You may have heard of endometriosis, but understanding what it is can be helpful when talking to your doctor about painful menstrual periods or pelvic pain. 

Endometriosis is a chronic condition that occurs when the endometrial tissue “finds a home” outside the uterus. Endometrial tissue is the lining of the uterus where pregnancies implant and grow. This is the tissue that sheds each month with a menstrual period. Most commonly, endometriosis is found on the ovaries or in the pelvis, but it can also be found on the bowel or in more distant locations.

What are symptoms of endometriosis?

The most common symptom of endometriosis is painful menstrual periods. Many women with endometriosis report menstrual pain that is so severe that they miss school or work. Endometriosis can also cause pain with sex and generalized pelvic pain. Conversely, there are many women with endometriosis who have no pain. Aside from pain, infertility is another potential complication of endometriosis.

How common is endometriosis?

Endometriosis can be definitively diagnosed only by surgery, so it is hard to know exactly how common it is. Some studies suggest that up to 10% of women of child-bearing age have endometriosis. Women with mild endometriosis often have no symptoms.

What causes endometriosis?

The exact cause of endometriosis is still unknown. The most common theory is “retrograde” menstruation, where menstrual blood flows backward through the fallopian tubes and into the pelvis. Stem cells and genetics likely also play a role in the development of endometriosis.

How is endometriosis treated?

Endometriosis can be managed with medications or by surgically removing the abnormal tissue. Many women require a combination of therapies to manage their endometriosis pain. Endometriosis is fueled by estrogen. Thus, medications that decrease or block estrogen are often used to treat endometriosis. Many women have significant improvement to their endometriosis pain by taking birth control pills. They may be instructed to take their pills “continuously” so they do not get periods at all. For women who do not improve with birth control pills, there are other medications that can be used to decrease endometriosis and endometriosis pain. However, some women require surgery as part of their treatment for endometriosis. Laparoscopic surgery is a minimally invasive technique that can be done to remove endometriosis tissue and related scar tissue.

What else should women know about pelvic pain?

Not all pelvic pain is endometriosis. Chronic pelvic pain is as common as asthma and there are many causes. Regardless of the cause of a woman’s pelvic pain, the pain can have a significant impact on quality of life. Working with a health care provider who specializes in pelvic pain management can help make a correct diagnosis and get you on the road to less pain and better quality of life.

If you have concerns about menstrual pain or pelvic pain, talk with your health care provider.

Lindsay Clark Donat, MD, FACOG

Dr. Lindsay Clark Donat, FACOG, is a gynecologist at Lifespan Physician Group, Obstetrics and Gynecology and a physician leader for the LPG OBGYN Ambulatory Gynecology Program