What is Endometriosis?
Endometriosis happens when the endometrium, the tissue that usually lines the inside of a woman’s uterus, grows outside it.
This tissue acts like regular uterine tissue does during your period: It will break apart and bleed at the end of the cycle. But this blood has nowhere to go. Surrounding areas may become inflamed or swollen. You might have scar tissue and lesions.
Endometriosis is most common on your ovaries.
Types of Endometriosis
There are three main types of endometriosis, based on where it is:
- Superficial peritoneal lesion. This is the most common kind. You have lesions on your peritoneum, a thin film that lines your pelvic cavity.
- Endometrioma (ovarian lesion). These dark, fluid-filled cysts, also called chocolate cysts, form deep in your ovaries. They don’t respond well to treatment and can damage healthy tissue.
- Deeply infiltrating endometriosis. This type grows under your peritoneum and can involve organs near your uterus, such as your bowels or bladder. About 1% to 5% of women with endometriosis have it.
You might not notice any symptoms. When you have them, they can include:
- Back pain during your period
- Severe menstrual cramps
- Pain when pooping or peeing, especially during your period
- Unusual or heavy bleeding during periods
- Blood in your stool or urine
- Diarrhea or constipation
- Painful sex
- Fatigue that won’t go away
- Trouble getting pregnant
Doctors don’t know exactly what causes endometriosis. Some experts think menstrual blood that contains endometrial cells may pass back through your fallopian tubes and into your pelvic cavity, where the cells stick to your organs. This is called retrograde menstruation.
Your genes could also play a role. If your mom or sister has endometriosis, you’re more likely to get it. Research shows that it tends to get worse from one generation to the next.
Some women with endometriosis also have immune system disorders. But doctors aren’t sure whether there’s a link.
Severe endometriosis pain can affect your quality of life. Some women struggle with anxiety or depression. Medical treatments and mental health care can help.
About 40% of women who have trouble getting pregnant have endometriosis. Researchers suspect that inflammation damages the sperm or egg or makes it harder for them to move. Or scar tissue might block your fallopian tubes. Surgery may boost your fertility.
Endometriosis may raise your risk of ovarian cancer or another cancer called endometriosis-associated adenocarcinoma.
Your doctor might suspect endometriosis based on your symptoms. To confirm it, they can do tests including:
- Pelvic exam. Your doctor might be able to feel cysts or scars behind your uterus.
- Imaging tests. An ultrasound, a CT scan, or an MRI can make detailed pictures of your organs.
- Laparoscopy. Your doctor makes a small cut in your belly and inserts a thin tube with a camera on the end (called a laparoscope). They can see where and how big lesions are. This is usually the only way to be totally certain that you have endometriosis.
- Biopsy. Your doctor takes a sample of tissue, often during a laparoscopy, and a specialist looks at it under a microscope to confirm the diagnosis.
Doctors use the American Society of Reproductive Medicine’s four stages of endometriosis:
- Stage I (minimal). You have a few small lesions but no scar tissue.
- Stage II (mild). There are more lesions but no scar tissue. Less than 2 inches of your abdomen are involved.
- Stage II (moderate). The lesions may be deep. You may have endometriomas and scar tissue around your ovaries or fallopian tubes.
- Stage IV (severe). There are many lesions and maybe large cysts in your ovaries. You may have scar tissue around your ovaries and fallopian tubes or between your uterus and the lower part of your intestines.
The stages don’t take pain or symptoms into account. For example, stage I endometriosis can cause severe pain, but a woman who has stage IV could have no symptoms at all.
There’s no cure for endometriosis. Treatments usually include surgery or medication. You might need to try different treatments to find what helps you feel better.
Pain medicine. Your doctor may recommend an over-the-counter pain reliever. Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil, Motrin) or naproxen (Aleve) work for many people. If these don’t relieve your pain, ask about other options.
Some other things you can do at home may help with pain:
- Take warm baths.
- Put a hot water bottle or heating pad on your belly.
- Exercise regularly.
Some women find that alternative therapies like acupuncture, diet changes, or homeopathy work for them. Before starting one, talk to your doctor to be sure it won’t interfere with another treatment.
Hormones. Hormonal therapy lowers the amount of estrogen your body creates and can stop your period. This helps lesions bleed less so you don’t have as much inflammation, scarring, and cyst formation. Common hormones include:
- Birth control pills, patches, and vaginal rings
- Gonadotropin-releasing hormone (Gn-RH) agonists and antagonists such as elagolix sodium (Orilissa) or leuprolide (Lupron)
- Progestin-only contraceptives
- Danazol (Danocrine)
Surgery. Your doctor might recommend surgery to take out as much of the affected tissue as possible. In some cases, surgery helps symptoms and can make you more likely to get pregnant. Your doctor might use a laparoscope or do a standard surgery that uses larger cuts. Pain sometimes comes back after surgery.