Wellness Workshop | Endometriosis Symptoms and Management | Helene Lacoste, MD
Helene Lacoste, MD, specializes in obstetrics and gynecology, the care of women during pregnancy, as well as the treatment of diseases that affect a woman’s reproductive system. Dr. Lacoste ...
Endometriosis: Symptoms and Management
Endometriosis is a chronic condition in which tissue similar to the lining of the uterus grows in areas outside the uterus — where it doesn’t belong. This misplaced tissue can cause inflammation, scarring, and pain that often intensifies during menstrual periods. Affecting roughly 1 in 10 women and people assigned female at birth (AFAB) globally, endometriosis is most commonly diagnosed in individuals in their 20s and 30s, although it can occur earlier or later in life.
Where Endometriosis Can Occur
Endometrial-like tissue can grow in a variety of locations, most commonly:
- Ovaries
- Fallopian tubes
- Peritoneum (lining of the abdomen)
- Behind the uterus
- Myometrium (muscular wall of the uterus)
Less commonly, it may also affect the rectum, bladder, intestines, diaphragm, vagina, or even the lungs. The widespread nature of this condition means that symptoms can vary greatly.
Recognizing the Symptoms
Pelvic pain is the hallmark of endometriosis, but other symptoms can include:
- Severe menstrual cramps
- Chronic lower back or abdominal pain
- Pain during or after sex
- Heavy periods or bleeding between cycles
- Gastrointestinal issues like bloating, diarrhea, or constipation
- Pain during urination or bowel movements
- Infertility
Interestingly, the severity of symptoms doesn’t always match the extent of the disease. Some individuals may have widespread endometriosis with minimal discomfort, while others experience debilitating pain with just a few lesions.
What Causes Endometriosis?
The exact cause remains unclear. Current theories include retrograde menstruation (when menstrual blood flows backward into the pelvis), immune system dysfunction, and hormonal imbalances. Genetics also appear to play a role — people with a family history are at higher risk.
How It’s Diagnosed
Diagnosing endometriosis often starts with a discussion about symptoms and a pelvic exam. Imaging such as ultrasound or MRI may follow, but the only definitive diagnostic tool is laparoscopy — a minimally invasive surgery that allows direct visualization of the tissue. During the procedure, biopsies may be taken, and visible lesions can often be removed or destroyed at the same time.
Treatment Options
There’s no one-size-fits-all approach to managing endometriosis. Treatment typically depends on symptom severity, desire for future pregnancies, and age. Options include:
Medications:
- NSAIDs for pain relief
- Hormonal birth control to lighten or stop periods
- GnRH agonists/antagonists to suppress hormone production
- Danazol, another hormone suppressor (less commonly used today)
Surgical Options:
- Laparoscopy to remove endometriotic tissue
- Hysterectomy, reserved for severe cases not responding to other treatments
Keep in mind that endometriosis is a chronic condition — symptoms can return, particularly after stopping medications or some time after surgery.
Fertility and Complications
Endometriosis is a leading cause of infertility. The condition can block fallopian tubes or distort reproductive anatomy, making it harder for sperm to meet egg. Other complications may include:
- Cysts and adhesions
- Bladder or bowel problems
- Rarely, respiratory issues if tissue reaches the diaphragm or lungs
If left untreated, symptoms may worsen over time, leading to more significant pain and fertility challenges.
Living with Endometriosis
Living with endometriosis can be both physically and emotionally exhausting. The chronic pain and unpredictability of symptoms can interfere with work, relationships, and everyday activities. Mental health support and regular follow-up with a knowledgeable healthcare provider are vital parts of long-term management.
Although there’s no guaranteed way to prevent endometriosis, pregnancies and breastfeeding may reduce risk. While some people experience symptom relief after menopause, the condition does not always disappear entirely.
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