Endometriosis: Answering 8 Commonly Asked Questions

Endometriosis is a condition that causes the inside lining of the uterus, called the endometrium, to grow outside of the uterus. Endometrial tissue may grow around the ovaries, in the fallopian tubes or in other areas of the abdomen.

While there isn’t an exact cause of endometriosis, it’s thought to be a combination of genetic, immune and hormonal factors. One theory that scientists believe may be the cause of endometriosis is retrograde menstruation, which is the backward flow of menstrual blood and tissue through the fallopian tubes and into the pelvic cavity, rather than exiting the body.

Endometriosis pain varies for every woman, but most say that it feels like:

• Digestive problems, such as nausea, constipation or diarrhea
• Intense period pain and cramping
• Pain or aching during sex
• Pain when peeing
• Pelvic floor spasms
• Severe bloating, especially during your period
• Severe pelvic pain

The three main types of endometriosis include superficial peritoneal endometriosis (SPE), ovarian endometrioma (OMA) and deep infiltrating endometriosis (DIE).

Accounting for nearly 80% of all cases, this type of endometriosis involves the development of shallow lesions on the pelvic lining, often appearing as red, black or white spots. While the exact cause of SPE is unknown, retrograde menstruation is thought to be a main cause. Common symptoms include painful menstruation or urination, infertility and pain during sex.

This type of endometrioma is when benign cysts filled with old blood are present on the pelvic lining. OMA typically affects fertility and can cause mild to severe pelvic pain, most often affecting premenopausal women. Common symptoms of an endometrioma include pelvic and lower back pain, nausea, vomiting or diarrhea.

Deep infiltrating endometriosis is the most aggressive form of endometriosis and occurs when tissue that’s similar to the lining of the uterus embeds deeply into other areas of the body. According to the National Library of Medicine, DIE can affect the uterosacral ligaments, vagina, rectovaginal septum, pelvic side walls, ureter, bladder or bowels. DIE symptoms include severe pain or blood in your urine or bowels.

Although there are three types of endometriosis, they tend to share common symptoms, which include:

• Bleeding that lasts for more than seven days
• Bleeding that soaks through one or more tampons or pads per hour for several hours
• Bloating
• Constipation or diarrhea
• Cramps that begin early or before your cycle
• Cramps that don’t go away with over-the-counter medication
• Fatigue
• Infertility
• Nonperiod pelvic pain
• Pain during sex
• Pain when using the bathroom

Endometriosis doesn’t directly cause weight gain, but may be a contributing factor due to increased bloating, hormonal imbalances, fluid retention and severe pain that limits physical activity.

Yes, it’s possible to have both polycystic ovarian syndrome (PCOS) and endometriosis, even though they’re distinct conditions. According to a study performed by the National Library of Medicine, 1 in 20 women had both PCOS and endometriosis. These two conditions can coexist and share common symptoms like chronic pain, infertility or irregular periods.

While ultrasounds can’t provide a diagnosis, it’s possible to see certain types of endometriosis on an ultrasound. Superficial peritoneal endometriosis is often not detected by an ultrasound because it’s too small to see. However, ultrasounds are effective at visualizing ovarian endometrioma and deep infiltrating endometriosis. For the most accurate picture, it’s best to have a transvaginal ultrasound rather than an abdominal one.

Endometriosis and adenomyosis are on the same spectrum and share abnormal endometrial tissue, but the biggest difference is their locations. While endometriosis causes endometrial cells to grow outside the uterus, adenomyosis occurs when these cells grow within the uterine muscle, typically causing it to become enlarged and thickened.

When it comes to treating endometriosis, one of the biggest factors to consider is whether you hope to become pregnant. Usually, your doctor will prescribe medication first to see if it helps. If not, surgery to ablate, or remove, the endometriosis tissue is recommended for women who still wish to become pregnant. However, pain may return over time after surgery. If you don’t wish to become pregnant and previous treatment methods haven’t worked, your doctor may recommend a hysterectomy with the removal of the ovaries.