Endo warriors live with relentless pain that disrupts their daily life. Endo pain intensifies during periods, sexual intercourse (also known as dyspareunia), or even during a simple trip to the bathroom. It is the reality for around 190 million women and girls of reproductive age worldwide, all battling endometriosis.
More than just period pain, this chronic condition brings with it a range of debilitating symptoms like chronic pelvic pain, bloating, fatigue, and even emotional struggles such as anxiety and depression. Endometriosis can begin at the start of a person's menstrual period and last until menopause.
Endometriosis occurs when tissue similar to the endometrium (the tissue that lines the inside of the uterus) begins to grow outside the uterus, typically in areas such as the ovaries, fallopian tubes, or the lining of the pelvic cavity.The disease triggers a chronic inflammatory response, often leading to scar tissue (adhesions and fibrosis) forming in the pelvic region and other body parts.
Several types of lesions have been identified:
- Superficial endometriosis, which is primarily found on the pelvic peritoneum.
- Cystic ovarian endometriosis (endometrioma) is located in the ovaries.
- Deep endometriosis affects areas such as the recto-vaginal septum, bladder, and bowel.
In rare cases, endometrial lesions can be found outside the pelvis, further complicating the condition. Experts and healthcare practitioners believe that there is no known cure; however, managing endometriosis requires early diagnosis and effective treatment.
In this blog, we will explore this chronic condition's causes, risks, and treatment.
Beginners guide (Part 2): Everything you need to know about endometriosis.
What are the risk factors of endometriosis?
Several factors can increase the risk of developing endometriosis. These include:
- Women who haven't had children may be more prone to endometriosis.
- Starting your period at a young age can raise the risk.
- The later you go through menopause, the higher the chance of developing endometriosis.
- Having short menstrual cycles, shorter than 27 days can increase your risk.
- Heavy and extended periods that last more than seven days and are particularly heavy could add to the risk.
- Higher estrogen levels or prolonged lifetime exposure to it can also be contributing factors.
- If close relatives like your grandmother, mother, sister, or aunt have had endometriosis, your chances increase.
- Conditions that block blood from flowing out during menstruation or affect the reproductive system could raise the risk as well.
Endometriosis symptoms, like severe pain during menstruation, typically appear several years after periods begin. Pregnancy may offer temporary relief from these symptoms, and the pain often reduces during menopause unless estrogen therapy is used. Recognizing these risk factors early on can help you identify whether you're more likely to develop endometriosis and prompt conversations with the right expert for foolproof assistance.
What causes endometriosis?
While the exact cause of endometriosis remains a mystery, several theories offer possible explanations:
Retrograde menstruation:
One of the leading ideas is that menstrual blood flows backward through the fallopian tubes and into the pelvic area instead of leaving the body. This blood contains endometrial cells, which can stick to the pelvic walls or organs like the bladder and ovaries, causing them to grow, thicken, and bleed during each cycle.Research supports this theory, showing higher volumes of menstrual blood and tissue in women with endometriosis.
Coelomic metaplasia
Peritoneum (the thin membrane lining the abdominal cavity) contains undifferentiated or multipotent cells that have the ability to transform into endometrial cells under specific conditions. This metaplastic transformation may be triggered by inflammation, hormonal influences (especially estrogen), genetic factors, or environmental toxins.
Persistent irritation or inflammation in the peritoneal cavity, possibly due to menstrual reflux, immune dysfunction, or exposure to endocrine-disrupting chemicals, could stimulate this transformation. Additionally, embryonic remnants of Müllerian duct tissue in the peritoneum may also contribute to this process, leading to the spontaneous formation of endometrial tissue outside the uterus.
This theory is particularly significant in explaining cases of endometriosis in individuals who have no history of retrograde menstruation, such as prepubescent girls or postmenopausal women. It may also account for rare cases of endometriosis found in unusual locations, such as the lungs or other distant organs.
Embryonic cell theory:
Hormones, particularly estrogen, may cause cells left over from the fetal stage (embryonic cells) to change into endometrial cells during puberty, leading to growth outside the uterus.
Surgical scars:
Endometrial cells can sometimes attach to scar tissue after surgeries like C-sections, resulting in endometriosis in areas where the uterus has no direct connection.
