National Endometriosis Awareness Month

Woman with abdomen pain

Endometriosis: What You Need to Know

Endometriosis may affect more than 11% of American women between 15 and 44 years of age, or roughly 6.5 million U.S. women. According to research, endometriosis affects an estimated 1 in 10 U.S. women.

While women of any age who still experience monthly menstruation are susceptible, endometriosis is especially common among women of reproductive age who are in their 30s and 40s, making it more difficult for those wishing to conceive.

Endometriosis can take 7 to 10 years to diagnose, due to lack of noninvasive diagnostic tests. For those women wanting to become pregnant, it’s especially important to be vigilant about endometriosis symptoms and voice concerns or questions to their OB/GYN so their desired pregnancy goals become reality.

March is designated as National Endometriosis Awareness Month. Your local Capital Women’s Care team of women’s health professionals shares valuable information concerning endometriosis and its possible causes; symptoms and known risk factors; diagnosis and treatment options, including research and trials currently showing promise; plus reducing your personal risk factors, especially should you wish to become pregnant.

What Is Endometriosis?

According to the Office on Women’s Health (OWH), endometriosis occurs when similar tissue to the uterine lining grows outside the uterus and in other areas within a woman’s body. It most often occurs on the:

  • ovaries
  • fallopian tubes
  • tissues holding the uterus in place
  • or outer uterine surface.

Other sites for endometrial growths include the vagina, cervix, vulva, bowel, bladder or rectum. Endometriosis rarely appears in other areas of the body (like the lungs, brain and skin.)

Possible Causes of Endometriosis

Although exact cause of endometriosis isn’t known, some possible explanations include:

  • Retrograde menstruation. Menstrual blood containing endometrial cells flows back through the fallopian tubes and into the pelvic cavity instead of exiting the body. These endometrial cells adhere to pelvic walls and pelvic organ surfaces, where they grow and continue to thicken and bleed over the course of each menstrual cycle.

  • Transformation of peritoneal cells. Experts propose hormones or immune factors promote transformation of peritoneal cells (the cells lining the inner side of the abdomen) into endometrial-like cells.

  • Embryonic cell transformation. Hormones like estrogen may transform embryonic cells (cells in earliest developmental stages) into endometrial-like cell implants during puberty.

  • Surgical scar implantation. After a surgery, like a hysterectomy or C-section, endometrial cells may attach to a surgical incision.

  • Endometrial cell transport. The blood vessels or tissue fluid (lymphatic) system may transport endometrial cells to other areas of the body.

  • Immune system disorder. An immune system issue may make the body unable to recognize and destroy endometrial-like tissue growing outside the uterus.

Endometriosis Symptoms

Symptoms can include:

  • Pain, the most common symptom. Women with endometriosis may have differing pain, including:

    - very painful menstrual cramps, with worsening pain over time.

    - chronic (long-term) lower back and pelvic pain.

    - pain during or after sex. This is usually described as a "deep" pain and is different from pain felt when penetration begins.

    - intestinal pain.

    - painful bowel movements or pain when urinating during menstrual periods. In rare instances, blood in the stool or urine may present.

  • Bleeding or spotting between menstrual periods. If it happens often, you should see your doctor, as it may not be due to endometriosis.

  • Infertility (not being able to conceive.)

  • Stomach (digestive) problems, including diarrhea, constipation, bloating, or nausea, especially during menstrual periods.

  • Fatigue or lack of energy. Experiencing overall lethargy is another symptom to alert your practitioner, especially if it’s in combination with other symptoms.

If you notice any of these symptoms, contact your Capital Women’s Care practitioner and schedule a checkup.

While endometrial growths are benign (non-cancerous), they still cause several health issues in those diagnosed. The growths may swell and bleed in the same manner the uterine lining does each month during the menstrual cycle. Swelling and pain result, as the tissue continues to grow and bleed within the body, causing problems like:

  • blocking fallopian tubes when growths cover or grow into the ovaries. The trapped blood within the ovaries can then form cysts (known as endometriomas).

  • inflammation (swelling.)

  • forming scar tissue and adhesions, a tissue that can bind organs. This scar tissue may cause pelvic pain, making it difficult for conception to occur.

  • and problems within the intestines and bladder.

Endometriosis Risk Factors

You might be more prone to endometriosis if you have:

  • never had children.
  • menstrual periods lasting longer than 7 days.
  • started periods at an early age (age 11 years or younger.)
  • short menstrual cycles (27 days or fewer.)
  • higher estrogen levels within your body or greater lifetime exposure to the estrogen your body produces.
  • a low Body Mass Index (BMI).
  • previous invasive abdominal surgeries.
  • a family member (mother, aunt and/or sister) diagnosed with endometriosis.
  • gone through menopause at a later age.
  • reproductive tract disorders.
  • a health issue that blocks normal flow of menstrual blood from your body during your period.

Diagnosis and Treatment

Surgery is the only way to diagnose endometriosis. Your Capital Women’s Care practitioner will ask about your symptoms and medical history. A pelvic exam and some imaging tests can determine if you need laparoscopy to confirm diagnosis. This is a type of surgery that uses a laparoscope, a thin tube with a camera and light. The surgeon inserts the laparoscope through a small skin cut. Your practitioner can then determine diagnosis based on the appearance of endometriosis patches and perform a biopsy if necessary.

