Endometriosis is a condition that can affect females. It happens when tissue that is similar to that of endometrial tissue grows outside the uterus.

The tissue responds to hormones that affect the menstrual cycle in the same way that endometrial tissue does. It swells and bleeds like endometrial tissue, but there is nowhere for the waste tissue and blood to go.

The tissue is not cancerous, but it can lead to scarring and adhesions. It can block the fallopian tubes, and cysts can form due to trapped blood. Tissues can fuse, leading to changes in the reproductive organs.

Symptoms include pain and unusual bleeding. It may affect a person’s chances of becoming pregnant.

Experts believe endometriosis affects around 11% of females in the United States aged 15–44 years. It is most common among those in their 30s and 40s.

Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.

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Endometrosis occurs when tissue, similar to the lining of the endometrium, grows outside the uterus. The tissue that grows outside the uterus in endometriosis is not the same as endometrial tissue, but they have some features in common.

The tissue can develop anywhere in the body, but it usually affects the pelvic area, including:

  • the ovaries
  • the fallopian tubes
  • tissues that support the uterus
  • the outside of the uterus

Endometrial tissue can also develop in other areas, including the digestive tract, the lungs, and around the heart.

The body usually expels this type of tissue during menstruation, but the tissue that forms in endometriosis may remain in the body, which can lead to inflammation. As tissue decomposes, scar tissue can form.

Endometriosis can significantly affect a person’s quality of life. In addition to the pain, they may experience pressures relating to:

  • chronic pain
  • employment
  • the cost of medical care
  • relationships
  • difficulty maintaining a social life
  • concerns about not being able to become pregnant
  • stress, anxiety, and depression

A 2013 report notes that it can take an average of 6.7 years to get an accurate diagnosis. During this time, people lose an average of 10.8 hours of work a week due to the debilitating impact of the condition.

Symptoms of endometriosis include:

  • painful cramping, similar to menstrual cramps
  • long-term lower back and pelvic pain
  • periods lasting longer than 7 days
  • heavy menstrual bleeding
  • bowel and urinary problems, including pain, diarrhea, constipation, and bloating
  • blood in the stool or urine
  • nausea and vomiting
  • fatigue
  • pain during sex
  • spotting or bleeding between periods
  • difficulty becoming pregnant

Pain is the most common indication of endometriosis, but the severity of the pain does not always correlate with the extent of the disease.

Pain often disappears after menopause, when the body stops producing estrogen. However, if a person uses hormone therapy during menopause, symptoms may persist.

Pregnancy may provide temporary relief from symptoms.

What are endometriosis adhesions?

Diseases with similar symptoms

Endometriosis can be difficult to diagnose. One reason for this is that other medical conditions have similar symptoms. These include:

Complications of endometriosis include:

  • infertility, which can affect up to 50% of those with the condition
  • a higher risk of ovarian cancer or endometriosis-linked adenocarcinoma
  • ovarian cysts
  • inflammation
  • scar tissue and adhesion development
  • intestinal and bladder complications

Monitoring symptoms and seeking help may help prevent long-term complications. People should let their doctor know if they experience severe pain or unexpected bleeding.

There is currently no cure for endometriosis, but various treatment options may help manage symptoms. They include:

Pain relief

Medications can help manage pain. They include nonsteroidal anti-inflammatory drugs such as ibuprofen (Advil, Motrin IB, others) and drugs to relieve painful menstruation.

If over-the-counter options do not help, a doctor may prescribe stronger drugs.

Hormonal treatment

A doctor may recommend birth control pills or other hormonal methods of birth control, such as the Mirena device. In some cases, they may recommend gonadotrophin-releasing hormone.

These may reduce estrogen levels and help limit the development of unwanted tissue. However, they cannot repair adhesions or improve fertility.

Surgery

If other treatments do not work, a doctor may recommend surgery to remove unwanted tissue. In some cases, a hysterectomy with removal of both ovaries may be necessary.

Fertility treatment

If endometriosis affects fertility, in-vitro fertilization may be an option.

What is the latest research on endometriosis treatment?

Some complementary and alternative treatments and lifestyle choices may help manage endometriosis symptoms. They include:

  • acupuncture
  • herbal medicine
  • avoiding caffeine
  • hypnosis
  • biofeedback
  • counseling
  • regular exercise, such as walking

Some people may find these methods help, but there is little scientific evidence to show that they are effective. They will not cure endometriosis or reverse any damage that has occurred.

Click here for some tips on living with endometriosis.

It can be difficult for a medical professional to diagnose endometriosis because no specific test can confirm it, and the symptoms may be hard to see. The symptoms can also resemble the symptoms of other conditions.

Possible diagnostic strategies include:

  • a pelvic exam
  • imaging tests, such as an ultrasound or MRI scan
  • laparoscopy
  • a biopsy

Surgical laparoscopy is the only way to confirm a diagnosis of endometriosis. This is a minimally invasive procedure in which a doctor inserts a laparoscope through a small incision in the pelvic area. This provides images of tissue changes.

Stages

There are different ways of staging endometriosis. In 1996, the American Society of Reproductive Medicine (ASRM) set out four stages to describe the severity of endometriosis, ranging from minimal to severe.

StageCategoryFeatures
1MinimalIsolated implants and no significant adhesions
2MildSuperficial implants on the peritoneum and ovaries; no significant adhesions.
3ModerateMultiple implants, both superficial and deeply invasive. Adhesions may be present about the tubs and ovaries.
4SevereMultiple superficial and deep implants and large ovarian endometriomas; dense, filmy adhesions in most cases.

The stages of endometriosis are not specifically linked to levels of pain, the impact on mental health, and other factors. However, the risk of infertility appears to increase as the stages progress.

There is controversy regarding the stages. Some experts say they do not help doctors decide which treatment to offer, as they do not adequately reflect how the disease affects an individual.

Various dietary factors may affect the risk of developing endometriosis, the way a person experiences symptoms, and their overall sense of well-being.

A 2020 interview study involving 12 people concluded that focusing on dietary factors helped relieve pain and fatigue. This may be partly due to an enhanced awareness of endometriosis and an increased focus on diet and well-being overall.

Dietary factors that may be beneficial include:

  • removing gluten and dairy products from the diet
  • increasing the consumption of fruits and vegetables
  • avoiding junk food
  • preparing meals using fresh ingredients
  • avoiding caffeine and alcohol
  • following a low-FODMAP diet
  • consuming a type of seaweed known as bladderwrack

However, the studies that produced these suggestions were small, and there is no information regarding the race or ethnicity of participants. Researchers have not yet found enough evidence to confirm that any dietary steps will affect the risk or impact of endometriosis.

Here, learn more about how dietary choices may benefit a person with endometriosis.

Experts do not know exactly why endometriosis happens.

Two known risk factors are starting menstruation before the age of 11 years and heavy and prolonged menstruation, but other factors may play a role.

These include:

  • genetic factors, as it appears to run in families
  • problems with menstrual flow, resulting in blood and tissue not leaving the body
  • immune system problems, in which the immune system does not eliminate unwanted tissue
  • high levels of the hormone estrogen in the body
  • surgery to the abdominal area, such as a cesarean delivery or hysterectomy
  • shorter menstrual cycle
  • alcohol and caffeine consumption

Experts have linked some health conditions with endometriosis. These include:

Researchers also have found links between endometriosis and exposure to certain chemicals, including phthalates.

Endometriosis is a condition in which tissue resembling that which grows in the uterus develops in other areas of the body. It can lead to tissue damage and pain, and it can affect fertility.

There is currently no cure for endometriosis, but there are ways to relieve the pain and discomfort. Some people may need surgery.