Metastatic spread:
Some suggest that endometrial cells can travel to other parts of the body through the bloodstream or the lymphatic system, spreading the condition beyond the reproductive organs.
Stem cells
Recent studies suggest that stem cells may contribute to the development of endometriosis. For example, bone marrow-derived stem cells might differentiate into endometrial cells and cause endometriosis outside the uterus, such as in the lungs or nervous system.
Heritability and genetics
Research shows that genetics play a role in endometriosis, with studies suggesting that 47-51% of the risk is inherited. Of this, around 26% is linked to genetic variations. Scientists have identified 19 genetic markers through large-scale studies, but these markers explain only a small part of the overall risk. Most of these genetic variations are linked to more severe stages of the disease (stages III/IV).
While no specific high-risk genes have been found yet, researchers believe that understanding these genetic markers could uncover new pathways for how endometriosis develops. Future studies aim to link genes with symptoms such as pain, infertility, and treatment responses, as well as related conditions like autoimmune diseases, cancer, and cardiovascular issues.
Immune system issues:
Differences in the immune and inflammatory responses are noted in women with endometriosis compared to those without. Inflammation in the pelvic area may prevent the body from clearing abnormal endometrial cells, help these cells stick to pelvic surfaces and grow, reduce natural cell death, and promote lesion formation. It also supports lesion survival by encouraging blood vessel growth (angiogenesis).
Additionally, menstrual blood contains high levels of inflammatory proteins and immune cells, which may alter the pelvic environment, making it easier for lesions to develop. This could explain why some women develop endometriosis despite retrograde menstruation.
No matter the cause, every woman battling endo seeks a secret solution that can help them get rid of this severe pain and discomfort.
What complications could endometriosis cause?
Endometriosis is a complex, estrogen-driven gynecological condition that affects many aspects of a woman's health, often causing pain and a range of other health complications.
Infertility challenges
One of the most significant complications of endometriosis is infertility. Up to half of women diagnosed with the condition experience difficulty conceiving. Due to endometriosis, the fallopian tubes can get blocked, preventing the union of the egg and sperm. It can even damage reproductive tissues, making fertilization difficult. While some women with mild to moderate endometriosis can still conceive, the condition often worsens over time, making it harder to become pregnant. Fertility can also be affected by the degree of endometriosis and the involvement of reproductive organs.
Mental health struggles
The impact of endometriosis extends beyond physical pain to mental health challenges. Chronic pain caused by the condition can cause mental health issues like depression, anxiety, and emotional fatigue. The mental strain can affect daily life, making it challenging to engage in everyday activities.
Pain during intercourse can add to the stress of maintaining satisfying relationships with partners. Managing work, education or other responsibilities becomes a herculean task. This emotional strain can worsen the overall impact on endo-warriors.
Research suggests that women with endometriosis often experience higher levels of neuroticism. Neuroticism is a personality trait associated with mood swings, irritability, and heightened anxiety. Neuroticism can make it harder for individuals to deal with endometriosis, making it a multisystem issue that affects both the body and mind. Additionally, the emotional toll of living with a condition that is not always understood or treated effectively can exacerbate feelings of hopelessness or frustration.
Associated health conditions
Endometriosis is not only a reproductive health issue; it can be linked with several associated conditions that affect other systems in the body:
Chronic pain conditions:
People with endometriosis are at a higher risk for conditions like fibromyalgia, migraines, and arthritis, which can increase the overall burden of chronic pain.
Bladder and bowel issues:
Many women with endometriosis also experience bladder pain syndrome (interstitial cystitis), which causes pelvic pressure, frequent urination, and pain while urinating. Some also struggle with frequent urinary tract infections (UTIs), adding to their discomfort.
Digestive problems are common too, especially irritable bowel syndrome (IBS), which often occurs alongside endometriosis. Depending on the type, IBS can cause constipation (IBS-C), diarrhea (IBS-D), or a mix of both (IBS-M). These symptoms can make it hard to tell if the pain is from endometriosis or digestive issues, leading to delays in diagnosis and treatment.
Bloating, often called ‘Endo Belly,’ is another major concern. It can cause severe swelling in the abdomen due to inflammation, fluid retention, and digestive issues, leading to both physical discomfort and emotional distress.
