As one of the most common gynecologic diseases, endometriosis often goes undetected for years because the abdominal pain associated with the condition is mistaken for menstrual cramps, or because there may be no symptoms. On average, women in the United States will suffer from endometriosis for 10 years before receiving a proper diagnosis. Endometriosis is a progressive disease – if caught early, it can be stopped from spreading and causing scarring and adhesions.
What is Endometriosis?
Endometriosis affects an estimated 2 to 10 percent of American women of childbearing age. The name of this condition comes from the word “endometrium,” which is the tissue that lines the uterus. Endometriosis occurs when endometrial-like tissue grows outside of the uterus, affecting the surrounding pelvic structures, such as the ovaries, fallopian tubes, and the pelvis. As displaced tissue continues to act as it normally would (thickening, breaking down, and bleeding), it becomes trapped.
Without an exit point from the body, surrounding areas become inflamed or swollen over time, and scar tissues and cysts can form.
Much like fibroids and adenomyosis, endometriosis can cause pelvic pain, severe menstrual cramps, and abnormal or heavy bleeding during periods. Many women with endometriosis report experiencing the following symptoms:
- Pelvic pain that worsens during menstruation
- Bloody urine
- Pain in the low abdomen
- Pain or cramping during sexual intercourse
- Diarrhea or constipation
- Lower back pain
- Excessive bleeding
- Chronic fatigue
Left untreated, this chronic condition worsens, compromising the reproductive organs and pelvic structure. Fertility issues, pain, and other complications escalate over time. Luckily, medical and surgical treatment options are available once a diagnosis is made.
What Causes Endometriosis?
The exact cause of endometriosis is not known. However, it’s believed to be caused by retrograde menstruation, a condition in which a woman’s menstrual flow (which contains endometrial cells) moves backwards into the pelvic cavity instead of out of the body. The displaced endometrial cells then stick to the pelvic walls and surfaces of pelvic organs.
What are the Common Risk Factors for Endometriosis?
Any woman can develop endometriosis. However, biologically, there are several known risk factors that increase a woman’s odds of developing this condition. These risk factors include:
- Family history
Endometriosis is about four to seven times more likely to develop in a woman with a first-degree relative who has endometriosis than the general population.
- Unusual menstrual cycle characteristics
Abnormal menstruation problems are associated with a higher risk of developing endometriosis, including the following:
- Early menarche – the onset of period at an early age (typically before age 11).
- Periods that last longer than a week.
- Periods that occur less than 27 days apart.
- Dysmenorrhea, or painful menstruation and severe cramps.
In a meta-analysis of 11 studies aiming to identify a correlation between body mass index and endometriosis risk, the results concluded that women with a high body mass index are at higher risk for developing endometriosis.
- Never giving birth
Women who have never given birth have a higher risk of developing endometriosis than those who have successfully conceived a child.
- Uterine abnormalities
Women who have any medical condition that prevents the normal passage of menstrual flow out of the body are at a greater risk of developing endometriosis.
- Organ Fusion
In advanced stages, pelvic tissue can fuse with organs and distort the internal anatomy. Fertility problems can also occur.
Prolonged or profuse menstrual bleeding experienced by women with endometriosis can sometimes cause a woman to become anemic, a condition often caused by an iron deficiency.
Endometriosis appears in many different forms with a wide variety of clinical presentations depending on the extension of the disease, organs affected and individual circumstances. That is why, a unified classification system for the stages of the disease is not a simple task.
The most used and best-known system was developed by the American Society for Reproductive Medicine (ASRM).
|Stage I (1-5 points)||Minimal|
Few superficial implants
|Stage II (6-15 points)||Mild|
More and deeper implants
|Stage III (16-40 points)||Moderate|
Many deep implants
Small cysts on one or both ovaries
Presence of filmy adhesions
|Stage IV (>40 points)||Severe|
Many deep implantsLarge cysts on one or both ovaries
Many dense adhesions
This classification uses a point system to try to quantify endometriotic lesions. This point system allows for a way to numerically scale the disease. A score of 15 or less indicates minimal or mild disease. A score of 16 or higher may indicate moderate or severe disease. As mentioned before, the severity or the score of the disease does not necessarily correlate to the level of pain or presence of other symptoms.
Diagnosis & Care
Because the physical clues for endometriosis look a lot like other gynecological conditions, such as uterine polyps, adenomyosis, and fibroids, a clinical diagnosis must be determined by a endometriosis specialist or a highly skilled Ob/Gyn.
To accurately diagnose endometriosis, your Viva Eve healthcare provider will typically collect your medical history, then order a set of tests that may include a pelvic exam, ultrasound, magnetic resonance imaging (MRI), or laparoscopy. It is not unusual for women to have both endometriosis and fibroids.
Viva Eve recommends that women who have not already received a confirmed diagnosis explaining their symptoms discuss their condition with an expert who can diagnose one or both conditions as the cause.
Once endometriosis and any other co-occurring conditions are diagnosed, your Viva Eve endometriosis specialist can help you choose a course of treatment based on the progression of your condition and your own individual circumstances. These include:
- Hormonal Contraceptives
Once endometriosis and any other co-occurring conditions are diagnosed, a specialist can help you choose a treatment based on the progression of your condition and your own individual circumstances.
- Hormone Therapy
Hormone therapy suppresses the hormones responsible for the buildup of endometrial tissue each month. This treatment will prevent your menstrual period, lower your estrogen levels, and cause endometrial tissue to shrink. However, as a by-product of the treatment, women experience artificial menopause. This treatment is not recommended for more than 6 months. Once the treatment stops, symptoms return.
- Laparoscopic Surgery
Laparoscopic surgery is a procedure during which a surgeon creates small “keyhole” incisions in the abdomen (using a laparoscope) to remove endometrial tissue and scar tissue.
Other medical procedures that remove tissues include cauterization, ablation, electrocoagulation, and endometrial ablation.
Without medical intervention, endometriosis can progress into a severely debilitating disorder. If you’re experiencing menstrual irregularities and painful period symptoms, you should seek a clinical opinion at a practice that specializes in treating this condition.
Viva Eve women’s health experts are uniquely qualified to provide you with a correct diagnosis and find the best treatment options that work for you and your individual circumstances.