Endometriosis – Symptoms and Causes

ByJanis Updated

Overview

Endometriosis is a health condition where tissue similar to the uterine lining grows outside the uterus. This misplaced tissue commonly develops in the pelvic region, affecting organs like the ovaries and fallopian tubes.

It can also involve nearby structures such as the bowel and bladder. During menstrual cycles, this tissue responds to hormones just like normal uterine lining would.

However, because it’s growing in the wrong location, it can cause significant pain and other symptoms. The displaced tissue can irritate surrounding areas, leading to scarring and adhesions (sticky fibers that bind tissues together).

Common locations of endometriosis tissue:

  • Ovaries and fallopian tubes
  • Pelvic tissue lining
  • Bowel and bladder
  • Rarely, areas beyond the pelvis

When endometriosis affects the ovaries, it may create cysts called endometriomas. The condition can lead to inflammation in nearby tissues, which may result in scar tissue and adhesions that cause pelvic organs to stick together.

Risk factors that may increase the chance of developing endometriosis include:

  • Never giving birth
  • Short menstrual cycles (less than 28 days)
  • Heavy, prolonged periods lasting over 7 days
  • Higher estrogen levels
  • Low body mass index
  • Structural issues with reproductive organs
  • Family history of endometriosis
  • Early start of menstruation
  • Later onset of menopause

The most common symptom is pelvic pain that exceeds normal menstrual cramping. Normal cramping shouldn’t force someone to miss school, work, or daily activities.

Other symptoms include cramps before and after periods, lower back or abdominal pain, and pain during intercourse, bowel movements, or urination.

Many people with endometriosis also experience:

  • Fatigue
  • Constipation
  • Bloating
  • Nausea (especially during periods)
  • Fertility problems

Doctors diagnose endometriosis through several steps. They’ll first discuss symptoms and perform a pelvic exam. Imaging tests like ultrasounds or MRIs help visualize the reproductive organs.

A definitive diagnosis typically requires surgery, usually laparoscopy. A surgeon uses a camera through a small incision to find and remove suspicious tissue for testing.

Treatment approaches vary depending on symptom severity. Initial management often involves:

  1. Pain medications to control discomfort.
  2. Hormone therapy (like birth control pills) to regulate estrogen and progesterone.
  3. Surgical removal of endometriosis tissue when other treatments fail and quality of life is significantly affected.

Living with endometriosis can be challenging due to chronic pain and potential fertility issues. Many people find joining support groups helpful for connecting with others who understand their experiences.

Signs and Symptoms

Pelvic pain is the main symptom of endometriosis. This pain often happens during menstrual periods.

While many people feel cramps during periods, those with endometriosis typically experience much more severe pain. This pain may worsen as time passes.

Common endometriosis symptoms include:

  • Period pain: Pelvic pain and cramping might begin before your period and continue for several days. Lower back and abdominal pain may also occur. This condition is sometimes called dysmenorrhea.

  • Pain during intimacy: Discomfort during or after sexual activity is frequently reported.

  • Bathroom discomfort: Pain during bowel movements or urination, especially around your period.

  • Heavy bleeding: Some people experience heavier-than-normal periods or bleeding between periods.

  • Fertility problems: For some, endometriosis is discovered during fertility testing.

  • Other issues: Tiredness, digestive problems (diarrhea, constipation), bloating, and nausea can occur, especially around your period.

The severity of pain doesn’t always match the extent of endometriosis in your body. You might have small areas of endometriosis tissue but severe pain, or extensive tissue with little to no pain.

Some people with endometriosis have no symptoms at all. They may learn about their condition when facing fertility challenges or during surgery for something else.

Endometriosis may be mistaken for other conditions that cause pelvic pain, like pelvic inflammatory disease, ovarian cysts, or irritable bowel syndrome (IBS). Sometimes, a person may have both endometriosis and IBS, making diagnosis more complex.

