Endometriosis: Causes, Symptoms, Treatment

By Lizzie Duszynski-Goodman
September 28, 2021

For many women, discomfort while menstruating is common. But for others, the symptoms they experience, such as cramping and pelvic pain, may be severe or chronic and indicate a gynecological disorder called endometriosis.

What Is Endometriosis?

Endometriosis is a disease in which tissue from the endometrium (the lining of the uterus) migrates outside the uterus. Symptoms typically begin in adolescence and may include pelvic pain, painful periods and bleeding between periods. As many as 10% to 15% of women suffer from this disease during their reproductive years^[1]. Endometriosis is a chronic disease that can be managed through medication or surgery.

“As [endometrial tissue outside the uterus] builds up and breaks down over the course of a menstrual cycle, it causes a small amount of bleeding inside the pelvis,” says Lauren Sundheimer, M.D., a reproductive endocrinology and infertility specialist at CCRM Fertility in Newport Beach, California. This bleeding, she explains, may lead to severe cramping and pelvic, lower abdominal and back pain. Sometimes pelvic pain may even present as chronic and severe, occurring beyond the days of menstruation, adds Dr. Sundheimer.

Endometriosis can impact the quality of life, too, says Eric Surrey, M.D., a reproductive endocrinologist at CCRM Fertility in Lone Tree, Colorado. He explains that symptoms range from mild to debilitating, and many people suffering from this disease may struggle in their profession, academics or personal relationships as they take time to focus on their physical needs.

Causes of Endometriosis

While there’s no definitive cause of endometriosis, Dr. Sundheimer says there are several theories. One of the most common is the idea of retrograde menstruation, she says, which essentially means some menstrual blood flows backwards into the pelvis instead of exiting the body.

“In this case, the menstrual blood (that contains endometrial cells) that should normally flow out of the body travels back through the fallopian tubes and into the pelvis,” she says. “The endometrial cells then stick to the pelvic cavity where they build up and break down similarly to how they would in the uterus over the course of a menstrual cycle.”

Women who begin menstruating before they turn 11 and those who struggle with heavy or particularly long periods are at greater risk for developing this disease.

Symptoms of Endometriosis

Endometriosis can present the following symptoms, according to Natasha Spencer, M.D., an OB-GYN with Orlando Health Physician Associates in Orlando, Florida:

Painful periods
Painful sex
Chronic pelvic pain throughout the month
Infertility
Pelvic lesions
Ovarian mass

Additionally, endometriosis can be asymptomatic, and diagnosis can be complicated. “The only way to definitively make this diagnosis is to perform surgery,” says Dr. Surrey, referring to laparoscopy, a minimally invasive surgical procedure that, Dr. Sundheimer explains, looks for small lesions, scar tissue or cysts in the ovaries that indicate endometriosis. However, Dr. Surrey notes a combination of present symptoms and ultrasound imaging can help make a presumptive diagnosis and be enough to implement treatment.

Treatments for Endometriosis

While there’s not yet a cure for this disease, there are treatments available to address the pain and potential infertility associated with it. Depending on your age, symptom severity, disease severity and plans for your reproductive future, your doctor may discuss the following treatments with you:

Hormone therapy, such as oral contraceptives or progesterone, as it can influence hormone levels that impact the disease
Pain medication like nonsteroidal anti-inflammatory drugs (NSAIDs)
Surgical procedures to remove lesions or, in cases of severe disease, ovaries and fallopian tubes
In vitro fertilization (IVF) to assist in pregnancy

Unfortunately, none of these options promise long-term symptom relief and some women may find their pain or symptoms return after treatment. Endometriosis-related pain may recur following surgery, and symptoms may return once pain medication is ceased.

How Does Endometriosis Affect Pregnancy?

Women with endometriosis often find their symptoms drastically improve while pregnant, according to Dr. Spencer. However, she also notes the condition comes with increased risks during pregnancy, namely higher rates of preterm birth, preeclampsia and Cesarean sections—and that’s only if women can get pregnant in the first place.

Endometriosis is a “major cause of infertility,” says Dr. Surrey, citing that between 30% to 50% of women with this condition struggle to conceive^[2]. Infertility may be an issue even for women who don’t display additional symptoms, he adds.

Currently, there’s no clear consensus on why endometriosis impacts a woman’s chances of pregnancy, though there are theories. “Theories of infertility and endometriosis include tubal damage from inflammation and poor implantation due to inflammatory mediators within the uterus,” says Dr. Surrey. Still, the condition affects people differently, as some women with this condition have no trouble conceiving while others require fertility treatment.

When to See a Doctor

While there’s no cure for endometriosis, there are treatment options available to improve your symptoms and offer relief. “If someone is experiencing significant and debilitating pain, they should speak with their doctor,” says Dr. Sundheimer.

She adds that many women wait years before receiving a proper diagnosis and urges anyone concerned or struggling with symptoms to speak with a gynecologist or pelvic pain specialist. A physician can help determine a path forward and create a treatment plan that makes endometriosis more manageable.

Do you have endometriosis and struggling to conceive? Contact us today to make an appointment with a CCRM Fertility specialist.