If you suffer from extremely painful menstrual cramps that prevent you from taking part in everyday activities, or experience pain during or after sex, you might wonder whether you have endometriosis.

But what exactly is it, and what can be done about endometriosis symptoms?

What is Endometriosis?

Endometriosis occurs when endometrial tissue (the tissue lining the uterus) grows outside of the uterus. Endometrial-like tissue might be found on other organs such as the bladder, bowel, ovaries or fallopian tubes.

Endometriosis can cause significant pain and inflammation during the menstrual cycle.

It’s one of the most common gynaecological disorders, affecting around 1 in 10 people assigned female at birth. It is estimated that in the UK 1.5 millions individuals are living with the chronic gynaecological condition. It occurs across all races and ethnicities, at any point from the onset of periods until the menopause.

There are 4 different stages of endometriosis. They are categorized by the location, depth and amount of endometrial tissue found.

You can learn about these different stages in depth by reading our informative article Endometriosis Stages | 4 Critical Stages.

How serious is endometriosis?

Endometriosis is not considered a fatal illness; it can, however, have a significant impact on those who suffer from it and can negatively affect their quality of life and lead to various complications.

Some people with endometriosis do not experience any symptoms and do not even realize they have the condition. It might only be discovered during investigations for another condition. Others might experience symptoms that can range from mild to severe.

As with many chronic pain conditions, endometriosis can have emotional and psychological effects as well as physical symptoms. There’s an association between endometriosis and depression.

Women with endometriosis might find they need to take time off from school or work to manage their severe pain and debilitating symptoms, which can have negative consequences for academic work or for career progression.

If you believe you might have endometriosis, speak to a gynaecologist experienced in dealing with the condition. Unfortunately, endometriosis is frequently misdiagnosed for other conditions, such as irritable bowel syndrome (IBS) or pelvic inflammatory disease (PID). Symptoms are often dismissed by professionals who are not familiar with the condition.

Causes of endometriosis pain

The pain of endometriosis is caused by the body’s inflammatory response and the presence of endometrial tissue in other areas of the body, outside the lining of the uterus. The endometrial cells behave as they would do in the uterus: they thicken, break down and bleed with each menstrual period. However, as these cells are found outside of the uterus, in the pelvic region, there’s no way for the blood to leave the body, as it normally would.

Something known as ‘retrograde menstruation’ occurs when menstrual blood containing endometrial cells flows back through the fallopian tubes and out into the pelvic cavity. This could contribute to the development of endometriosis.

It causes inflammation in the pelvic area and can lead to the formation of adhesions, scar tissue and even ovarian cysts – all of which can cause severe pain during menstrual periods and even during bowel movements or sex.

Another potential cause of endometriosis is a problem with the immune system, where the body doesn’t recognize and destroy endometrial tissue growing outside of the uterus.

How do I know if I have endometriosis?

You might suspect you have endometriosis if you experience painful periods, chronic pelvic pain or painful bowel movements – particularly if your symptoms are interfering with your ability to enjoy normal everyday activities.

It’s important to discuss your symptoms in as much detail as possible with your doctor, as many of the symptoms of endometriosis can be similar to those of other medical conditions. There’s often a significant delay in diagnosing the condition because the reasons for the symptoms might not always be apparent. Before seeing your doctor, it might be helpful to keep a log or a diary of your symptoms, noting when they occur.

In order for your care provider to diagnose endometriosis, numerous tests and investigations will need to be performed.

A physical exam, blood tests, an internal examination and an ultrasound might be the first steps towards diagnosis, but these types of test are not conclusive for diagnosing the condition.

Related reading: Adenomyosis Vs Endometriosis | 5 Risk Factors.

How is endometriosis diagnosed?

Although the condition might be suspected because you have a number of the symptoms listed below, the only definitive way to diagnose endometriosis, is by a laparoscopy. This is a surgery performed under a general anaesthetic. A small entry hole is made in the abdomen and a tiny camera (laparoscope) is passed into the pelvic cavity to look at the reproductive organs and check for scar tissue and other signs of endometriosis.

Common endometriosis symptoms

Endometriosis symptoms can vary widely between individuals. Some women can experience severe symptoms, whereas others might have only mild symptoms or none at all.

Some common endometriosis symptoms are:

Pelvic pain in the lower back or tummy (usually worse during your period)
Severe period pains
Heavy periods
Painful sex (during or after)
Painful bowel movements during periods
A change in bowel symptoms or habits during your period
Fertility problems.