Ovarian cancer:
While rare, endometriosis slightly increases the risk of ovarian cancer, particularly types like clear cell and endometrioid cancers. The risk of ovarian cancer in endometriosis patients is about 2.5%, compared to 1.3% in the general population.
Gynecological disorders:
Women with endometriosis may also face other gynecological conditions, such as uterine fibroids and adenomyosis, which can further complicate treatment and management.
Inflammation-related complication:
Inflammatory processes complicate the overall health of individuals with endometriosis. Chronic inflammation can lead to persistent pelvic pain by activating pain receptors. It can trigger immune system dysfunction, making the body more susceptible to autoimmune diseases, early menopause, cardiovascular problems, and other systemic conditions.
Challenges in diagnosis
Despite the advances in medical science, endometriosis is often challenging to diagnose due to the overlap of symptoms with other conditions. The uncertainty of diagnostic tools makes it harder for healthcare providers to distinguish endometriosis from similar situations. This delay in diagnosis can cause further emotional and physical strain, as endo-patients may face years of uncertainty and misdiagnosis.
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What are endometriosis treatment options?
Endometriosis treatment requires a tailored approach based on symptom severity, fertility goals, and patient preferences. A multidisciplinary strategy that combines these approaches often yields the best outcomes for managing pain and improving quality of life.
Over-the-counter pain relievers
Over-the-counter pain relievers, such as ibuprofen (Advil, Motrin IB) or naproxen sodium (Aleve), can help reduce inflammation and alleviate menstrual cramps. These medications are frequently used alongside other treatment modalities.For more severe pain, prescription medications like stronger NSAIDs or opioids may be necessary, though they should be used cautiously due to potential side effects and dependency risks.
Some women find that taking pain relievers before sexual activity can help minimize discomfort and improve their experience. Additionally, nerve pain medications, such as gabapentin or amitriptyline, may be beneficial for those experiencing hypersensitivity, as they work by altering how the nervous system processes pain signals.
Hormonal therapies
Hormonal therapy helps manage endometrial tissue growth by regulating hormonal fluctuations, thereby reducing pain and slowing disease progression. These treatments work by suppressing or adjusting menstrual cycles, which helps decrease the growth of endometrial tissue outside the uterus and reduces inflammation.
However, hormonal therapy does not cure endometriosis, and symptoms may return after discontinuation. Additionally, these medications can have side effects, including mood changes, fatigue, weight fluctuations, and decreased libido. Since individual responses to hormonal treatment vary, a personalized approach is essential to balance symptom relief with potential side effects.
Types of hormonal therapies:
Hormonal contraceptives
Birth control pills, patches, injections, and vaginal rings help control hormones that stimulate endometriosis. These treatments often result in lighter periods and reduced pain. Continuous use, particularly for a year or more, tends to be more effective.
Gonadotropin-Releasing Hormone (GnRH) agonists and antagonists
These medications lower estrogen levels, inducing a temporary menopause-like state that causes endometriosis tissue to shrink. Supplementing with small doses of estrogen or progestin can mitigate side effects like hot flashes and bone loss. Fertility and menstruation typically resume after stopping treatment.
Progestin therapy
Progestin, a synthetic hormone, halts periods and inhibits endometrial tissue growth, offering symptom relief. It is available in various forms, including IUDs (Mirena), implants (Nexplanon), injections (Depo-Provera), or progestin-only pills (Camila).
Aromatase inhibitors
These drugs lower estrogen levels in the body and are sometimes combined with other hormonal therapies to manage endometriosis symptoms.
Danazol
This medication suppresses menstruation and alleviates symptoms but may have side effects like acne and excessive hair growth. Additionally, Danazol does not halt disease progression.
Surgical options
Conservative surgery
For severe pain or infertility, endometrial tissue may have to be removed using surgery. Laparoscopic surgery is the gold standard when it comes to endometriosis. It involves making small incisions to excise or destroy abnormal tissue. Robotic-assisted surgery is another option.
In cases where sexual function is a concern, nerve-sparing surgical techniques can be used to minimize damage to pelvic nerves, reducing the risk of post-surgical pain or numbness. While surgery can provide long-term relief, symptoms can recur post-surgery, and additional hormone therapy may be required to manage pain.
