Painful periods. The most frequent presentation is that of painful menstruation. As the individual implants undergo changes during menstruation and bleed, they cause localized inflammation. During this reaction, chemicals released may induce the pain response.

Pain with urination and bowel movements. The symptoms can vary depending on where the endometriosis is located. For example, if it were located on or near the rectum, painful bowel movements can be felt. Patients can also experience pain during urination.

Pain during intercourse. Women often experience pain during or after sexual intercourse.

Heavy bleeding. The flow of the menstrual cycle can become heavier and there may be premenstrual spotting. There may also be bleeding between periods.

Infertility. Endometriosis can be diagnosed when women are seeking infertility treatments.

Other symptoms. Include bloating, nausea, fatigue, diarrhea, and constipation (especially during menstrual cycles).

The cause of endometriosis is still unknown. Some possible causes are:

Genetic predisposition. Some genes can be passed through family members to women making them more susceptible to developing endometriosis.

Retrograde menstruation. Occurs when menstrual blood that contains endometrial (lining) cells flows backwards through the fallopian tubes and into the pelvic cavity. These cells stick to the pelvic walls along the way, growing, thickening, and possibly bleeding over the menstrual cycle.

Lymphatic or circulatory spread. Occurs when endometrial cells travel around the body through the lymphatic system or in the bloodstream.

Environmental exposure. Research studies have shown that animals exposed to high levels of the toxin dioxin developed endometriosis.

Immune dysfunction. Many women with endometriosis have a suppressed immune system which suggests that they are unable to fight off the endometriosis.

Metaplasia. This occurs when a cell changes into a different type of cell in response to inflammation.

Surgical scar implantation. A surgery may leave endometrial cells attached to a surgical incision after a hysterectomy or C-section.

Transformation of peritoneal cells (metaplasia). These cells line the cells of the inner abdomen. Some theorists propose that the peritoneal cells are changed into endometrial cells in response to inflammation or auto-immune factors.

• History of infertility
• Abnormal or heavy bleeding
• Dysmenorrhea (irregular periods)
• Early menarche (age at first period)
• Prolonged menstrual flow
• Pelvic pain
• Family history of endometriosis
• Low body weight
• Late menopause
• Never giving birth
• High levels of exposure to estrogen for a longer period of time
• Age
• Alcohol use
• Smoking
• Low physical activity

The initial step in reaching a diagnosis is to perform a pelvic ultrasound. This is an imaging study done at the bedside that allows internal structures to be seen. The different implants can be observed along with any scar tissue that may have formed. To confirm the diagnosis of endometriosis a laparoscopy is performed. Laparoscopy is a minimally invasive surgical procedure that serves a dual purpose: to diagnose and to treat. Through small incisions on the lower abdomen, tubes equipped with a light source and cameras are passed inside to allow for better visualization. Depending on the location of the lesions and other factors, the endometriosis is staged from one to four. The stage identifies the severity of the disease and its extent.

To alleviate pain, non-steroidal anti-inflammatory drugs (also known as NSAIDs) are used. Hormonal therapies such as oral contraceptive pills (OCPs) are also used for pain reduction. OCPs can prevent menstruation if taken continuously and this can help to reduce the size of the lesions or eliminate them. Surgical options are available and vary depending on whether or not the woman wants to try to conceive. Laparoscopy is used to remove the implants along with scar tissue, and this is typically done when laparoscopy is performed for diagnostic purposes. If a woman does not wish to conceive, she can have her uterus and other affected reproductive tract organs removed.

If you are experiencing pain during sex, heavy or abnormal periods, and/or pelvic pain, make an appointment to see your doctor right away. Consult with your doctor about any alternative supplements or remedies you are using at home to make sure they are safe for you to use.

Herbal products. Turmeric is a powerful anti-inflammatory herb that has been shown in research to inhibit the growth of endometrial cells by reducing the production of the hormone estradiol (promotes endometrial cell growth). Chamomile, peppermint, and lavender are also beneficial herbs that help reduce menstrual cramps and relax the body and mind. Ginger tea is a wonderful remedy for nausea associated with endometriosis. You can use fresh ginger sliced in a cup of boiling water or tea bags.

Acupuncture. This form of treatment can be used to help with pain associated with endometriosis. Electroacupuncuture is a new acupuncture therapy that gives the body a trace current of electricity at acupoints. It has been effectively used to treat pain and symptoms of dysmenorrhea.

Heat. Using warm baths, heating pads, or hot water bottles can give you pain relieve and relax your pelvic muscles.

Diet. Increasing intake of omega-3 fatty acids (found in foods like salmon, tuna, flaxseed) may help reduce inflammation. Decrease your intake of trans fats. A study from 2010 showed a near 50% increased risk of endometriosis in women who ate a high amount of trans fats. Avoid highly processed foods and refined sugars. Eat natural fruits and vegetables instead.

Massage. Gently massage your pelvic muscles before you start your period, but not during. A gentle massage may help to reduce inflammation and relax the pelvic region, especially if you use a few drops of lavender oil in a carrier oil.

Endometriosis may lead to risks of ectopic pregnancy (a pregnancy that develops outside of the uterus) and/or infertility. These complications are due to the scarring that results from the constant inflammation, which distorts the normal anatomy of the reproductive tract. Scar tissue can block sperm from reaching the ovum for fertilization resulting in infertility or it can prevent an already fertilized ovum from entering its normal place in the uterus, causing it to develop elsewhere (most commonly in the fallopian tube) which is termed an ectopic pregnancy. These pregnancies rarely survive and can be hazardous to the mother due to rupture and bleeding of the organ housing the developing embryo. Another common complication that can develop is called an endometrioma. This is a fluid containing structure that forms on an ovary that contains an endometriotic lesion. This structure can lead to pain and/or infertility and often requires surgical removal of the affected ovary.

Endometriosis affects 10-15% of all women who are of reproductive age and 70% of all women who suffer from chronic pelvic pain. Many women experience a delay in diagnosis for several years, with an average delay of at least 6.5 years. Clinical trials are available for women that help treat the symptoms, but further research the underlying causes of the disease. If you are interested in these clinical trials go here for further information.

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National Endometriosis Society. (2012, March). Understanding endometriosis. Retrieved from endometriosis uk: https://www.endometriosis-uk.org/sites/default/files/files/Information/Understanding-endometriosis.pdf

Mayo Clinic Staff. (2019, May 16). Endometriosis. Retrieved from Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/endometriosis/symptoms-causes/syc-20354656#:~:text=Endometriosis%20(en%2Ddoe%2Dme,the%20tissue%20lining%20your%20pelvis

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Peterson, C. P., et. al. (2013, February 27). Risk factors associated with endometriosis: importance of study population for characterizing disease in the ENDO Study. American Journal of Obstetrics and Gynecology, 208(6). Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4114145/

Schrager, S., Falleroni, J., & Edgoose, J. Evaluation and treatment of endometriosis. Retrieved from American Academy of Family Physicians: https://www.aafp.org/afp/2013/0115/afp20130115p107.pdf