Endometriosis: What it is and how to treat it

Highlights

• Endometriosis is a common menstrual condition in which the tissue that lines the uterus spreads outside the uterine walls, causing severe cramps and adhesions across pelvic organs
• Medical treatments for endometriosis range from prescription medication (birth control and others) to surgery to remove invasive tissue
• Complementary therapies like acupuncture, pelvic floor physical therapy, herbal remedies, or diet modification can help address symptoms of endometriosis and improve quality of life

Endometriosis is a pelvic disorder affecting more than ten percent of women and people with ovaries in which tissue that is meant to line the uterus spreads outside the uterine walls. This lining, called endometrium, is the tissue that is normally shed during menstruation.

In endometriosis, instead of staying inside the uterus, the endometrium or endometrial cells can grow on the ovaries, fallopian tubes, cervix, vulva, bladder, bowels, throughout the pelvic tissues and lining of the pelvic cavity. This extra-uterine growth is called endometrial implants. Rarely, endometrial implants can spread outside the pelvic region.

Endometriosis can be extremely painful, and can cause severe pelvic pain, menstrual cramps, adhesions (which are when your pelvic organs become stuck together by endometrial tissue), and infertility. It ranges in severity from mild to quite severe pain, but the amount of pain and symptoms a person experiences isn’t a reflection of how advanced their endometrial implants are.

Endometriosis is formally diagnosed according to four stages. Stages of endometriosis move from: Stage I is minimal superficial implants, while Stage IV is severe, deep implants with large cysts on one or both ovaries and many dense adhesions. 

Who gets endometriosis and how it is diagnosed

Doctors aren’t sure why some people get endometriosis and others don’t. Researchers are studying whether genetic factors, immune system issues, problems with estrogen production, or “retrograde menstrual period flow” (in which endometrial tissue flows through the fallopian tubes during menstruation) may be factors, but there aren’t yet any conclusive answers.

Anyone who gets menstrual periods can get endometriosis, but you’re more likely to get it in your 30s and 40s than earlier in your life. In terms of risk factors, you are statistically likelier to have endometriosis if you’ve never given birth, if your menstrual periods last longer than a week, if your menstrual cycles (the length of time from one period to the next) are shorter than 27 days, or if a close family member like your mother, sister, or aunt has endometriosis.

Most people get a diagnosis of endometriosis after seeking treatment for pelvic pain. There are many types of pain that can be caused by “endo” (as it’s commonly abbreviated), including painful periods, painful cramps before menstruation, pain during or following sexual penetration, pain with bowel movements, and nonspecific lower back pain.

These pains are caused by endometrial implants, which can create blockages, blood-filled cysts, inflammation, scar tissue, and adhesions. Some women with endometriosis, however, don’t ever experience pelvic pain—that’s why it’s important to have regular checkups by a gynecologist to monitor any changes to your condition, even if you’re not noticing pain or symptoms of endometriosis. 

If you have undiagnosed pelvic or menstrual pain, talk to your gynecologist about your symptoms and the possibility of endometriosis. To diagnose endo, a doctor will perform a digital pelvic exam during which they will feel for cysts or scars. They may also perform an internal (intravaginal) or external (abdominal) ultrasound, and/or an MRI to look for ovarian cysts and other evidence of endometrial implants.

Unfortunately, surgery is the only certain way for a doctor to positively diagnose endometriosis. For this reason, some doctors will recommend exploratory laparoscopic surgery, wherein a tiny incision is made through your belly button. 

Treatment options for endometriosis

To date, there is no cure for endometriosis. There are several options for treatment of endometriosis to manage the common symptoms, mitigate damage, and preserve or restore fertility, however. 

Hormonal birth control is a common treatment for endometriosis in patients who aren’t trying to get pregnant. It works by reducing the levels of estrogen in the body, which in turn slows down growth of endometrial tissue. Birth control pills, patches, rings, implants, and hormonal IUDs can all be effective in this way, but it’s important to note that with hormonal IUDs, their effect on endometriosis may not last for as long as their efficacy period as a method of birth control. 

There is also a class of doctor-prescribed medications that can be used for patients who are trying to conceive. This class of drugs is called gonadotropin-releasing hormone agonists. They prevent the body’s production of the hormones that signal ovulation, menstruation, and growth of endometrial tissue.

These drugs temporarily stop menstruation, and in doing so they slow the growth of endometrium. Once the spread of implants has been controlled, medication is stopped, the menstrual cycle begins again, and, ideally, fertility is improved. 

In more severe cases of endo, surgery is sometimes indicated to remove implants and cysts and to break apart adhesions without damaging the reproductive organs. Endometrial surgery can be laparoscopic (which is less invasive, less dangerous, and requires a shorter recovery period), or open-abdominal, which carries greater risks. During the surgery, the surgeon will confirm the diagnosis, locate the implants, and remove implants as they are safely able to do so. Often, implants grow back, so surgery is not considered a permanent solution. 

For relief from endometriosis pain, over-the-counter medications like ibuprofen (Motrin or Advil) and naproxen (Aleve) can be effective. There are also many treatment options in the world of complementary medicine, which can be used alongside Western medicine or as their own courses of treatment. Some of these options include:

• Acupuncture: A traditional Chinese medicine doctor or acupuncturist can improve pain management
• Chiropractic care: Adjustments from a chiropractor are thought to help some people with symptoms of endo, particularly lower back pain
• Pelvic floor physical therapy: Because endo affects the pelvic organs, work with a pelvic floor physical therapist can treat symptoms and manage pain with pelvic floor exercises
• Herbal remedies: An herbalist can prepare remedies like licorice root that may improve endometriosis.
• Diet and supplements: A registered dietitian can guide you through the world of dietary choices and supplements to explore whether your endometriosis may be impacted by these interventions
• Breathwork: Similar to some of the techniques of yoga, a holistic healer can guide you through targeted breathwork that focuses on the abdominal cavity 
• Visceral massage: Uterine massage from an LMT who is specially trained in visceral or medical massage may be helpful in managing life with endometriosis

Living well with endometriosis means managing your condition

Endometriosis can have a profound effect on quality of life. Because it negatively impacts fertility and sexual pleasure as well as causes chronic pain, it can be emotionally challenging to live with. Working simultaneously with a behavioral health practitioner, a gynecologist who specializes in endo, and complementary medicine providers like herbalists and acupuncturists can help you address your symptoms as well as your mindset and ability to manage them.

While there is much that is still unknown about endometriosis, the good news is that it is common enough that most practitioners are familiar with how their area of expertise can improve outcomes for people with endo. 

If you think you may be experiencing endometriosis, the right provider can help you build a personalized plan to support your wellbeing. Connect with a credentialed expert who serves your area here.