The Signs and Symptoms of Endometriosis

Author
Kristin Hoppe
,
Reviewer
Melissa M. Keenan
,
Ph.D.
Endometriosis affects more than 6.5 million people in the United States a year. So, what do the signs and symptoms look like?

If you’re wondering whether you have endometriosis, you’re not alone.


Endometriosis is a common gynecological condition that affects about 11% of American women¹ between ages 15 and 44.


Any woman can develop endometriosis, but people may have a higher risk if they²:

  • Have a close biological relative who shares the condition
  • Started their period before age 11
  • Have monthly cycles of less than 27 days
  • Have heavy periods that last longer than 7 days


What is endometriosis?

When a person has endometriosis, an endometrium-like tissue (often referred to as implant, nodule, or lesion) is found on reproductive organs such as³⁻⁴:

  • Ovaries
  • Fallopian tubes
  • Tissues that hold the uterus in place
  • Outer surface of the uterus
  • Vagina, cervix, vulva, bowel, bladder, or rectum
  • Abdominal cavity

In addition to causing pain, endometriosis sometimes makes it harder for people to get pregnant.


Signs and symptoms of endometriosis

Not everyone presents all symptoms or the exact same symptoms, but some of the common signs may include¹ ﹐⁴:

  • Pain (like excessive menstrual cramps in your abdomen or lower back)
  • Bleeding or spotting between periods
  • ​​Abnormal or heavy menstrual flow
  • Infertility (detailed more in the next section)
  • Gastrointestinal problems

If you are experiencing any of these symptoms, keep a journal of what pain occurs and when before seeing your doctor. This may help clarify whether or not you have endometriosis, and help you come with more evidence than just generic pain.


How is endometriosis diagnosed?

In order to receive a diagnosis for endometriosis⁵, your healthcare provider or gynecologist will:

  1. Ask questions about your medical history (including family medical history)
  2. Conduct a physical examination and pelvic exam
  3. Perform an ultrasound, or MRI scan to view internal organs

However, the only way to get a completely certain diagnosis of endometriosis is for a doctor to use laparoscopy and perform a biopsy on unusual tissue.


Laparoscopy uses a laparoscope, which is a thin tube with a camera at the end. In this minor medical procedure, your healthcare provider would create a small incision and insert the laparoscope⁶ in order to understand the size, location, and extent of endometrial growths.


What causes endometriosis?

Long story short, the causes of endometriosis are not definitively clear. However, there are a few different theories⁴:

  1. While you're on your period, some of the tissue may back up through your fallopian tubes into the abdomen, where it attaches and then grows, sort of like a reverse period.
  2. Endometrial tissue may travel and implant itself through lymphatic channels or blood
  3. Cells in any location may transform into endometrial cells.

Other potential causes may include¹:

  • Immune system problems
  • Genetic factors
  • Hormones
  • Certain surgeries


How is endometriosis treated?

Most healthcare providers use "watchful waiting"⁴ to see how the health condition progresses. That means repeating tests or allowing some time to pass before making major health interventions.


There are also several types of medicine you can take to address symptoms of endometriosis, such as:


Pain medication

Nonsteroidal anti-inflammatory drugs⁷ like ibuprofen can help you manage pain from endometriosis. Other over-the-counter analgesics like acetaminophen, aspirin, and naproxen may help with the pain as well.


Extended cycle or continuous cycle birth control

Extended cycle birth control⁸ is a daily combination pill of estrogen and progestin that allows you to have your period only once every three to four months. Continuous cycle birth control, such as the combination pill or mini pill⁹, may also be used to treat the symptoms of endometriosis¹. Some recent studies have come out that suggest progestin-only (mini) pills might be better¹⁰ than combination pills in treating endometriosis.


Hormonal IUD

A hormonal IUD such as Mirena can be used to treat endometriosis by suppressing tissue growth, reducing bleeding, and easing pelvic inflammation. However, this is a more recently employed, off-label use that requires additional research and clinical trials to fully validate¹¹.


