Home Women's Health Endometriosis: Types, Symptoms, Causes,Treatment

Endometriosis: Types, Symptoms, Causes,Treatment

Signs and Symptoms of Endometriosis

by GP

What is endometriosis and why should you know about it? Endometriosis is a long-term issue that changes the tissue called endometrium that lines the uterus, according to Mayo Clinic. With endometriosis, the tissue can travel outside of the uterus or affect another area near it. This affects fertility and some women have chronic pain with certain bowel or bladder activities.

What is Endometriosis?

Endometriosis is a disorder caused when the tissue that normally lines the uterus (the endometrium) grows outside of the uterus. This tissue can be found on the ovaries, Fallopian tubes, pelvic ligaments, and anywhere in the abdominal cavity. When this happens, it’s called an ectopic pregnancy.

Endometriosis can cause severe pain, heavy bleeding, and infertility. It’s a chronic condition that affects women of reproductive age. It’s estimated that 1 in 10 women have endometriosis, but the exact number is unknown because many cases are mild and don’t require treatment.

Endometriosis is a common condition that can cause pain, trouble with your period, and, in some cases, infertility. Being diagnosed with endometriosis doesn’t mean you’re going to have trouble conceiving a baby. Many people with this condition can still have children later in life when their symptoms have subsided.

A few places you can develop endometriosis include the:

  • Outside and back of your uterus.
  • Fallopian tubes.
  • Ovaries.
  • Vagina.
  • Peritoneum (the lining of your abdomen and pelvis).
  • Bladder and ureters.
  • Intestines.
  • Rectum.
  • Diaphragm (a muscle near the bottom of your chest that plays an important role in breathing).

There are four stages of endometriosis, depending on how much endometrial tissue is present and where it’s located:

Stage 1: Minimal — A few small implants or lesions on the ovaries or Fallopian tubes
Stage 2: Mild — More extensive lesions on the ovaries or Fallopian tubes and some deep lesions in the pelvis
Stage 3: Moderate — Many deep lesions in the pelvis and possible kidney or bladder involvement
Stage 4: Severe — Extensive lesions throughout the pelvic area and possibly elsewhere in the body

Types of Endometriosis

Endometriosis is a chronic, often painful condition in which the endometrium, or lining of the uterus, grows outside of the uterus. Endometriosis most commonly involves the ovaries, fallopian tubes, and the tissue lining the pelvis. Endometriosis can also occur in other parts of the body, such as the intestine, bladder, and rectum.

Endometriosis is classified into four types, depending on where and how deeply the endometrium implants are growing:

1. Superficial endometriosis: Involves growths on or near the surface of your pelvic organs or cavity. In some cases, superficial endometriosis can lead to deeper implantations.
2. Ovarian endometriomas (also called “chocolate cysts”): Fluid-filled sacs that develop on your ovary as a result of endometrial tissue implants becoming stuck to your ovary surface and growing within its structure. These chocolate cysts can range in size from small (the size of a pea) to large (the size of an orange).
3. Endometrial implants: Growth of endometrial tissue on organs in your pelvis other than your uterus, such as your ovaries, fallopian tubes, or outer surfaces of your uterus. Implants can be found on nearby structures such as ligaments and bowel surfaces. They can also be found in abdominal scars from previous surgery.

Signs and Symptoms of Endometriosis

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, diarrheaconstipation, and bloating
  • blood in the stool or urine
  • nausea and vomiting
  • fatigue
  • pain during sex
  • spotting or bleeding between periods
  • difficulty becoming pregnant

The symptoms of endometriosis vary. Some people experience mild symptoms, but others can have moderate to severe symptoms. The severity of your pain does not indicate the degree or stage of the condition. You may have a mild form of the disease yet experience agonizing pain. It’s also possible to have a severe form and very little discomfort.

It’s important to note that you may not experience any symptoms.

Pelvic pain is the most common symptom of endometriosis.

RECOMMENDED: Endometrial Ablation

Causes of Endometriosis

During a regular menstrual cycle, your body sheds the lining of your uterus. This allows menstrual blood to flow from your uterus through the small opening in the cervix and out through your vagina.

The exact cause of endometriosis isn’t known. There are several trusted Source theories regarding the cause, although no one theory has been scientifically proven.

One of the oldest theories is that endometriosis occurs due to a process called retrograde menstruation, which 90 percent trusted Source of women’s experience, according to research. This happens when menstrual blood flows back through your fallopian tubes into your pelvic cavity instead of leaving your body through the vagina.

Another theory is that hormones transform the cells outside the uterus into cells similar to those lining the inside of the uterus, which are known as endometrial cells.

Others believe the condition may occur if small areas of your abdomen convert into endometrial-like tissue. This may happen because cells in your abdomen grow from embryonic cells, which can change shape and act like endometrial cells. It’s not known why this occurs.

These displaced endometrial cells may be on your pelvic walls and the surfaces of your pelvic organs, such as your bladder, ovaries, and rectum. They continue to grow, thicken and bleed over the course of your menstrual cycle in response to the hormones of your cycle.

It’s also possible for the menstrual blood to leak into the pelvic cavity through a surgical scar, such as after a cesarean delivery, also commonly called a C-section.

Another theory is that the endometrial cells are transported out of the uterus through the lymphatic system. Still another theory purports it may be due to the immune system not working properly in destroying errant endometrial cells.

Some believe endometriosis might start in the fetal period with misplaced cell tissue that begins to respond to the hormones of puberty. This is often called Mullerian theory.

