Endometriosis: What Every Woman Should Know

Last month was Endometriosis Awareness Month, which shines a light on a chronic and painful condition that affects an estimated one in 10 American women of reproductive age. The disorder can devastate women’s physical and emotional well-being, quality of life, and reproductive health.  

Dr. Alison Baker, a board-certified physician in obstetrics and gynecology with Lee Physician Group, Obstetrics and Gynecology, explains more about this condition, what symptoms to look for, and potential treatment options women can discuss with their healthcare providers.

What is endometriosis?

Endometriosis occurs when the endometrium, the tissue that normally lines the inside of the uterus, grows outside the uterus on other organs, such as the fallopian tubes, bowel, and ovaries. The misplaced tissue behaves just like the endometrial lining, thickening, breaking down and bleeding with each menstrual cycle, according to Dr. Baker.

“However, unlike the tissue lining the uterus, which is expelled during menstruation, this displaced tissue has no way to exit the body,” Dr. Baker explains. “It can lead to internal bleeding, inflammation, scarring, and painful cysts. Also, it can lead to the buildup of fibrous tissues between reproductive organs, causing them to adhere (stick) together (adhesions).” 

Common symptoms

Pain is a primary symptom of endometriosis. Types of pain vary in women with endometriosis but can include:

• Menstrual cramps
• Chronic (long-term) pain in the lower back and pelvis
• Pain during or after sex
• Intestinal pain
• Painful bowel movements or pain when urinating during menstrual periods 
• Bleeding or spotting between menstrual periods
• Abnormal or heavy menstrual flow
• Infertility (difficulty with getting pregnant)
• Stomach (digestive) problems, such as diarrhea, constipation, bloating, or nausea, especially during menstrual periods

Source: Womenshealth.gov

“Painful periods are the most common symptom of endometriosis. Pelvic pain may start before periods and extend several days into the period,” Dr. Baker notes. “But it’s also important to be aware that pelvic pain during ovulation or menstruation sometimes happens to healthy patients, too. Also, women with endometriosis may not have pelvic pain or only mild discomfort. They will often learn of their condition because of fertility challenges or when they’re having surgery for something else.”

Dr. Baker adds that the symptoms of endometriosis will depend on the areas it invades. “More gastrointestinal (GI) symptoms are seen with bowel invasion, and more urinary symptoms typically occur with bladder invasion.”

Risk factors for endometriosis

Any girl or woman who has menstrual periods can develop endometriosis. But the disorder is mostly diagnosed in women 30 to 40 years of age, Dr. Baker says. 

“Research shows that risk factors for endometriosis include having a family history of the condition, starting menstruation at an early age, having heavy menstrual periods that last more than seven days, and having defects in your uterus or fallopian tubes.

“The exact cause of endometriosis isn’t known, but research suggests a family history of the disease is a leading risk for developing it,” Dr. Baker says. “If any woman in your family has endometriosis, you should talk with your doctor about your risk.”

Diagnosis and treatment

Imaging tests like ultrasound, computed tomography (CT), or magnetic resonance imaging (MRI) can identify cysts associated with endometriosis. Also, special techniques employed during ultrasound can show evidence of endometriosis. However, not all facilities can accomplish these specialized imaging techniques. 

“Imaging modalities may not be able to provide a definitive diagnosis,” Dr. Baker says. “Definitive diagnosis comes from surgery, during which endometriosis can be excised (removed).  So, not only is surgery diagnostic, but it can also be therapeutic.”

Unfortunately, endometriosis has no cure, but there are treatments to help manage the symptoms. Dr. Baker says treatment options depend on factors like the severity of your symptoms and if you have plans for future pregnancies.

Common nonmedical treatments for endometriosis are hormone therapy and pain management. When pain is the primary problem, medication typically is tried first, Dr. Baker notes. Finding the right treatment depends on many factors, including age and symptoms.

• Pain medication: Over-the-counter anti-inflammatories or prescription medications can help manage pelvic pain.
• Hormone therapy: Supplemental hormones like birth control pills, patches, or rings can regulate the menstrual cycle and shrink endometriosis growth. Also, progestin-only medications, including the hormonal intrauterine device (IUD), release progestin into the uterus.
• Gonadotropin-releasing hormone (GnRH) agonists).  These drugs create a temporary and reversible postmenopausal state to shrink endometriosis growth and pain but can only be taken for short periods.
• GnRH antagonists: These drugs also can create a temporary postmenopausal state with less side effects than GnRH agonists. These drugs sometimes are combined with hormonal medication for a synergistic effect. 

Patients with advanced endometriosis pain who fail to respond to hormone or medication therapy may benefit from laparoscopic surgery. The procedure can remove endometrial growths and scar tissue, although both often will recur over time.

In severe cases of endometriosis, when pain remains after medical treatment, surgical management may be an option. 

“The goal of endometriosis surgery is complete excision of all endometriosis lesions,” Dr. Baker explains. “This may require a hysterectomy, with removal of one or both ovaries and excision of lesions from other organs, such as the bowel, bladder or diaphragm.” 

Dr. Baker says the most effective approach uses a combination of medical therapy and conservative surgery tailored to each patient's specific needs and life plan. 

If you experience severe menstrual cramps, heavy periods, pelvic pain, or fertility issues, see your gynecologist. Identifying and treating endometriosis early can relieve symptoms and improve your quality of life.

Women's Health Services & Specialties

Lee Health Women’s Health offers a wide range of women’s health services, including obstetrics and gynecology, maternity services, and breast care with compassionate care and personalized treatment options.

For appointments with a Women's Health Provider, call 239-481-4111. For screenings and other imaging services, call 239-349-3182.