GnRH agonist

Also known as gonadotropin releasing hormone, GnRH agonists are modified versions of a naturally occurring hormone. By reducing the level of estrogen made by the ovaries, this can shrink the endometriosis.¹²

However, GnRH should not be taken for longer than six months because it can cause other severe side effects¹³ such as bone loss. It can also cause temporary infertility, so it would not be a good choice for those who are seeking to get pregnant.


Danazol

Danazol is a synthetic derivative of testosterone¹⁴. Treatments of danazol¹⁵ usually last between three to six months, but may have side effects such as increased body hair and acne.


Surgery

Surgery is only used for severe symptoms of endometriosis¹. A surgeon can locate where the endometriosis is and remove it. Some patients resume taking hormonal treatments, such as oral contraceptives, after surgery to prevent the endometriosis from recurring¹⁶. However, as of 2016, there is limited clinical evidence to suggest this works.¹⁷

Identifying and managing endometriosis might feel like an overwhelming task. But if you do receive a diagnosis, there are many different treatments available that can help ease your symptoms.


adyn can help

We specialize in helping people find the right birth control for their bodies. If you have been diagnosed with endometriosis and are looking for birth control as treatment without negative side effects, our team may be able to help you find the best birth control for your body.

Citations

  1. Office on Women’s Health. (2019b, April 1). Endometriosis. https://www.womenshealth.gov/a-z-topics/endometriosis
  2. National Institutes of Health. (2021). What are the risk factors for endometriosis? https://www.nichd.nih.gov/health/topics/endometri/conditioninfo/at-risk
  3. National Institutes of Health. (2020, February 21). About Endometriosis. https://www.nichd.nih.gov/health/topics/endometri/conditioninfo
  4. Johns Hopkins Medicine. (2021). Endometriosis. https://www.hopkinsmedicine.org/health/conditions-and-diseases/endometriosis
  5. A, H. (2011, June 1). Invasive and non-invasive methods for the diagnosis of endometriosis. NCBI. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2880548/
  6. Office of Communications. (2020, February 2). How do healthcare providers diagnose endometriosis? National Institutes of Health. https://www.nichd.nih.gov/health/topics/endometri/conditioninfo/diagnose
  7. Endometriosis UK. (2021). Pain relief for endometriosis. https://www.endometriosis-uk.org/pain-relief-endometriosis
  8. University of Michigan Health. (2019, July 18). ethinyl estradiol and levonorgestrel (extended-cycle). https://www.uofmhealth.org/health-library/d03242t1
  9. Centers for Disease Control and Prevention. (2017, February 1). Combined Hormonal Contraceptives. https://www.cdc.gov/reproductivehealth/contraception/mmwr/spr/combined.html
  10. Casper, R. F. (2017). Progestin-only pills may be a better first-line treatment for endometriosis than combined estrogen-progestin contraceptive pills. American Society for Reproductive Medicine. Published. https://pubmed.ncbi.nlm.nih.gov/28162779/
  11. Wood, R. (2021). Mirena. Https://Endometriosis.Org/Treatments/Mirena/. https://endometriosis.org/treatments/mirena/
  12. Rafique, S. (2018). Medical management of endometriosis. National Library of Medicine. Published. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5794019/
  13. LiverTox. (2018). Gonadotropin Releasing Hormone (GnRH) Analogues. LiverTox. Published. https://www.ncbi.nlm.nih.gov/books/NBK547863/
  14. National Cancer Institute, Drug Dictionary. danazol. https://www.cancer.gov/publications/dictionaries/cancer-drug/def/danazol?redirect=true
  15. MedlinePlus. (2017, May 24). Danazol. https://medlineplus.gov/druginfo/meds/a682599.html
  16. National Institutes of Health. (2020, February 21). What are the treatments for endometriosis? https://www.nichd.nih.gov/health/topics/endometri/conditioninfo/treatment 
  17. Somigliana, E. (2017). Postoperative hormonal therapy after surgical excision of deep endometriosis. National Library of Medicine. Published. https://pubmed.ncbi.nlm.nih.gov/27067871/


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