When to Contact a Healthcare Provider

If you think you might have endometriosis symptoms, make an appointment with a healthcare provider. Early diagnosis and treatment can make a big difference in managing this condition.

Managing endometriosis can be challenging. You’ll have better results if:

  • Your condition is diagnosed early
  • You learn about endometriosis and treatment options
  • You work with specialized healthcare providers, if needed

What Causes Endometriosis?

Endometriosis develops when tissue similar to the uterine lining grows outside the uterus. While doctors don’t fully understand why this happens, several theories help explain this condition.

Backward Menstrual Flow

One major theory suggests that during menstruation, some blood flows backward through the fallopian tubes into the pelvic area.

This blood contains uterine lining cells that can attach to pelvic organs, grow, and bleed during monthly cycles.

Cell Transformation

Several types of cell changes may contribute to endometriosis:

  • Peritoneal cells (cells lining the abdomen) may transform into endometrial-like cells due to hormones or immune factors
  • Early developmental cells may change into endometrial tissue during puberty when exposed to estrogen
  • Immune system problems might prevent the body from recognizing and removing misplaced endometrial tissue

Transport of Endometrial Cells

Endometrial cells can travel to unusual locations through:

  • Blood vessels carrying cells to distant body parts
  • The lymphatic system moves cells throughout the body
  • Surgical procedures where cells attach to incision sites (particularly C-section scars)

These theories may explain why endometriosis appears in different locations and varies in severity between individuals. Research continues to improve our understanding of this complex condition.

Risk Factors

Several factors may increase your chances of developing endometriosis:

  • Reproductive history: Women who have never given birth face a higher risk.
  • Menstrual patterns: Early onset of periods, late menopause, or cycles shorter than 27 days.
  • Menstrual characteristics: Heavy bleeding or periods lasting more than one week.
  • Hormonal factors: Higher estrogen levels or greater lifetime exposure to natural estrogens.
  • Physical attributes: Lower body mass index.

Having a close relative with endometriosis, such as a mother, sister, or aunt, increases your risk.

Medical conditions that block menstrual blood flow can contribute to endometriosis development. Various reproductive tract disorders may also raise risk levels.

The timing of symptoms often appears years after menstruation begins. Pregnancy has the potential to temporarily alleviate symptoms. For many women, pain decreases during menopause unless they use estrogen therapy.

Complications

Endometriosis can lead to several health issues beyond the typical symptoms. These complications can impact quality of life and future health planning.

Infertility

Difficulty conceiving represents one of the most common complications of endometriosis, affecting up to 50% of people with this condition.

The reproductive process involves several key steps: an egg is released from the ovary, travels through the fallopian tube, is fertilized by sperm, and then attaches to the uterine wall. Endometriosis can disrupt this process in several ways:

  • Physical blockages in the fallopian tubes
  • Damage to eggs or sperm
  • Changes to the reproductive environment

People with mild to moderate endometriosis can still become pregnant naturally. Healthcare providers often advise against delaying pregnancy plans for those with endometriosis who wish to have children, as the condition may worsen over time.

Cancer

The relationship between endometriosis and cancer involves some increased risks, though these remain relatively small.

Research indicates a slightly elevated risk of ovarian cancer in people with endometriosis. However, it’s important to understand that:

  • The baseline lifetime risk of ovarian cancer is already quite low
  • The increased risk with endometriosis still results in a relatively low overall chance
  • Regular monitoring can help detect any changes early

A rare cancer called endometriosis-associated adenocarcinoma can develop later in life in those who previously had endometriosis.

This uncommon complication typically occurs years after the initial endometriosis diagnosis.


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Health Writer

Janis's areas of expertise include nutrition, exercise, stress management, and mental health. She is passionate about educating and empowering people to take control of their health and make positive changes that can last a lifetime. Janis believes that small, sustainable changes are the key to long-term success, and she works with her clients to develop personalized plans that fit their individual needs and lifestyles.