Endometriosis

Endometriosis is a painful condition where there is tissue from the lining of the uterus that is found outside of the uterus. It is a common condition that affects 1 in 10 females world wide. It is often diagnosed in people in their 20s and 30s. It affects the ovaries, fallopian tubes and the tissue lining the pelvis. Endometriosis rarely happens in organs beyond the pelvis.  The female reproductive organs include the uterus, fallopian tubes, ovaries and vagina.  Endometriosis gets its name from endometrium, which is the lining of the uterus.  The uterus is the organ that a growing fetus develops in.  The endometrium functions to nourish a newly fertilized and implanted egg until the placenta develops.  Ovaries take turns in releasing an egg each month.  The fallopian tubes provide a means of transport for the egg to the uterus, and is where fertilization takes place.  Lastly, the vagina is the entry point to allow access to the cervix.

Endometriosis tissue acts as the lining of the uterus does. It thickens, breaks down and bleeds with each menstrual cycle. It grows in places it doesn’t belong, and it doesn’t leave the body. When endometriosis is involved with the ovaries, cysts called endometriomas can form.  Surrounding tissue can become irritated and form scar tissue. Bands of fibrous tissue called adhesions also may form. These can cause pelvic tissue and organs to stick to each other. It can cause pain especially during menstrual periods. Fertility problems can develop as it can scar the fallopian tubes and block them off. 

The main symptom of endometriosis is pelvic pain. Although many people have cramps during periods, those with endometriosis often describe menstrual pain as far worse than usual.

The pain can also worsen over time. Pelvic pain and cramping may start before a menstrual period and last for days into it. Pain during or after sex(dyspareunia) is common with endometriosis. Pain with bowel movement (dyschezia) or urination(dysuria) after occurs before or during menstruation. Sometimes you may have heavy menstrual periods or bleeding between periods. For most people endometriosis is first found during tests for infertility treatment. Other symptoms people with endometriosis may have are fatigue, diarrhea, constipation, bloating or nausea (Mayo Clinic 2024).  Some people with endometriosis have trouble getting pregnant due to scarring and fallopian tube blockage which affects the descent of the egg and fertilization.  The only true way to diagnose endometriosis is with laparoscopic surgery.  

First line treatment of endometriosis is typically birth control to suppress hormones including hormone signals to endometriosis implants.  This can include birth control pills, patch, vaginal ring, injectables and progesterone containing iuds.  If these are not successful, then a medication called a GnRH agonist is used to suppress the ovaries and puts the patient into a temporary menopause-like state.  This lack of hormones will shrink endometriosis implants, thus relieving pain.  Once the GnRH agonist is stopped, the ovaries will begin to function normally again and hormone production will return to normal levels.  If there is continued pain, then laparoscopy and laser ablation of any implants is done.  Lysis of adhesions can also be done at the same time to help relieve pain.  The definitive treatment for endometriosis pain is a hysterectomy.  In many cases the ovaries are also removed to ensure that any remaining implants do not get the hormones that feed them.  

Endometriosis can have a significant impact on a woman’s life.  They may miss school or work monthly due to their menstrual pain or bleeding.  Fertility can also be affected.  Early diagnosis and treatment can make a huge difference in their quality of life.

‌Mayo Clinic (2024, August 30). Endometriosis. Mayo Clinic

https://www.mybib.com/tools/apa-citation-generator

Cleveland Clinic. (2024, September 16). Endometriosis: Symptoms, Causes, Treatment & Tests. Cleveland Clinic.

https://my.clevelandclinic.org/health/diseases/10857-endometriosis

Xie, M., Qing, X., Huang, H., Zhang, L., Tu, Q., Guo, H., & Zhang, J. (2025). The effectiveness and safety of physical activity and exercise on women with endometriosis: A systematic review and meta-analysis. PloS One, 20(2), e0317820. 

https://doi-org.uaf.idm.oclc.org/10.1371/journal.pone.0317820

Mercorio, A., Della Corte, L., Dell’Aquila, M., Pacella, D., Bifulco, G., & Giampaolino, P. (2025). Adenomyosis: A potential cause of surgical failure in treating dyspareunia in rectovaginal septum endometriosis. International Journal of Gynaecology and Obstetrics: The Official Organ of the International Federation of Gynaecology and Obstetrics, 168(3), 1298–1304. https://doi-org.uaf.idm.oclc.org/10.1002/ijgo.15975 

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