Endometriosis is a complex and misunderstood condition that affects an estimated 1 in 10 people during their reproductive years. Despite being relatively common, there’s still a shroud of mystery surrounding it, which often leads to misdiagnosis and years of silent struggle. This article aims to shed more light on the complexities of this complicated disease, its immense impact on health and wellness, and the ongoing journey to understand it better.

What is endometriosis?

Endometriosis is a condition in which cells similar to, but not identical to the lining of the uterus are located of the uterus. Common areas include the uterosacral ligaments, pelvic side walls, ovaries, and fallopian tubes. Endometriosis lesions release inflammatory factors that can cause pain and adhesions in the areas they are located. Endometriosis can cause acute pain, chronic pain, and infertility. Adenomyosis, a condition often found in people with endometriosis, can cause cramping pain. (Endometriosis doesn't really shed like endometrium dose, it's quite different in many ways. It doesn't implant (like retrograde menstruation suggests).

As an aside... It is likely something people are born with, as it is found in fetuses and is located on areas outside of the pelvis in some people.

The cause of endometriosis is unknown, however the limited research conducted on this condition has led to several working theories:

• Retrograde menstruation: Menstrual blood containing endometrial cells flows backward through the fallopian tubes and into the pelvic cavity where it deposits outside the uterus, implants, and grows.
• Cellular metaplasia: Cells outside the uterus change into endometrial-like cells and spread throughout the body via blood or lymphatic vessels.
• Genetics: People are more likely to experience endometriosis if a family member has the disorder.
• Immune-system complications: When the body’s natural defense system breaks down, endometriosis is more likely to occur.

The truth about endometriosis symptoms

The hallmark symptom of endometriosis is pelvic pain, usually associated with menstrual periods. While many people experience pain, pressure, or cramps during their cycles, endometriosis sufferers report pain that’s far worse than usual. Making matters more complicated (and making its diagnosis more difficult), symptoms of endometriosis aren’t limited to period pain, and the severity of pain isn’t a reliable indicator of the extent of the condition. Some people with mild endometriosis have intense pain; others with advanced disease might have mild symptoms.

Other Symptoms of Endometriosis:

• Pain during sex
• Pain with bowel movements or urination
• Infertility
• Excessive bleeding during or between periods
• Anxiety, depression, and fatigue
• Bloating, constipation, diarrhea, and nausea

The dilemma of diagnosing endometriosis

Diagnosing endometriosis is a notorious challenge. Also, because many symptoms of endometriosis overlap with other conditions, it’s commonly misdiagnosed as irritable bowel syndrome (IBS), pelvic inflammatory disease (PID), or ovarian cysts among other things. In reality, the only definitive way to diagnose endometriosis is through laparoscopic surgery, a minimally-invasive surgical procedure where a camera is inserted into the pelvis via a small incision. This allows a doctor to “explore” the pelvis and directly view endometrial tissue outside the uterus. Short of this, most doctors consider endometriosis to be a diagnosis-of-exclusion: Once they have ruled out other conditions with similar presentations, they diagnose endometriosis in their absence.

A tailored approach to treating endometriosis

Currently, there is no known way to prevent endometriosis or cure the condition, so treatment is essentially aimed at controlling its symptoms:

• Pain medication: For mild symptoms, healthcare providers may recommend over-the-counter pain relievers like ibuprofen or naproxen.
• Continuous hormonal therapy: Medications containing estrogen and progestin (birth control pills, vaginal rings, patches) can be used to control periods and suppress the activity of endometriosis. All hormonal meds appear to be most effective when used in a continuous fashion, which means skipping the hormone-free week when you’d normally have your period. Some research indicates that continuous progestin-only hormonal therapy (pills, IUDs) is even more effective at controlling endometriosis symptoms than combination hormonal therapy.
• Danazol: A synthetic androgen (male hormone) that inactivates endometriosis implants and lowers estrogen levels.
• Lupron: Given as a shot every 1-3 months, Lupron works by stopping the hormonal signals that tell the ovaries to make estrogen, which can make endometriosis inactive.
• Exploratory laparoscopic surgery: For people wanting to get pregnant, surgery to remove as much endometriosis as possible while preserving the uterus and ovaries may reduce symptoms and increase fertility.
• Hysterectomy: In severe cases and when no future pregnancy is desired, surgery to remove the uterus and ovaries is the most effective and definitive treatment available.

How does endometriosis impact fertility?

Endometriosis can significantly impact fertility in several ways:

• Inflammation and scarring: Endometriosis can cause inflammation and scarring in the pelvic region, which can affect the functioning of the ovaries, fallopian tubes, and uterus. This inflammation can lead to the formation of adhesions, which are bands of scar tissue that can block the fallopian tubes, preventing the egg from traveling from the ovary to the uterus.
• Ovarian function: Endometriosis can affect ovarian function, leading to the production of fewer eggs and a lower ovarian reserve (the number of eggs a woman has available for fertilization). This can make it more difficult to conceive.
• Endometrial implantation: In people with endometriosis, the endometrial tissue that grows outside the uterus can also affect the uterine lining, making it less receptive to implantation of a fertilized egg.
• Inflammatory environment: The inflammatory environment created by endometriosis can also affect the quality of the sperm and the ability of the sperm to fertilize the egg.
• Hormonal imbalance: Endometriosis is associated with hormonal imbalances, particularly elevated levels of estrogen. This can affect ovulation and the menstrual cycle, making it more difficult to conceive.

Tia has your back

Endometriosis is a multi-faceted, misunderstood condition that extends far beyond physical symptoms. Chronic pain can lead to emotional distress, depression, and anxiety. Infertility struggles can be mentally exhausting and emotionally taxing. And the uncertainty and unpredictability of symptoms often disrupts personal relationships and professional life. Awareness and education are essential to early diagnosis and effective management. It can also be useful to build a support system – friends, family, groups – to help navigate the journey. Remember, endometriosis is a common condition, and there’s no need to struggle in solitude or travel the road alone. If you’re experiencing endometriosis symptoms, talk to your healthcare provider and don’t be afraid to advocate for yourself.

At Tia, you will always be seen, heard, and taken seriously. Our team of clinical experts are experienced in diagnosing and treating women’s health issues like endometriosis, and our dedicated endometriosis appointments provide a safe, supportive space in which to explore symptoms and treatment options that are purposeful and personalized.