Uncommon endometriosis symptoms

There are also some lesser known symptoms of endometriosis. These symptoms might include:

Abnormal bleeding in between periods
Periods/bleeding lasting more than 7 days
Pain when peeing
Fatigue
Ovulation pain
Pelvic or Nerve pain during exercise
Depression.

Related reading: Adenomyosis | Why Heavy Periods Are Not Normal.

Endometriosis treatment options

Unfortunately, there’s no known cure for endometriosis, so endometriosis treatment focuses mainly on minimising and managing the symptoms.

Optimal treatment will depend on the severity of symptoms and the degree to which it affects your life. What is right for one person might not be right for the next. Discussing your symptoms with your doctor or specialist is the first step towards working out a treatment plan that is right for you. Your doctor will be able to discuss the best options with you.

Endometriosis treatment can be broken down into various categories:

Pain Medications

The most common symptom of endometriosis is pain; therefore, finding something to ease the discomfort is key.

Simple at-home remedies, such as a warm bath or heat packs, might be helpful to ease endometriosis pain.

Simple analgesia, such as Paracetamol or Tylenol, can help with mild pain but non-steroidal anti-inflammatory drugs (NSAIDs), such as Ibuprofen or Voltarol, are likely to work better. These medications block the body’s production of prostaglandins, which cause pain and inflammation. It’s thought that women with endometriosis produce more prostaglandins than those without the condition. NSAIDs are only effective if taken before the body starts producing prostaglandins, so it’s best to start taking them several days before the pain is expected.

There are other types of medication that could help manage your symptoms. Speak to your practitioner about what would work best for you.

Hormone therapy and reproductive medicine

It is known that endometriosis responds to hormone therapy, which means that endometrial-like tissue will grow in the presence of estrogen. That’s why hormone therapy, such as oral contraceptives (birth control pills), which work by blocking or reducing the production of estrogen, are a common treatment for this chronic disease.

The Mirena coil or progesterone therapy might also be suggested, as progesterone is thought to relieve symptoms of endometriosis by suppressing abnormal endometrial tissue growth.

Endometriosis surgery

For some women with severe endometriosis, surgery might be the best option. If symptoms are severe and affecting your day to day living, surgery is likely to be suggested.

The aim of surgery is to improve symptoms and relieve pain by removing the displaced tissue, adhesions and scar tissue from the pelvic cavity. This procedure will be performed using key hole surgery, while you’re asleep under general anaesthetic.

How to treat endometriosis naturally

To learn about more natural methods for treating endometriosis, read the article Endometriosis Treatment | What Are My Options? written by our resident Women’s Health and Reproductive specialist, Dr Andrew Orr.

Is it OK to leave endometriosis untreated?

Endometriosis left untreated can lead to further complications over time. Symptoms might not necessarily worsen but you could still be putting your health at risk.

Untreated endometriosis might lead to the following complications:

Chronic pain
Chronic fatigue
Irregular menstrual periods
Infertility or reduced fertility
Ectopic pregnancy
Painful sex
Urinary incontinence
Bowel obstruction
Damage to surrounding organs.

Related reading: Ectopic Pregnancy | Symptoms, Signs And Treatment.

To protect your general, sexual and reproductive health and to improve your quality of life, if you have painful symptoms or if you think you have the condition, it’s best to speak to your practitioner or specialist.

Can I prevent endometriosis?

There’s no known way to prevent endometriosis but some treatment options will focus on slowing or reducing further endometrial tissue growth.

Can I get pregnant with endometriosis?

It is possible to get pregnant if you have endometriosis; however, there is a known association between endometriosis and infertility. It’s estimated that infertility affects 30-50% of infertile women.

Women with endometriosis might have damage to the ovaries and fallopian tubes, which affects the way the egg is transported to the uterus. Scar tissue can cause blocked or restricted fallopian tubes, making it difficult for the egg to pass through. This increases the risk of ectopic pregnancy where a fertilized egg develops in the fallopian tube instead of the uterus.

Read more in our article What Is An Ectopic Pregnancy? | Discover the 6 Risk Factors.

A problem with the immune system might also make it difficult for an embryo to embed into the lining of the uterus, also increasing the risk of miscarriage and pregnancy loss.

Not all women with endometriosis will experience fertility problems. Some will be able to get pregnant without difficulty and others will become pregnant with the aid of fertility treatments.

Speak to your doctor if you have endometriosis and you’re planning a family, or if you’re having difficulties getting pregnant, even if you don’t have symptoms of endometriosis.

Some women only discover they have endometriosis after investigating fertility problems.