There is no known cure for endometriosis, but there are treatments for managing its symptoms. Your Capital Women’s Care practitioner will work with you to determine best treatment options for you.

Treatments for endometriosis pain include:

  • Pain relievers, including nonsteroidal anti-inflammatory drugs (NSAIDS) like ibuprofen and prescription medicine specific to treating endometriosis.

  • Hormone therapy, including birth control pills, progestin therapy, and gonadotropin-releasing hormone (GnRH) agonists. GnRH agonists cause a temporary menopause, but also help control endometriosis growth.

  • Surgical treatments for severe pain, including procedures to remove endometriosis patches or cut some pelvic nerves in the pelvis. The surgery can vary depending on the severity of your pain, from laparoscopy to major surgery.

Treatments for infertility caused by endometriosis include:

The main complication of endometriosis is impaired fertility. Approximately 33% to 50% of women diagnosed with endometriosis have difficulty becoming pregnant.

Ovarian cancer does occur at higher-than-expected rates in those women diagnosed with endometriosis; however, their overall lifetime risk is considered low.

Although rare, endometriosis-associated adenocarcinoma can develop later in life in those diagnosed with endometriosis.

Lowering Your Risk

You can reduce your chance of developing endometriosis by lowering your body’s estrogen levels. Estrogen is a hormone that also helps thicken uterine lining during a woman’s menstrual cycle.

To maintain lower estrogen levels within your body, you can:

  • talk to your doctor about hormonal birth control methods, such as pills, patches or rings with lower estrogen doses.
  • exercise regularly (more than 4 hours a week). This will also help you keep a low percentage of body fat. Regular exercise and a lower amount of body fat help decrease the amount of estrogen circulating through your body.
  • avoid large amounts of alcohol. Alcohol raises estrogen levels. No more than 1 drink per day is recommended for women choosing to drink alcohol.
  • and eliminate many caffeinated beverages. Studies show drinking more than 1 caffeinated beverage a day (especially sodas and green tea) can raise estrogen levels.

New Research

Researchers continue to prioritize the quest for new endometriosis pain and symptom management medications, treatments and diagnosis strategies:

  • Upcoming pain and symptom management. In 2018, the first oral gnRH agonist was approved by the Federal Drug Administration (FDA.) Others are currently being studied in clinical trials to treat endometrial pain.

    Another oral medication is currently approved to treat heavy menstrual bleeding in those with uterine fibroids. In 2021, the manufacturers applied for approval to treat this symptom in endometriosis as well.

    Another clinical trial is underway to assess the use of dichloroacetate (DCA) for treating endometriosis. DCA is currently used to treat metabolic disorders in children.

    Preliminary data shows that DCA could help stop the growth and survival of endometriosis cells and reduce lactate production in the pelvis, which women with endometriosis are thought to have more of compared to women not diagnosed with endometriosis.

    A 2020 study found 59% of women who reported using cannabis for endometriosis relief were able to stop relying on pain medications, including opioids.

  • Pelvic floor physical therapy. This is increasing in popularity among those with endometriosis. Research from a 2021 study found regular pelvic floor physical therapy can help reduce endometriosis symptoms like painful sex and pelvic pain plus improve pelvic relaxation in women diagnosed.

  • Surgery. The Endometriosis Foundation of America considers laparoscopic excision surgery to be the gold standard for surgical treatment of the condition and to confirm a formal diagnosis. The goal of the surgery as treatment is to remove endometrial lesions while preserving healthy tissue.

    A 2018 study involving more than 4,000 participants found laparoscopic excision surgery was also effective at treating pelvic pain and bowel-related symptoms of endometriosis.

    A clinical trial underway in the Netherlands aims to make surgery even more effective.

  • Testing. In 2018, scientists with the Feinstein Institute of Medical Research published a study suggesting tests on menstrual blood samples may provide a viable, noninvasive method of diagnosing endometriosis.

  • Reprogramming cells. In a 2018 study from Northwestern Medicine, researchers discovered that induced human pluripotent stem (iPS) cells can be “reprogrammed” to transform into healthy, replacement uterine cells. This means that uterine cells causing pain or inflammation can be replaced with healthy cells.

  • Gene therapies. Scientists at Yale University published a study In 2018 that found that the microRNA Let-7b, a genetic precursor that controls gene expressions, is repressed in women with endometriosis.

    Another 2021 study found DNA variations in the gene that produces the protein neuropeptide S receptor 1 (NPSR1) occur more often in women with endometriosis compared to those without the condition. NPSR1 is thought to play a role in endometriosis-related inflammation.

    If gene therapy does prove effective in humans, it could be a nonsurgical, noninvasive, and nonhormonal way to treat endometriosis.

While there’s no cure for endometriosis, available treatment options can help alleviate symptoms. Placing continued emphasis on prioritizing research and findings, treatment options and management of endometriosis, scientists are discovering more options for helping those women diagnosed.

Your Capital Women’s Care team of seasoned, compassionate women’s health care providers is here to address your questions and concerns relating to endometriosis and any women’s health issue. Our premier group of doctors, nurses and support staff prioritize comprehensive care and treatment to optimize your health and wellbeing, so you enjoy a long quality life.


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The providers of Capital Women's Care seek the highest quality medical and ethical standard in an environment that nurtures the spirit of caring for every woman.


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