Endometriosis occurs when tissue similar to the uterine lining (called endometrium) grows outside of the uterus in areas including the ovaries, fallopian tubes, cervix, bladder and even the intestines. This excess tissue serves as an irritant to these structures, resulting in chronic pain and tissue scarring. Endometriosis tissue can also grow inside the ovary and form a cyst called an endometrioma, which may affect fertility. Learning to recognize endometriosis symptoms is the first step toward treatment.
Endometriosis Symptoms
Not all women with endometriosis experience the same symptoms, and often, endometriosis symptoms are attributed to other women’s health issues. However, excessive pain is not a normal symptom of menstruation and it’s important to address these chronic symptoms with a professional. For expert treatment, find a women’s health care provider at UMMS. Endometriosis symptoms include but are not limited to:
- Digestive or gastrointestinal issues
- Fatigue
- Heavy periods
- Infertility
- Pain during penetrative intercourse
- Pain with bowel movements or urination
- Painful periods
- Pelvic pain
Stages of Endometriosis
The American Society of Reproductive Medicine (ASRM) categorizes endometriosis into four stages from least to most invasive. ASRM uses these stages to indicate the number of endometrial lesions (also called implants) present in the body through a point system. Determining the stages of endometriosis is sometimes difficult and requires medical imaging or surgery.
- Stage 1 (1-5 points): Minimal with few superficial implants
- Stage 2 (6-15 points): Mild with more, deeper implants
- Stage 3 (16-40 points): Moderate with many deep implants and small cysts on one or both ovaries with filmy adhesions present
- Stage 4 (>40 points): Severe with many deep implants, large cysts and dense adhesions present
Who’s at Risk for Endometriosis?
- Endometriosis can occur in women of childbearing age, though it’s more common between ages 30 and 40. A woman may be at higher risk if she has:
- A family history of endometriosis
- A health problem that prevents a normal menstrual cycle
- Longer periods (seven or more days)
- Never had children
- Shorter menstrual cycles (fewer than 27 days)
How is Endometriosis Diagnosed?
The only way to formally diagnose endometriosis is through surgery. However, there are several methods health care providers use to investigate endometriosis symptoms:
- Physician consultation. Discussing endometriosis symptoms in detail with a health care provider is a critical component of diagnosis and treatment.
- Pelvic exam. Pelvic exams are a first step in exploring endometriosis systems to examine sensitive areas or swollen reproductive organs.
- Medical imaging. External ultrasounds performed outside the body or transvaginal ultrasounds, when an ultrasound wand is inserted inside the vagina, can determine the presence of ovarian cysts. More detailed imaging exams, such as CT scans or MRI, may be used as well.
- Laparoscopic surgery. This type of minimally invasive surgery is used to check for lesions and/or biopsy (sample) suspicious tissue.
Endometriosis Treatment
While endometriosis has no cure, treatment is focused on managing painful symptoms and potentially preserve fertility.
- Hormonal birth control. Forms of contraception, including the birth control pill, shot and intrauterine devices (IUDs) can help reduce bleeding and relieve or eliminate painful periods.
- Hormone therapy. This medication prevents the body from making the hormone responsible for ovulation and menstruation, effectively putting the body into a type of menopause to slow endometrial growths. Once you stop taking the medicine, your menstrual cycle returns, but you may have a better chance of getting pregnant.
- Mild pain medication. Over-the-counter pain medication such as ibuprofen or naproxen can help manage pelvic pain.
- Lifestyle changes. Modifying your diet, eliminating caffeine and alcohol, and maintaining a regular exercise regimen are all important parts of managing endometriosis symptoms. Some patients report success with alternative medicine such as acupuncture, supplements or chiropractic care.
- Surgery. In more advanced stages of endometriosis, surgery may be necessary to remove lesions, ease pain and improve fertility. A health care provider will discuss all surgical options with you. Learn more about surgical treatment available at University of Maryland Medical System.
Endometriosis and Fertility
ASRM reports that up to 30% to 50% of women with infertility issues have endometriosis. Experts aren’t sure exactly why endometriosis makes conception difficult. Below are some theories:
- Endometrial tissue may obstruct or change the shape of the reproductive organs including the ovaries and fallopian tubes.
- The endometrium lining in the uterus is often altered in endometriosis patients making embryo implantation difficult.
- Inflammation of the reproductive organs or excessive scar tissue may impact their functioning.
Again, there’s no cure for endometriosis but many of the same treatments that relieve endometriosis symptoms will also aid fertility. In vitro fertilization (IVF) therapy can be very effective in women with advanced endometriosis who want to conceive.
Why is it Important to Treat Endometriosis?
Aside from achieving a better quality of life, endometriosis treatment may reduce the risk of developing further health complications and reduce the symptoms caused by these conditions.
Some health issues related to endometriosis are:
- Autoimmune conditions. Certain autoimmune conditions, such as thyroid disease, are reported at higher rates in endometriosis patients.
- Breast and ovarian cancer. Researchers found an increased rate of these cancers in endometriosis, with data still emerging.
- Chronic fatigue. Aside from the physical reasons endometriosis patients may feel fatigue, the mental stress of constant discomfort or going without a diagnosis can be exhausting. Chronic fatigue may affect mental health and productivity.
