Endometriosis

• Endometriosis is a condition in which tissue resembling the inner lining of the uterus grows in other places outside the uterus
• The symptoms of endometriosis often include abdominal pain, painful periods with heavy bleeding, pain when passing urine or having a bowel movement, and deep pain during sexual intercourse
• Endometriosis treatment is mainly focused on relieving symptoms and improving fertility

Endometriosis is a chronic condition characterized by the growth of tissue outside of the uterus that resembles the inner lining of the uterus. This abnormal growth can cause abdominal pain and is also linked to difficulty getting pregnant. With early treatment, the symptoms of the condition can be relieved and your chances of pregnancy can improve. In this article by Ada’s medical team, you can find a full guide on endometriosis, its symptoms, diagnosis, and treatment.

Endometriosis is a chronic disease that affects about 10% of reproductive-age women worldwide. With endometriosis, tissue that resembles the lining of the uterus grows in other places, outside of the uterus. The additional growth usually occurs within the pelvis, although there are some rare cases in which endometriosis can also be found outside of the pelvis. Some places where endometriosis can commonly be found are the ovaries, the fallopian tubes, the bladder, and the bowels. The unusual growth of this tissue can cause inflammation and scar tissue to form. This condition can have a severe impact on life, as it can cause many symptoms that decrease the quality of life. In severe cases, it can also affect your possibility of pregnancy. 1

Endometriosis can happen to any woman during the reproductive years, from the first menstruation to menopause. After menopause, the symptoms of endometriosis usually decrease, although in some cases they can also persist. 2

Endometriosis stages can be helpful to assess how severe your endometriosis is. Endometriosis specialists classify the condition based on how many tissue growths there are, and how deep they have grown. 3

• Stage 1 endometriosis: minimal endometriosis with only a few superficial tissue growths
• Stage 2 endometriosis: mild endometriosis with more and deeper tissue growths 
• Stage 3 endometriosis: moderate endometriosis with many deep tissue growths, small cysts on the ovaries, and adhesion between tissues
• Stage 4 endometriosis: severe endometriosis with many deep tissue growths, large cysts on the ovaries, and severe adhesion between tissues

The symptoms of endometriosis can vary. Some women only experience mild discomfort or no signs of endometriosis at all, whereas others can have severe pain that impacts the quality of life. 

The most common endometriosis symptom is pain in the lower part of your belly or your back during periods, sexual intercourse, bowel movements, or urination. Although it’s more common to experience pain at these specific moments, some women also experience this pain for a longer period of time. Other common endometriosis symptoms include: 1 2

• Heavy bleeding during or between periods
• Severe pain during your period
• Bloating
• Nausea
• Feeling tired
• Constipation, diarrhea, or blood in your stool or urine during your period
• Trouble getting pregnant 
• Depression 

It’s important to talk to your healthcare provider if you experience any of these symptoms, as early detection can help you get to the correct treatment earlier on. 

Endometriosis's causes are not fully understood. Scientists have however indicated a few reasons that may contribute to the condition: 2

• Genetics
• Issues with the immune system
• Retrograde menstruation, which means that period blood containing cells of the inner lining of the uterus flows back into the pelvic cavity. This can cause these cells to implant themselves in new locations where they can start to grow. 
• Cells outside the uterus may change into cells that resemble the inner lining of the uterus during a process called cellular metaplasia.
• Cells from the inner lining of the uterus can spread to other parts of the body through the lymphatic system or the bloodstream

Scientists believe that there is also a link between estrogen and endometriosis, although further research is still needed.

Endometriosis pain can improve over time, but without the correct treatment, it is likely that your endometriosis evolves into a further stage. How long this takes can be different for everyone. It’s important to keep a close eye on your symptoms and to follow up with your healthcare provider so that you can get the appropriate treatment when needed. 4

Endometriosis diagnosis can be made after a careful evaluation of your symptoms and your medical history. As endometriosis can present itself with symptoms similar to other conditions, it’s important that the diagnosis gets confirmed with a laparoscopy. This is a procedure in which a small camera is inserted into the lower belly so that your doctor can look for signs of endometriosis. 5

Endometriosis treatments focus on symptom relief, as there is no permanent cure available at this time. Your endometriosis treatment will be based on the aim of the treatment, which can be pain relief, removal of endometriosis tissue, increasing your chances of pregnancy or reducing the chance of endometriosis returning. Some possible treatment options are: 2 4

• Pain medication such as ibuprofen or paracetamol to relieve your symptoms
• Hormone treatment to limit the production of estrogen in your body
• Surgery to remove the endometriosis tissue

The main complication of endometriosis is difficulty getting pregnant. This happens as the tissue growth may cause damage to the fallopian tubes or the ovaries. By removing the endometriosis tissue, you can increase your fertility again, although this is not a certainty. 

In some cases, endometriosis can affect the bladder or the bowel, which can require major surgery to remove a part of your bladder or a section of your bowel. 4

Endometriosis is a chronic condition that can cause severe symptoms and it can even lead to infertility. As the symptoms of this condition resemble those of other conditions, it’s important to provide your healthcare provider with as much information as possible, so that the diagnosis can be made early on and treatment can be initiated as soon as possible. 

Q: Can you get pregnant with endometriosis? 
A: It’s possible to get pregnant if you have endometriosis, although difficulty getting pregnant is a known complication of the condition. 

Q: Does endometriosis cause infertility? 
A: Endometriosis and pregnancy difficulties are closely related, especially if the condition causes damage to the fallopian tubes or the ovaries. There are however possible treatments to improve your chances of pregnancy. 

Q: Is endometriosis genetic? 
A: Although the exact cause of endometriosis remains uncertain, it’s possible that there may be a genetic factor playing a role in the development of endometriosis. 

Q: Does endometriosis cause weight gain? 
A: Endometriosis doesn’t cause weight gain directly, although treatments for endometriosis can contribute to weight gain. Endometriosis also causes bloating, which can be mistaken for weight gain as well. 

Q: What is the main cause of endometriosis? 
A: The cause of endometriosis is thought to be related to cells from the inner lining of the uterus appearing and growing in other places of the body. This can happen because of retrograde menstruation, issues with estrogen, genetics, or issues with the immune system.