Infertility treatment:
Moderate evidence suggests that laparoscopic treatment (e.g., ablation or excision) of superficial peritoneal endometriosis improves natural pregnancy rates compared to diagnostic laparoscopy alone. The Endometriosis Fertility Index can guide decisions about whether surgery or medically assisted reproduction is more appropriate.
Hysterectomy and ovarian removal (Oophorectomy)
As a last resort, hysterectomy (removal of the uterus) may be considered for severe, unresponsive cases. Oophorectomy (removal of the ovaries) stops estrogen production, which fuels endometriosis growth. However, these procedures can induce early menopause, and symptoms may persist in some cases. Hysterectomy is typically recommended only when other treatments have failed, and the patient does not wish to conceive.
Assisted Reproductive Technologies (ART)
Intrauterine Insemination (IUI)
For women with mild endometriosis, ovarian stimulation combined with IUI can increase pregnancy rates compared to expectant management or IUI alone. However, evidence for its efficacy in severe cases is limited.
In Vitro Fertilization (IVF)
IVF is a widely used assisted reproductive technology (ART) for women experiencing infertility due to endometriosis. In cases of severe endometriosis (stages III and IV), the condition can negatively impact fertility by affecting ovarian function, egg quality, and the receptivity of the uterine lining. Despite these challenges, studies suggest that IVF can still be an effective option, particularly when tailored to individual needs, such as optimizing ovarian stimulation protocols or using embryo freezing strategies.
IVF involves several key steps to help achieve pregnancy:
Ovarian Stimulation – The patient is given hormonal medications to stimulate the ovaries to produce multiple mature eggs instead of the usual one per cycle. This increases the chances of fertilization.
Egg Retrieval – Once the eggs are mature, they are retrieved from the ovaries using a thin needle guided by ultrasound. This is a minimally invasive procedure performed under mild sedation.
Fertilization – The retrieved eggs are combined with sperm in a laboratory. In cases of poor sperm quality, Intracytoplasmic Sperm Injection (ICSI) may be used, where a single sperm is injected directly into an egg to increase the chances of fertilization.
Embryo Culture & Selection – The fertilized eggs (embryos) are monitored for several days to assess their development. The best-quality embryos are then selected for transfer. Some may be frozen for future use.
Embryo Transfer – A selected embryo is transferred into the uterus using a thin catheter. If the embryo successfully implants into the uterine lining, pregnancy occurs.
Luteal Phase Support & Pregnancy Testing – Hormonal support (such as progesterone) is given to help the uterus support implantation. After about two weeks, a blood test is conducted to confirm pregnancy.
One concern with IVF for endometriosis patients is that repeated surgeries, especially for removing ovarian endometriomas, may reduce ovarian reserve without significantly improving pregnancy rates. As a result, surgery before IVF is generally not recommended unless absolutely necessary, such as in cases of large cysts or severe pelvic adhesions that may hinder egg retrieval. Additionally, managing inflammation and hormonal imbalances before starting IVF can contribute to better outcomes.
Holistic approaches have been explored as complementary treatments to improve IVF success.
Some approaches that benefit IVF are:
Acupuncture may enhance blood flow to the ovaries and uterus, regulate reproductive hormones, reduce stress, and improve pregnancy and live birth rates during IVF cycles.
Yoga and mindfulness practices have been shown to reduce anxiety, balance cortisol levels, and improve emotional well-being, which can positively influence reproductive hormones and IVF success.
Massage therapy, particularly techniques like myofascial release, may help reduce pelvic adhesions, improve circulation, and create a more favorable uterine environment for embryo implantation.
Anti-inflammatory diets rich in antioxidants, omega-3s, and whole foods may also support egg quality and reduce oxidative stress, which is often elevated in endometriosis patients undergoing IVF.
Conclusion: Overcome endopain with EndoHeal
Endometriosis treatments range from medication to hormone therapy and surgery, but symptoms can recur. It’s essential to work closely with EndoHeal to create a personalized treatment plan tailored to your needs for symptom relief.
The pain-free endo system can help you manage endometriosis challenges, empowering you to live life without being held back by pain. Connect with us today and take the first step towards a pain-free future.
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Learn about endometriosis causes, risks and treatments, and discover how EndoHeal’s natural approach can provide long-lasting relief.
