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Endometriosis

If you have pain with periods, you are not alone.

Endometriosis affects 1 in 10 women worldwide, and symptoms can begin before age 20.

Endometriosis is an estrogen-dependent disease that occurs when endometrial cells and tissue from inside the uterus get out and attach to other areas of the body. These rogue cells are stimulated by estrogen, which triggers an immune response – leading to inflammation, hypersensitivity, and ultimately, pain.

Endometriosis has been found everywhere in the body. It has been found:

Most often

  • Ovaries
  • Fallopian tubes
  • Uterus outer surface
  • Tissues holding uterus in place

Less often

  • Vagina, cervix, vulva
  • Bowel
  • Bladder
  • Rectum

Rarely

  • Lungs
  • Brain
  •  Skin

This painful, chronic condition often goes undiagnosed for a number of reasons. Sometimes women put up with severe pain thinking it’s just a “bad period.” Because there’s no simple diagnostic test, it can be a challenge to properly diagnose.

Here's what you need to know:

When endometriosis growths occur outside the uterus, they can swell and bleed in the same way your uterus swells and sheds blood during your menstrual period. When this happens outside the uterus, there’s nowhere for the blood to go. This can cause a variety of symptoms, including:

  • Painful periods (dysmenorrhea)
  • Recurring pain halfway between periods (intermenstrual pain)
  • Non-menstrual pelvic pain
  • Painful sexual intercourse (dyspareunia)
  • Painful urination/bowel movements
  • Stomach/digestive problems
  • Infertility

It’s not yet known what precisely causes endometriosis. Some factors being studied include:

  • Retrograde menstrual flow (blood flowing into pelvis through fallopian tubes)
  • Genetic factors
  • Immune system disorders/certain cancers
  • Hormones
  • Surgery (cesarean section/hysterectomy) 

Endometriosis can be diagnosed in the clinic by looking for clues to the presence of endometrial tissue through a pelvic exam and imaging tests such as ultrasound and MRI.

A surgical diagnosis through laparoscopy is considered more conclusive because it visually locates endometrial tissue, but is used for more severe cases.

A diagnosis can also occur when hormonal medications improve pain symptoms, which would indicate that endometriosis is the likely cause. 

Symptoms of endometriosis are managed conservatively whenever possible. For mild symptoms, NSAIDS/analgesics can be used to relieve pain.

Hormones are a treatment option which has pros and cons. Lowering the amount of estrogen in the body decreases its ability to stimulate growth of endometrial tissue, but can have drawbacks, such as negatively affecting fertility.

These factors are weighed on an individual basis. Options include: 

  • Estrogen/progestin combination (oral, vaginal ring or transdermal)
  • Progestogens (oral medication such as progesterone pill, levonorgestrel-releasing system, etonogestrel-releasing subdermal implant, IUD)
  • Gn-RH agonists (combined hormones add back therapy to prevent bone loss and hypoestrogenic symptoms)
  • GnRH antagonist

Surgery through laparoscopy may be recommended to remove affected tissues. This is generally an option for severe symptoms or when other options do not provide relief.

Nutrition choices have been found to impact symptoms of endometriosis, so adjusting your diet may improve how you feel.

The recommended anti-inflammatory approach includes:

  • Add fruits and vegetables daily, including berries, oranges, cherries, tomatoes and green leafy vegetables.
  • Reduce saturated and trans fats, especially highly processed foods, red meats and ham, deep-fat fried foods and palm and coconut oils.
  • Increase omega-3 fats, such as extra virgin olive oil, flax and chia seeds, avocado and tree nuts like walnuts. 

Other Conditions

Endometriosis can be complicated when the sufferer is also managing one or more additional diseases. People with endometriosis may be at higher risk of:

  • Gynecologic cancers such as ovarian cancer
  • Autoimmune diseases such as rheumatoid arthritis and Graves (thyroid) disease
  • Asthma
  • Cardiovascular disease
  • Preterm labor

Other diseases you may have with endometriosis:

  • Rheumatoid arthritis
  • High blood pressure
  • Ovarian cancer
  • Preterm labor
  • Depression
  • Ulcerative colitis/irritable bowel syndrome
  • Sjögren’s syndrome
  • Multiple sclerosis
  • Chronic fatigue syndrome
  • Fibromyalgia

Pelvic Health Navigator

Endometriosis is considered a chronic condition that requires lifelong management.

At CHI Health, we offer a navigator service specific to pelvic health conditions to help you navigate referrals and treatments.

Future research

Research is essential to improving our understanding of endometriosis and our ability to effectively treat this challenging condition. CHI Health is actively involved in clinical research.