Endometriosis is a chronic condition affecting an estimated 10% of women of reproductive age. It can negatively affect fertility, sexual intercourse, bowel movement, and menstruation, often causing persistent pain and discomfort in the pelvis, abdomen, or chest. While there is no cure, early diagnosis and proper treatment can significantly alleviate symptoms and improve quality of life.
This article explores endometriosis, its common symptoms, risk factors, diagnostic methods, and available treatment options.
What Is Endometriosis?
Endometriosis is a chronic disease that affects more than 11% of American women of reproductive age, with symptoms such as infertility, abdominal bloating, painful periods, heavy menstrual bleeding, and chronic pelvic pain. It can also interfere with bowel movements, sexual intercourse, and mental health, often leading to hormonal imbalances, anxiety, and depression.
The endometrium is the lining of the uterus that thickens during the menstrual cycle to prepare for implantation. In endometriosis, endometrium-like tissue grows outside the uterus, most commonly around the ovaries, fallopian tubes, bladder, and bowels, causing inflammation and scar tissue formation.
Due to the stigma and lack of awareness surrounding this condition and symptom overlap, it often remains undiagnosed for years, with an average diagnosis delay of seven to ten years, depending on the severity and access to medical care.
Although endometriosis can affect anyone who menstruates, it is most frequently diagnosed in women in their twenties and thirties.
Endometriosis Causes and Risk Factors
The exact causes of endometriosis are unknown, but there are multiple factors that can increase the risk. Genetics, immune system dysregulation, hormonal imbalances, and lifestyle choices can all contribute to the development of this medical condition.
These are the underlying causes typically associated with endometriosis:
- Delayed childbearing
- Never having given birth
- Early menstruation (before the age of 11)
- Heavy menstrual bleeding (i.e., menorrhagia)
- Short menstrual cycles
- Retrograde menstrual flow
- Uterine growths (e.g., fibroids or polyps)
- Structural abnormalities of the uterus, cervix, or vagina
- Reproductive tract abnormalities
- Metaplasia (i.e., cellular transformation)
- Increased estrogen production
- High lifetime exposure to estrogen
- Family history of endometriosis
- Low body mass index (BMI)
- Abdominal surgery
- Autoimmune diseases (e.g., lupus, IBD, multiple sclerosis)
- Excessive nicotine and alcohol consumption
- A diet rich in red meat, trans fats, and processed foods
- Lack of exercise
- Chronic inflammation
Endometriosis Symptoms
Endometriosis symptoms vary among individuals. While some women experience severe pain and fertility issues, others may have little to no noticeable symptoms.
These are the most common symptoms of endometriosis.
- Chronic pelvic pain
- Painful intercourse
- Infertility
- Painful periods (dysmenorrhea)
- Heavy menstrual bleeding
- Spotting between periods
- Bowel movement discomfort
- Painful urination
- Bloating
- Nausea
- Diarrhea
- Constipation
- Fatigue
The number and intensity of your symptoms do not indicate the severity of the condition. You may experience intense pain with a small amount of tissue or feel only mild discomfort with lots of endometriosis growths in your body.
Endometriosis Comorbidities
Endometriosis has been linked with multiple physical, autoimmune, and mental health issues, including the following:
- Asthma
- Allergies
- Systemic lupus erythematosus
- Multiple sclerosis
- Rheumatoid arthritis
- Inflammatory bowel disease (IBD)
- Irritable bowel syndrome (IBS)
- Celiac disease
- Thyroid disorders
- Cardiovascular diseases
- Cancer
- Anxiety
- Depression
However, further scientific research is needed to understand the causes and consequences of endometriosis better, as the exact mechanisms underlying these associations remain unclear.
Endometriosis Diagnosis
Non-surgical examinations cannot provide a definitive diagnosis, which is why laparoscopy is the standard procedure for confirming a diagnosis of endometriosis.
The following diagnostic methods are commonly used:
- Physical examination – The patient shares their medical history, common symptoms, and describes where and when they feel discomfort.
- Pelvic and abdominal exam – Using one or two gloved fingers, the doctor will check for any abnormalities, irregular growths, painful spots, cysts, or scars behind the uterus.
- Ultrasound – The ultrasound device captures images using soundwave technology and can show ovarian cysts linked with endometriosis.
- Magnetic resonance imaging (MRI) – This imaging tool helps identify the location and size of endometriosis lesions, making it valuable for surgical planning and assessing the extent of deep infiltrating endometriosis.
- Laparoscopy – This is a minimally invasive surgical procedure, often performed under general anesthesia, in which the surgeon makes a tiny incision near your navel and inserts a viewing instrument called a laparoscope to identify the location, extent, and size of the endometriosis growths. A tissue sample can be taken for further testing, and the doctor will surgically remove endometrial tissue, concluding the treatment.
Endometriosis Risks and Complications
Untreated endometriosis can lead to more frequent flare-ups, chronic inflammation, worsening of symptoms, and other health complications.
The most common risks include:
- Infertility
- Miscarriages
- Ectopic pregnancy (i.e., the embryo attaches outside the uterus)
- Placenta previa (the placenta blocks the cervix, preventing vaginal birth)
- Cesarean delivery
- Bowel complications
- Bladder issues
- Chronic pelvic pain
- Ovarian endometriomas (“chocolate cysts”)
- Ovarian cancer
- Autoimmune diseases (e.g., systemic lupus)
- Mental health issues
- Chronic fatigue
- Cardiovascular issues
Endometriosis Treatment
Until the exact causes of endometriosis are fully understood, it is difficult to determine the most effective treatment. However, there are practical ways to lower the risk of developing the condition and ease its symptoms.
