in the ovaries can get damaged, resulting in decreased ovarian reserve and reduced egg quantity and quality.
Unfortunately, infertility in women due to endometriosis is usually resistant to treatment with ovarian stimulation as well as intrauterine insemination. If the pelvic anatomy is extensively distorted, artificial insemination is unlikely to be successful.
In such cases, in vitro fertilization may be needed to conceive.
This is another common but often ignored symptom of endometriosis. The exact reason for this extreme fatigue is still unknown but it is believed to be a result of the constant inflammation that occurs in this condition.
Plus, the chronic pain of endometriosis leads to mental exhaustion, tiredness and lack of energy. The whole frustration and stress of suffering from this condition also add to the feelings of exhaustion and a state of perpetual heaviness.
Chronic fatigue can be a debilitating aspect of the disease. To help cope with this problem, make sure you eat healthy and nutritious foods rich in protein and fiber to help increase your energy. Needless to say, take proper rest but also exercise consistently and moderately. You can also try yoga as a form of exercise as well as relaxation technique to help cope with endometriosis.
6. Bladder Problems
Endometriosis can also cause bladder problems. You may experience pain in the lower abdomen while urinating or during bowel movements, especially during your periods. You may also need to urinate more frequently or notice some other changes from your normal urinary habits. In rare cases, blood can be spotted in the urine.
Endometrial lesions on the bladder may cause frequent urination and feelings of bladder fullness. It causes you to feel like you have to use the bathroom all the time.
A 2012 study published in Urologia Internationalis reports that the bladder is the most common affected site in urinary tract endometriosis and is often diagnosed due to complaints of urinary symptoms during gynecologic follow-up procedures for a deep pelvic endometriosis.
Whatever the cause may be for frequent bathroom trips or other bladder problems, timely diagnosis is important for effective treatment.
7. Bowel Problems
Just like bladder issues, endometriosis can cause bowel problems, such as diarrhea, constipation or pain during bowel movements. There may also be bleeding from the bladder or bowel.
Increased abdominal bloating, with or without pain, at the time of the period is also common.
Endometrial lesions can invade the wall and inside of the bowel, resulting in bowel-related problems.
As these symptoms look similar to gastrointestinal problems or food intolerance, people often confuse endometriosis with irritable bowel syndrome (IBS). This can make a diagnosis more complicated.
8. Pain in Other Body Parts
Though rare, patches of endometriosis can occur in other sites of the body.
The endometrial tissue can be found in the arms, thighs and even the diaphragm. This can lead to pain in these parts of the body. Such pain occurs at the same time as period pains.
When the endometrial tissue occurs on the diaphragm, you can have terrible pain trying to breathe or move your upper arms or upper body during your period.
Such pain can also take a toll on your energy level, leading to tiredness.
Immediately see your doctor if you have some signs and symptoms that may indicate endometriosis.
Endometriosis can be difficult to diagnose. It is sometimes mistaken for other conditions like pelvic inflammatory disease (PID), ovarian cysts or IBS.
But it is important to properly diagnose and treat endometriosis, as it can lead to complications like impaired fertility and ovarian cancer. Early diagnosis may result in better treatment and management of your symptoms.
Expert Answers (Q&A)
Answered by Ms. Dr. Liza Colimon, MD (Obstetrician/Gynecologist)
What are the consequences of an untreated case of endometriosis?
Endometriosis is a noncancerous process. However short-and long-term consequences of the disease are caused by inflammation and the reaction inflammation creates within the body. Endometriosis can cause pain with periods (dysmenorrhea), pain during penetrative sex (dysparuenia), chronic pelvic pain and infertility. Less common symptoms are chronic fatigue, blood in the stool or urine, back pain, and pain with urinating or having a bowel movement.
Endometriosis in the ovary called an endometrioma, can lead to atypical cells forming in the ovary and slightly increase one’s risk for ovarian cancer. Endometriosis in the ovary can also replace and destroy the healthy ovarian tissue over time.
There is a type of endometriosis that forms solid masses or what doctors call “nodules”. This type of endometriosis is called “Deeply infiltrating endometriosis”. These nodules or masses require surgery to remove them. They can grow behind the vagina, in the vagina, bladder, retrosigmoid colon, on the ureters, and in other places in the abdomen.
Can a Pap smear test accurately diagnose endometriosis?
No. A Pap smear is meant for screening of cervical cancer only.
Can endometriosis lead to cancer?
Some medical studies have linked endometriomas- endometriosis in the ovary, to an overall increased risk of ovarian cancer (endometrioid, clear cell, and serious types). This increased risk appears low.
Can endometriosis lead to weight gain?
No, however, women may experience more bloating around the time of their menses.
What is the most effective treatment for endometriosis?
Laparoscopic surgery, which involves excision (cutting out) of the endometriosis, is the most effective treatment for endometriosis.
What are the chances of endometriosis to recur after surgery?
The growth of endometriosis depends on the estrogen in a woman’s body. Endometriomas recur in 50% of women within one year if medications such as birth control pills or Lupron are not used to suppress estrogen levels.
Surgical management alone is not sufficient. We recommend patients suppress future endometriosis implants from growing by taking oral contraceptive pills.
In severe, debilitating cases or if oral contraceptive pills are not tolerated, I’d suggest one considers Lupron with add-back hormonal therapy, Aygestin, which is a progesterone supplement, to minimize side effects.
Are endometriosis and ovarian cysts different conditions?
Yes. There are many types of ovarian cysts. However, an ovarian cyst containing endometriosis is called an endometrioma.
Can endometriosis affect fertility and pregnancy?
Endometriosis is a major risk factor causing infertility. The inflammatory reaction that occurs in the body can affect conception, which occurs in the fallopian tubes.
Endometriosis has also been associated with an increased risk of preeclampsia, cesarean delivery, and preterm birth.
In a national population-based cohort study of over 14,500 women followed over a 30-year time period, women with endometriosis had an increased risk of miscarriage, ectopic pregnancy, placenta previa, unexplained antepartum hemorrhage, postpartum hemorrhage, and preterm birth when compared with unaffected women.
Please provide some suggestions and tips for women with endometriosis on how to address their symptoms and cope with the condition.
Each case of endometriosis is different and patients will have unique presentations and symptoms. It is best not to assume. If you are suspicious you might have endometriosis, it is important to meet with your gynecologist and discuss your symptoms. Imaging studies such as a pelvic ultrasound or MRI will be ordered. Treatment may be offered, typically starting with birth control pills or non-steroidal anti-inflammatory drugs such as Motrin or Naproxen.
If symptoms persist, laparoscopic surgery is warranted to visually inspect the inside of your abdomen and pelvis and to take biopsies which will be used for definitive diagnosis of the condition. If endometriosis is found, it must be excised.
About Dr. Liza Colimon, MD: is the founder and Chief Executive Officer of Health Vows. She is a board certified Obstetrician/Gynecologist and a Clinical Instructor at Harvard Medical School. She is also a faculty member of the Department of Obstetrics and Gynecology in the Division of Urban Health at Brigham and Women’s Hospital.
Dr. Colimon has dedicated her expertise to serving in Boston’s neighborhoods and Community Health Centers to guarantee women have access to convenient, advanced gynecologic care and the full spectrum of gynecologic surgical services including laparoscopic and robotic surgery.