Endometriosis: What It Is, Causes, Symptoms, Diagnosis, Diet & Treatment

Endometriosis is a painful chronic condition affecting approximately 11% of American women aged 15 to 44, with symptoms that range from severe period pain, long-term pelvic pain, pain during sex and even infertility.

The Office on Women's Health says it is especially prevalent among women in their 30s and 40s and it poses challenges to women's reproductive health.

While a cure remains elusive, various treatments offer hope in mitigating specific symptoms. This article breaks down endometriosis, discussing its origins, symptoms, stages, diagnostic methods and available treatments.

What is endometriosis?

“Endometriosis is a medical condition in which the tissue that normally lines the inside of the uterus grows outside the uterus. This misplaced tissue can be found on the ovaries, fallopian tubes, outer surface of the uterus and other organs," said Dr. Donna Gin Baick, an associate clinical professor at the University of California, Irvine, School of Medicine.

"However, the displaced endometrial tissue cannot exit the body, leading to inflammation, scarring and adhesions. This can result in symptoms such as pelvic pain, painful and heavy periods, infertility and pain with intercourse,” Baick added.

Is endometriosis genetic?

It’s natural for women diagnosed with endometriosis to wonder how they got it, and if the illness is hereditary, Baick said.

“There is a possible genetic predisposition, with a nearly seven- to 10-fold increase of endometriosis in women with a first-degree relative [who has it]," Baick said. "However, the exact genetic disorder is not known. It is possible that there could be multiple genes involved and other factors such as environmental, age of menarche, age and number of pregnancies, and use of hormonal contraception.”

What causes endometriosis?

Though the specific origins are unknown, the Mayo Clinic indicates the following possible explanations and causes of endometriosis:

• Retrograde menstruation: Retrograde menstruation suggests that menstrual blood holding endometrial cells deviates from its natural course by flowing back through the fallopian tubes and into the pelvis instead of being expelled from the body. Subsequently, these displaced endometrial cells adhere to the pelvic surfaces and organs.
• Peritoneal cell transformation: The "induction theory" posits that hormonal or immune factors could induce the conversion of peritoneal cells, which line the abdominal inner wall, into cells resembling endometrial tissue.
• Embryonic cell metamorphosis: During the pubescent phase, estrogen can prompt embryonic cells, in their early developmental stages, to evolve into endometrial-like implants.
• Surgical scar implantation: Endometrial cells can affix themselves to surgical incision sites following surgeries like hysterectomies or C-sections.
• Endometrial cell migration: Endometrial cells might be transported to distant body regions via blood vessels or the lymphatic system, potentially seeding the growth of endometriosis in locations beyond the pelvic region.
• Immune system disorder: An immune system malfunction could impede the body's ability to identify and eliminate endometrial-like tissue infiltrating outside the uterus.

Endometriosis symptoms

Endometriosis can come with many different symptoms. The Cleveland Clinic suggests that the most common endometriosis symptom is pain, which can be intense or mild and is usually felt in the abdomen, pelvic area and lower back.

Additional symptoms of endometriosis include the following:

• Excruciating menstrual cramps
• Abdominal and back pain
• Dyspareunia (painful intercourse)
• Menstrual irregularities
• Fertility challenges
• Discomfort during bowel movements

Endometriosis stages

John Hopkins Medicine indicates that endometriosis is classified from stage one to stage four. These stages are based on where endometrial tissue exists in the body, how much tissue is in those areas, and how far it has spread.

However, a more advanced stage of endometriosis doesn’t necessarily mean a patient will have more severe symptoms or pain. Some women with stage four endometriosis have few or no symptoms at all, while some women with stage one endometriosis can have severe symptoms.

How is endometriosis diagnosed?

“Diagnosis of endometriosis can be challenging because the presentation and symptoms are varied," Baick explained. "Endometriosis can be clinically suspected due to a history of symptoms such as painful menses, heavy bleeding, chronic pelvic pain, pain with intercourse or bowel movements, or urination."

"Definitive diagnosis is by laparoscopy," she added. "This is a surgery in which a small incision is made in the abdomen, and a thin camera is inserted to view the pelvic organs. If endometriosis is seen, a piece of the tissue can be biopsied to confirm the diagnosis. However, depending on the location or stage of endometriosis, implants may be difficult to visualize. Ultrasound or MRI might also be helpful in the diagnosis of endometriosis if there are ovarian cysts or pelvic masses seen on imaging.”

Endometriosis treatment

Managing endometriosis typically encompasses medical intervention or surgical procedures, says the Mayo Clinic. The treatment choice hinges on the intensity of your symptoms and whether or not you wish to have children.

Endometriosis medications

Your medical provider might suggest utilizing an over-the-counter painkiller, like nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin IB, etc.) or naproxen (Aleve), to provide relief from distressing cramps.

If pregnancy is not your goal, your physician could propose hormone therapy as well as painkillers.

Endometriosis surgery

The Mayo Clinic also indicates that surgical removal of endometriosis implants, while preserving the uterus and ovaries, may enhance pregnancy prospects for those aiming to conceive. Surgery can also alleviate intense endometriosis-related pain, though recurrence remains possible.

The procedure, performed laparoscopically or through traditional abdominal surgery for extensive cases, involves using a slender laparoscope for tissue removal. Post-surgery, hormone medication might be advised for pain relief. Even with severe endometriosis, mostly are treated laparoscopically.

Endometriosis self-care

Mount Sinai suggests that some self-care approaches can be effective. A warm water bottle or heating pad on your lower abdomen can boost blood circulation and muscle relaxation. Easing pain can also be achieved through indulging in warm baths.

You can also rest by lying down, positioning a pillow beneath your knees while on your back, or drawing your knees toward your chest if you prefer the side. These stances alleviate pressure from your back. Further, incorporating regular physical activity into your routine, enhancing blood flow and activating natural pain-relieving endorphins, can help.

Eat a well-balanced diet for improved overall health. Ample fiber intake aids in maintaining regular bowel movements and reduces strain. The Cleveland Clinic states that the endometriosis diet can boost your fiber intake, fight inflammation, help relax your muscles and regulate your cycle.

• Whole fruits and vegetables
• Leafy greens like arugula, dark lettuce, kale and spinach
• Legumes, such beans, lentils and chickpeas
• Whole grains, including whole-wheat pasta and brown rice
• Fatty fish, such as sardines, salmon and tuna
• Shellfish, like oysters, crab and lobster
• Nuts and seeds, like walnuts, flaxseed and chia seeds
• Plant oils, such as flaxseed oil and canola oil
• Dark chocolate, in small quantities
• Legumes, such as black beans and edamame
• Nuts and seeds, particularly almonds and pumpkin seeds
• Poultry, like chicken or turkey
• Red meat (only two low-fat servings per week)

Foods to avoid with endometriosis include:

• Alcohol
• Caffeine
• Fatty meat
• Processed foods
• Sugary drinks

Living with endometriosis

Beyond medical interventions, fostering a better quality of life while living with endometriosis entails making mindful adjustments to daily routines. Complementing the medical care you receive from your physician, St. Luke's suggests stress-reduction techniques, engaging in 30 minutes of daily physical activity and getting rejuvenating sleep.

Many women with endometriosis struggle to sleep well, a study recently published in the Journal of Women's Health found, and that poor sleep led to increased depression, bladder pain and a worse overall quality of life for patients.

Embracing all of these lifestyle changes, in tandem with professional guidance, can empower you to manage your endometriosis symptoms.

SOURCE: Donna Gin Baick, MD, associate clinical professor, University of California, Irvine, School of Medicine