Endometriosis: What you need to know

Allison Jackson, MD

Obstetrics and Gynecology

Do you have painful periods, chronic pelvic pain, or unexplained infertility? If you answered yes, you may be experiencing endometriosis. Allie Jackson, MD, explained everything you need to know about the disease.

What is endometriosis?

Endometriosis is a chronic gynecologic disorder that occurs in up to 1 in 10 women of reproductive age. The rates are even higher in women with infertility and chronic pelvic pain or those with a family history.

Endometriosis occurs when the inside lining of the uterus travels to the abdomen through the fallopian tubes and implants on the pelvic lining and structures during your period. Over time this leads to a chronic inflammatory disorder causing pain and infertility.

What are the symptoms of endometriosis?

Abdominal and pelvic pain and painful periods are the most common symptoms to watch for. Other symptoms you may experience include:

• Painful intercourse
• Infertility
• Painful urination during menstruation or blood in urine
• Painful bowel movements during periods, diarrhea, or constipation
• Heavy menstrual bleeding
• Many patients have no symptoms at all

How is endometriosis diagnosed?

Because many patients have no symptoms of endometriosis, it often goes unrecognized. Many patients will not realize they have it until they struggle with infertility. The average time to diagnosis is an astonishingly long 11 years. The delay in diagnosis for endometriosis can lead to chronic pain and infertility. 

Unfortunately, there is no test for endometriosis. However, a doctor can develop a high index of suspicion based on a menstrual history and by doing a pelvic exam. The only way to know for sure if you have endometriosis is to have a surgical procedure called a laparoscopy performed.

How does endometriosis affect fertility?

Endometriosis is present in 80% of couples with unexplained infertility and is a common condition in women with unexplained recurrent pregnancy loss. The condition can cause inflammation which may damage the sperm or the egg and interfere with a woman’s ability to get pregnant.

How is endometriosis treated?

The pain associated with endometriosis is driven by the preparation and release of an egg by the ovary, so treatment is targeted at suppressing this process. First line treatment usually consists of medical therapies like birth control pills or Depo-Provera (“the shot”). Typically, the recommendation is to take them continuously to avoid having a period since this is when the worst pain happens and when pelvic inflammation is triggered. When these medications are ineffective, there are other more aggressive, suppressive therapies to consider. Surgery is generally reserved for patients who have failed to improve on medications or for those seeking pregnancy. Talk to your doctor about the best option for you.

If you or someone you know has unexplained pain or unexplained infertility that gets worse during menstruation, endometriosis is a possible cause. “The best advice is to see a doctor who understands the disease and who knows how to treat it and prevent recurrence. Recognizing the signs and symptoms is the first step toward getting the care that you need and improving your quality of life,” said Dr. Jackson.