Endometriosis 101: what to know about the uterine condition

woman in pain from endometriosis

Endometriosis is a condition that affects 10% of women. And, of those who have it, 1 in 4 don’t realize it.

That lack of a diagnosis can cause problems, says Dr. Edwin Thorpe, medical director at BlueCross BlueShield of Tennessee, especially when it comes to preventing pain and infertility. Here’s what you need to know.

What is endometriosis?

Dr. Thorpe: Endometriosis is a complex condition in which the tissue that normally lines the uterine cavity (the endometrium) implants and grows outside of the uterus.

While endometriosis tissue grows in other places (abdomen, ovaries, bowels, pelvis), it behaves the same way it would in the uterus with each menstrual cycle – thickening, breaking down and bleeding. Because these are very different and delicate organs and surfaces, they become inflamed, which translates into pain, scarring and tissue distortion (adhesions).

What are the symptoms of endometriosis?

Dr. Thorpe: Pain is by far the most common symptom. Because the cells are behaving as they would in the uterus but they’re implanted in other places, it causes discomfort from inflammation. Many describe the pain as “really bad menstrual cramps,” though the discomfort isn’t always connected to a menstrual period. The pain generally becomes more severe over time if untreated. Pain during intercourse, bowel movements and urination during periods may also occur.

Some may also see irregular bleeding or spotting between periods, or they may experience GI-related issues such as diarrhea, constipation or nausea associated with the pain during their cycles. If you think about the proximity of the rectum and bladder to the uterus, it’s not surprising that irritation and inflammation can affect the entire area, thus producing pain. Sometimes endometriosis is diagnosed during an evaluation for infertility.

It’s important to know that endometriosis can be mistakenly diagnosed as:

  • Pelvic inflammatory disease (PID)
  • Ovarian cysts, or
  • Irritable bowel syndrome (IBS).

How do you treat endometriosis?

Dr. Thorpe: Hormone therapy with birth control pills, rings or patches is usually the first line of treatment. Hormonal contraceptives decrease the monthly growth of endometrial tissue, which is what often causes pain with endometriosis. Intrauterine devices (IUDs), progestin hormone therapy are also a common treatment for mild cases.

More serious cases may require a different type of therapy, such as GnRH (Gonadotropin-releasing hormone) agonists, to stop the menstrual cycle by blocking ovary-stimulating hormones. This decreases estrogen production and prevents menstruation.

There are also various surgical options if other therapies aren’t effective. Minimally invasive surgery, such as laparoscopy, allows doctors to see what organs the endometriosis may have affected so they can perform treatment.

Who’s most likely to be affected by endometriosis?

Dr. Thorpe: Endometriosis is most commonly diagnosed in people who have:

  • Never conceived or given birth
  • Early-onset menstruation, or
  • Menstrual period abnormalities such as short cycles or longer, heavier periods.

Sometimes endometriosis is associated with other family members (mother, sister, aunt). Often, it’s only when someone tries to conceive and cannot that endometriosis is diagnosed during the infertility evaluation.

When endometriosis is diagnosed later, it may be more difficult to treat — especially in severe cases where extensive scarring or damage to reproductive organs has occurred.

The important takeaways are to:

  1. Know the symptoms, and
  2. Have a discussion with your doctor if you are suspicious.

Early, effective treatment can help prevent the serious effects.

More from Dr. Thorpe on WellTuned:

Ashley Brantley

Ashley Brantley has been writing about food, culture and health for more than a decade, and has lived in three of Tennessee’s four major cities (Memphis, Nashville and Knoxville).

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