These are the most effective treatment methods for endometriosis.
Laparoscopy and Laparotomy
These two surgical procedures use different approaches to treat endometriosis. Doctors select one or the other depending on the patient's condition and the severity of symptoms.
Laparoscopy is a minimally invasive procedure used for both diagnosis and removal of endometrial tissue. The surgeon makes a small “keyhole” incision in the abdomen and inserts a thin, lighted camera called a laparoscope to locate and excise abnormal tissue.
Laparotomy, on the other hand, is an open abdominal surgery that requires a larger incision to explore, diagnose, and remove endometrial growths. It is typically reserved for more complex or severe cases that cannot be effectively treated with laparoscopy.
Hormone Treatment
Hormonal imbalances, characterized by estrogen dominance and progesterone resistance, can contribute to endometriosis. Estrogen, the hormone responsible for the thickening of the uterine lining (endometrium), can overstimulate endometrial tissue growth when progesterone levels are low or dysfunctional.
Regulating estrogen levels and balancing estrogen and progesterone can significantly reduce the risk of endometriosis. Hormonal balance can be restored in the following ways:
- Gonadotropin-releasing hormone (GnRH) agonists and antagonists – These prescription drugs temporarily lower estrogen production, improving the symptoms of endometriosis within four to eight weeks of the start of the treatment.
- Progestin-only oral contraceptives – Since endometriosis is an estrogen-dependent condition, switching to a progestin-only birth control pill can alleviate many symptoms and prevent potential flare-ups.
- Aromatase inhibitors (AIs) – Studies show that aromatase inhibitors effectively inhibit extra-ovarian synthesis of estrogen, decreasing pain and overall discomfort.
- Bioidentical hormone replacement therapy (BHRT) – BHRT can prevent tissue buildup by restoring a healthy balance between estrogen and progesterone, especially during perimenopause.
Since some of these hormonal therapies can hinder your efforts to get pregnant, it is essential to consult your healthcare provider about the most suitable and effective hormonal treatment.
Note: Learn how to identify and treat PCOS, another hormone-related condition.
Exercise Regularly
A sedentary lifestyle can disrupt hormonal balance and increase inflammation, potentially triggering endometrial overgrowths, menstrual irregularities, and infertility.
Physical activity reduces oxidative stress by stimulating the release of anti-inflammatory cytokines. It also reduces muscle tension, restores pelvic floor strength, improves blood circulation, and reduces the severity of chronic abdominal pain.
Engaging regularly in low-to-moderate, low-impact exercises, such as aerobics, swimming, cycling, brisk walking, yoga, Pilates, Kegel exercises, and gentle stretching, can support your recovery from endometriosis and strengthen the pelvic muscles.
Note: Read about how exercise affects hormones and learn how to modify your fitness regimen based on your health goals.
Adopt a Balanced Diet
A nutrient-dense, anti-inflammatory diet rich in essential vitamins and minerals can reduce inflammation, optimize estrogen levels, and restore hormonal balance. A licensed nutritionist can customize an eating plan for endometriosis according to your needs, food intolerances and allergies, and overall health goals.
Choosing foods rich in the following nutrients can help you alleviate symptoms:
- Fiber – Studies show that fiber lowers circulating estrogen concentrations, helping the body eliminate excess estrogen associated with endometriosis. Examples include whole grains, fruits, vegetables, legumes, nuts, and seeds.
- Healthy fats - Omega-3 fatty acids have a potent anti-inflammatory effect and can reduce endometriosis-related abdominal discomfort. Good omega-3 sources include fatty fish, nuts, chia seeds, plant oils, and algae.
- Antioxidants– Antioxidants neutralize free radical damage, reduce stress, and strengthen the immune system, helping the body restore hormonal balance. Antioxidant-rich foods include berries, sweet potatoes, dark leafy greens, artichoke, citrus fruits, apples, grapes, apricots, dark chocolate, and green tea.
- Magnesium– Magnesium is a natural muscle relaxant that can reduce cramping and relieve abdominal tension. It is found in spinach, quinoa, whole wheat, dark chocolate, almonds, cashews, edamame, black beans, avocado, tofu, and yogurt.
- Zinc - Zinc modulates immune responses, reduces oxidative stress, and regulates hormones. You can find it in oysters, red meat, poultry, whole grains, eggs, nuts, and seeds.
As you increase the intake of these foods, reduce or eliminate refined sugar, salt, unhealthy fats, and artificial additives from your diet to reduce inflammation and regulate your hormonal status.
Note: Use Vibrant MG to boost your magnesium levels and promote relaxation and ease.
Reduce Caffeine Intake
High caffeine intake does not directly contribute to endometriosis, but it can worsen cramps, bloating, and dehydration. Doctors recommend moderate consumption of caffeinated foods and beverages to help prevent a potential worsening of symptoms.
Limit Alcohol and Nicotine Consumption
Alcohol and smoking increase inflammation and oxidative stress and may disrupt hormonal balance. Alcohol increases estrogen levels, leading to frequent endometrial flare-ups, while nicotine stimulates pro-inflammatory cytokines that disrupt normal cell function.
Conclusion
You may not know exactly what caused your endometriosis, but you can learn how to manage it and reduce its impact on your daily life. This article has outlined the most effective strategies for coping with symptoms and keeping this painful condition under control.
Contact our medical professionals to learn more how to achieve lasting hormonal balance and long-term wellness.