The development of endometriosis might also be linked to genetics or even environmental toxins.

Treatment of Endometriosis

Understandably, you want quick relief from pain and other symptoms of endometriosis. This condition can cause challenges in your day-to-day activities if it’s left untreated. Endometriosis has no cure, but its symptoms can be managed.

Medical and surgical options are available to help reduce your symptoms and manage any potential complications. Your doctor may first try conservative treatments. They may then recommend surgery if your condition does not improve.

Medical option

Medications are often used to help control the symptoms of endometriosis. These can include pain medications and hormone therapies.

Pain medications

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.

READ ALSO:2 Best Ways to Treat Ectopic Pregnancy 

Hormonal therapies

  • Birth control: There are multiple forms of hormonal suppression options including combination options using estrogen and progesterone or progesterone-only options. These come in multiple forms including oral birth control pills, patches, vaginal rings, birth control shots, Nexplanon implants, or IUDs. This hormonal treatment often helps people have lighter, less painful periods. These are not options for patients attempting pregnancy.
  • Danazol (Danocrine®): This is another form of hormonal medication that stops the production of the hormones that cause you to have a period. While taking this medication for endometriosis symptoms, you may have the occasional menstrual period, or they might stop entirely.
  • Gonadotropin-releasing hormone (GnRH) agonists and antagonists

    People take what are called gonadotropin-releasing hormone (GnRH) agonists and antagonists to block the production of estrogen which stimulates the ovaries. An example of a GnRH agonist is Lupron Depot, an injectable, while Elagolix, which is taken orally, is an antagonist. Both can suppress estrogen production.

    Estrogen is the hormone that’s mainly responsible for the development of sexual characteristics in people assigned female at birth. Blocking the production of estrogen prevents menstruation and creates artificial menopause.

    GnRH therapy has side effects like vaginal dryness and hot flashes. Taking small doses of estrogen and progesterone at the same time can help to limit or prevent these symptoms.

    Getting a diagnosis and starting treatment options early in the disease can be challenging. Thinking about — or coping with — symptoms like fertility issues and pain coupled with fear possibly setting in about getting relief can be stressful.

    It’s important to address your mental wellness as part of your overall well-being. Consider finding a support group and educating yourself more on the condition. Taking these steps can be helpful in creating a well-balanced approach to managing your condition.

Surgical options

  • Hysterectomy : During a total hysterectomy, a surgeon removes the uterus and cervix. They also remove the ovaries because these organs make estrogen, and estrogen can cause the growth of endometrial-like tissue. Additionally, the surgeon removes visible implant lesions.Two other types of hysterectomies are performed based on the condition a person is being treated for.A subtotal — also referred to as partial or supracervical — hysterectomy removes the upper part of the uterus, leaving the cervix in place.A radical hysterectomy is typically performed when cancer is present. It removes the entire uterus, cervix, and the top part of the vagina.While a hysterectomy can treat endometriosis it is not a cure. You’ll be unable to get pregnant after a hysterectomy. If you’re thinking about starting a family, get a second medical opinion before agreeing to surgery.
  • Laparoscopy: In this procedure, your surgeon will make a very small cut in your abdomen (< 1 centimeter) and insert a thin tube-like tool called a laparoscope into your body. This tool can be used to see inside your body and identify endometriosis with a high-definition camera. Additional 5-millimeter instruments can then be used to excise and remove lesions.


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 includeTrusted Source:

  • 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.

Endometriosis complications

Having fertility issues is a serious complication of endometriosis. Individuals with milder forms may be able to conceive and carry a baby to term.

Although there are medications used to treat endometriosis, they do not improve fertility.

Some people have been able to conceive after having endometrial-like tissue surgically removed. If this does not work in your case, you may want to consider fertility treatments or in vitro fertilization to help improve your chances of having a baby.

Talk with your doctor to better understand your options such as if you’re planning to start a family and whether you should consider having children sooner rather than later if you’ve been diagnosed with endometriosis. Or your doctor can help you in learning more about alternatives for becoming a parent or delaying pregnancy.

With endometriosis, your symptoms may worsen over time, which can make it difficult to naturally conceive. Your doctor will need to do an assessment before and during your pregnancy.

Even if fertility is not a complication that you experience, managing chronic pain can still present challenges. Depression, anxiety, and other mental health issues may arise as they’re not uncommon in people with endometriosis.

Talk with your doctor about ways to help cope with these side effects. They may recommend joining a support group or using other supportive resources to help manage your situation.

Risk factors

Endometriosis usually develops years after the start of your menstrual cycle. It can be a painful condition.

However, understanding its risk factors can help you determine whether you’re more likely to develop this condition and when you should talk with your doctor.


Women of all ages are at risk for endometriosis. It most commonly affects womenTrusted Source in their 30s and 40s, but symptoms can begin at pubertyTrusted Source.

Family history

Talk with your doctor if you have a family member who has endometriosis. You may have a higher risk of developing the disease.

Pregnancy history

Pregnancy may temporarily decrease the symptoms of endometriosis. Women who have not had children are at an increased risk of developing the disorder. However, endometriosis can still occur in women who’ve had children. This supports the understanding that hormones influence the development and progress of the condition.

Menstrual history

Talk with your doctor if you have problems with your period. These issues can include:

  • shorter cycles
  • heavier and longer periods

Natural remedies

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

  • 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.


Endometriosis is a chronic condition that has no known cause. Currently, there is no cure for the disease, though medications, hormone therapy, and surgery can significantly reduce its symptoms and complications. The symptoms of endometriosis usually improve after menopause.



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