Endometriosis is a condition where tissue similar to the lining of your uterus grows on other parts of the body. When this tissue grows in the wrong places, it can cause experiencing uncomfortable symptoms that can impact the daily life. Some women with endometriosis also have difficulties getting pregnant.

The endometrium is the inner lining of your uterus. When you have a period, these layers fall away from the walls of your uterus and leave your body. If you get pregnant, the endometrium helps support the early phases of development.

When you have endometriosis, endometrial-like tissue grows on other organs or structures. This tissue can grow within your abdomen, pelvis or even chest. This tissue is hormonally sensitive and can become inflamed during your menstrual cycle. These areas of endometrial-like tissue can cause ovarian cysts, superficial lesions, deeper nodules, adhesions (tissue that connects your organs and binds them together) and scar tissue within your body.

A few places you can develop endometriosis include the:

  • Outside and back of your uterus.
  • Fallopian tubes.
  • Ovaries.
  • Vagina.
  • Peritoneum (the lining of your abdomen and pelvis).
  • Bladder and ureters.
  • Intestines.
  • Rectum.
  • Diaphragm (a muscle near the bottom of your chest that plays an important role in breathing).

Symptoms of Endometriosis

There are many symptoms connected with endometriosis. The main symptom is pain. This pain can be intense or mild. It can typically be felt in your abdomen, pelvic region and lower back. Although endometriosis is a common condition, not all people will experience symptoms. Sometimes, you can have endometriosis and not know until it’s found during another procedure or investigation of infertility.

People who do experience symptoms of endometriosis may have:

  • Very painful menstrual cramps
  • Abdominal pain or back pain during your period or in between periods
  • Pain during sex
  • Heavy bleeding during periods or spotting (light bleeding) between periods
  • Infertility (difficulty becoming pregnant)
  • Painful bowel movements

There’s no connection between the symptoms of endometriosis and the severity of the condition. Some people may have very few patches of endometriosis and still experience severe pain. Other people might have severe endometriosis, but not experience a great deal of pain.

Causes of Endometriosis

The cause of endometriosis is unknown. When you have endometriosis, tissue similar to the lining of your uterus grows in the wrong places. When it develops in places like the outside of your uterus, fallopian tubes, ovaries, intestine and within your pelvic cavity, it can cause painful symptoms. This pain is related to increased inflammation and often fibrosis and adhesions.

When endometrial-like tissue grows outside of your uterus, it can cause scar tissue (adhesions). These sections of scar tissue can fuse your organs — creating connections between them that normally wouldn’t be there. This can lead to discomfort and pain.

Diagnostics for Endometriosis

In many cases, an endometriosis diagnosis will start with your symptoms. Painful and heavy periods might cause you to reach out to your healthcare provider. Once at an appointment, your provider (typically an Ob-Gyn) may start by asking you for your personal medical history, about any previous pregnancies and if any other people in your family have endometriosis. Your provider may do a pelvic exam. If your healthcare provider needs more information they’ll likely perform pelvic imaging starting with an ultrasound. Depending on your symptoms, physical exam and ultrasound results, an MRI may also be ordered for further endometriosis mapping. A laparoscopy may be offered for both definitive diagnosis and treatment. It can be a useful way to confirm endometriosis because your surgeon doing the procedure can use a small camera (laparoscope) to look inside your body. A biopsy (small tissue sample) might be taken during this procedure. The biopsy will be sent to a lab to confirm the diagnosis.

Treatment of Endometriosis

Your healthcare provider will help create your treatment plan for endometriosis based on a few factors, including:

  • The severity of your endometriosis
  • Your plans for future pregnancies
  • Your age
  • The severity of your symptoms (often pain)

In many cases, your treatment plan will focus primarily on managing your pain and improving fertility issues (if you are planning on a future pregnancy). This can be done through medications and surgery.

Medications are often used to help control the symptoms of endometriosis. These can include pain medications and hormone therapies.

Hormonal options for suppressing endometriosis can include:

  • Birth control: There are multiple forms of hormonal suppression options including combination options using estrogen and progesterone or progesterone-only options. These come in multiple forms including oral birth control pills, patch, vaginal ring, birth control shot, Nexplanon implant or IUD. This hormonal treatment often helps people have lighter, less painful periods. These are not options for patients attempting pregnancy.
  • Gonadotropin-releasing hormone (GnRH) medications: This medication is actually used to stop the hormones that cause your menstrual cycle. This basically puts your reproductive system on hold as a way to relieve your pain. GnRH medications can be taken as an oral pill (by mouth), a shot or a nasal spray.
  • Danazol (Danocrine®): This is another form of hormonal medication that stops the production of the hormones that cause you to have a period. While taking this medication for endometriosis symptoms, you may have the occasional menstrual period, or they might stop entirely.

With all of these medications, it’s important to note that your symptoms can come back if you stop taking the medication. These medications aren’t recommended during pregnancy or if you are actively attempting to achieve pregnancy.

Medications for endometriosis pain relief can include:

  • Over-the-counter pain relief.
  • Non-steroidal anti-inflammatory drugs (NSAIDs).

In some cases, your provider might recommend surgery as a way to confirm and treat endometriosis. There are always risks to a surgical procedure. However, surgery for endometriosis can be an effective way to relieve pain and, in some cases, improve your fertility.

Endometriosis is considered a chronic disease. Many people experience relief from endometriosis pain after surgery, but the symptoms may return within a few years. The severity of your endometriosis could play a part in how quickly — if at all — it comes back after surgery. Your provider might suggest combining a surgical procedure with medications for the best outcome. Your provider may recommend pelvic floor physical therapy with or without medications for central nerve pain.

Surgical options to treat endometriosis include:

  • Laparoscopy: In this procedure, your surgeon will make a very small cut in your abdomen (< 1 centimeter) and insert a thin tube-like tool called a laparoscope into your body. This tool can be used to see inside your body and identify endometriosis with a high-definition camera. Additional 5-millimeter instruments can then be used to excise and remove lesions.
  • Hysterectomy: In severe cases, your surgeon may suggest removing your uterus based on the amount of endometriosis and scar tissue present, if you have other uterine conditions like adenomyosis and your desire for future fertility. If you have a hysterectomy, areas of endometriosis should still be excised to optimize your pain relief.

If you have endometriosis and are trying to achieve pregnancy, in vitro fertilization (IVF) may help you achieve this goal.