Endometriosis is a condition that affects many women.  It is estimated that about 10% of females ages 15 to 49 are affected.  I think this percentage of women with endometriosis is much higher than 10%.  That is because the only sure way to be diagnosed with endometriosis is to have laparoscopic surgery.

There are many signs and symptoms of endometriosis, but they tend to overlap with other hormonal imbalances.  Often it is confused with fibroids, ovarian cysts, and painful, heavy periods to name a few. And like I said, the only sure way to know is having surgery and finding endometriosis in the pelvic cavity.  

What is Endometriosis?
Endometriosis is the lining of the uterus has seeded itself elsewhere in the body.  The top lining of the uterus is called the endometrium. It is the cells of this lining (endometrium) that is found outside of the uterus.  Common places endometriosis is found:
-Fallopian tubes: Sometimes it can cause scar tissue on the fallopian tubes reducing fertility or can contribute to an ectopic pregnancy (which is a health emergency).

• Ovaries: commonly it can cause ovarian endometrioid cysts.   
• Colon
• Cervix
• Vagina
• Bladder
• Some rare reports have shown in the lung cavities and other organs

Why is there Uterine Tissue Not in the Uterus?

There are many conflicting theories on why the endometrium lining that is supposed to be in the uterus is elsewhere in the pelvic cavity.  A long-held theory is in utero when cells are developing; uterine cells are seeded in other areas outside of the uterus. A more recent theory is there is a  retrograde of flow during a period. The blood backs up and out of the uterus causing uterine cells to plant themselves anywhere in the pelvic cavity.

New hypotheses are endometriosis is an extension of autoimmune and inflammatory diseases. But plenty of people do not have endometriosis.  Why some do and not others? Like mentioned above it could be genetic, autoimmune, lifestyle, retrograde mechanical flow, etc.
The old-school theory of developing in utero has pretty much been put on the shelf.  Endometriosis often comes back after laparoscopic surgery. Sometimes it comes back slightly, moderately or its back with a vengeance after surgery.  Which is why many women with endometriosis have had more than one surgery.

The big question: What Does Endometriosis Feel Like?
Pain: Pain is the number symptom that women with endometriosis are seeking answers.  There are several types of pain that are experienced in endometriosis. And the pain is no reflection of how much endometriosis they have in their pelvic cavity.  Some women have minimal endometrial lining seeded outside of the uterus. But report debilitating pain. Other women have stage four endometriosis and have little to no pain.  The only way to tell how much lining or endometriosis you have is by laparoscopic surgery. The pain is most commonly felt below the belly button to the top of the pubic bone. It might be all over this area or to the right or left depending on where the endometriosis tissue is located.  Some women even report low back pain that is associated with endometriosis.

Types of Pain Associated with Endometriosis: 

• Chronic pain all the time. Pain all month long.
• Pain half of the month starting about a week before your period and extending into the week of your period
• Painful periods (dysmenorrhea):  Horribly painful, cramping periods.  I have had patients that take sick days from work because of the pain or bring heating pads to work.
• Painful ovulation.  This can happen when the endometriosis tissue is on the ovary/ovaries.
• Ovarian pain all month long.  There can be a constant dull ache or sharp pain on the right or left side.  This is the case if there is an endometrioid cyst on one of the ovaries.
• Pain with bowel movements.
• Pain with urination.
• Pain with intercourse.

Associated Symptoms of Endometriosis: 

• Heavy periods (menorrhagia): Losing a lot of blood.  I have had women that cannot even wear tampons because the bleeding is heavy.  The menstrual cup can be effective to catch all the blood that is bleeding. But women report that it is a bloody nightmare’ to change that thing, especially in public.  There can be such heavy periods that women end up with anemia (low blood iron).
• Long periods: Periods lasting anywhere from 10 days to two weeks.  There is nothing worse than having a heavy period and then having it last for over a week.  And it always seems to happen on vacations or road trips (murphy’s law I guess).
• Spotting mid-cycle or anytime in your cycle: There can be spotting that ranges from brown to bright red.  There can be spotting after intercourse, exercise or after a bowel movement. Or slight spotting that just shows up the toilet paper after you goto the bathroom.
• Infertility: Endometriosis can decrease fertility.  It is common for surgeons to tell patients to try and get pregnant after laparoscopic surgery for endometriosis.  Endometriosis commonly improves after pregnancy. And a woman has the best chances for reproduction at that point after a laparoscopic surgery.  
• Bloating: There can be quite a bit of bloating below the belly button in endometriosis.  It can occur during ovulation. Bloating can also happen before (during PMS) and during a period.  
• Constipation: If the endometriosis is on the colon or rectum is can cause constipation and painful bowels.  Sometimes there can also be diarrhea. But constipation is more common.
• Frequent urination: If the endometriosis is seeded on the bladder it can cause a woman to feel like she has to constantly urinate.  Even if her bladder is not full.
• Painful sex (dyspareunia):  Endometriosis can cause pain during intercourse.  And I have had women report that they will have intense pain during or after a orgasm.

There are many other symptoms that women feel with endometriosis.  They can also have nausea, loss of appetite, fatigue. Not to mention the effect on the mood of the woman.  It is very frustrating and disempowering to have to deal with these symptoms. And there are not a lot of options out there for endometriosis.

Those mainly are hormone therapy and surgeries. Surgeries being laparoscopic to find and remove the endometriosis lesions in the pelvic cavity.  Even in some cases resorting a hysterectomy/oophorectomy (removal of uterus and ovaries). Every treatment plan for endometriosis is different for each woman.  And what works for some, may not work for others. So if you are dealing with endometriosis make sure you work with a patient, functional medicine doctor that is going to tailor a treatment that fits for you.

Hopefully is podcast has been helpful. If you have any questions, please leave a comment below or send an email to [email protected]