Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at January 15, 2016

Endometriosis is a very painful health condition involving the female reproductive system. The endometrial tissue, which is only supposed to line a woman’s uterus, grows and spreads to other areas of the pelvis. When tissue grows in the wrong areas it can cause ovarian cysts and fertility problems.


Definition & Facts

Endometriosis is an extremely common health condition amongst women. Although it is considered a chronic condition, it is treatable. Most commonly, treatment involves hormonal medications or surgery.

When a woman is diagnosed with endometriosis, excessive pain and complications most often occur during menstrual periods each month over and beyond what is typically noticed. Women face this condition during the reproductive years, usually between the ages of 15 to 49. Tissue can build up on the bladder, bowels, and ovaries.

Symptoms & Complaints

The most common symptom of endometriosis is severe pelvic pain during menstruation. Pelvic pain can occur both before and during a woman’s period and can also cause abdominal pain and low back pain. Endometriosis can cause pain during and after having sexual intercourse as well. Experiencing pain during bowel movements and urination is common also and happens most often while menstruating.

Excessive, heavy periods and bleeding in between periods happens on occasion, too. In addition, side effects can include dealing with constipation, diarrhea, bloating, nausea and fatigue while menstruating.

Infertility is an issue for women dealing with endometriosis also. Often times it is when infertility treatment is being sought that the condition is detected at all.


Medical professionals are still working to figure out what the precise cause(s) of endometriosis are, but have come up with a great deal of possible reasons. Of all the possibilities, it seems that what is called retrograde menstruation is what would make the most sense. During retrograde menstruation, endometrial cells flow in the wrong direction through the fallopian tubes. Instead of the cells leaving the body like they should, they attach to the pelvic wall instead.

Another possibility is embryonic cell growth. This means that these cells turn into endometrial tissue, hence causing endometriosis. When a woman has a Caesarean section or hysterectomy, it is thought that perhaps endometrial cells attach to the scar tissue from surgery. Sometimes the human system is unable to detect that the endometrial cells are growing in the wrong part of the body and cannot get rid of the cells because of an unrelated autoimmune disease.

Diagnosis & Tests

There are a number of ways that endometriosis can be detected and tested. An ultrasound can look at the abdomen from either the outside or from inside the vagina and detect whether there are cysts that can be caused by endometriosis called endometriomas. However, results from either type of ultrasound will not provide a positive diagnosis.

A pelvic exam can allow a doctor to feel for cysts and scars, although it is difficult to detect this way due to the small size of the cysts. The best and most accurate way to see if endometriosis exists is to have a specific kind of surgery called a laparoscopy. The patient is put under general anesthesia by a surgeon while the female reproductive system is examined through a small camera placed inside the body. Sometimes, the surgeon will also perform a biopsy simultaneously to test cells.

Because their symptom are similar to endometriosis, pelvic inflammatory disease (PID) or irritable bowel syndrome (IBS) are commonly diagnosed as the issue a woman is facing. Women can also be dually diagnosed with endometriosis and irritable bowel syndrome, which makes it even more difficult to detect endometriosis specifically.

Treatment & Therapy

The most common first step in the treatment process for patients suffering from endometriosis is taking over-the-counter non-steroidal anti-inflammatory drugs (NSAID's) such as naproxen or ibuprofen, which can reduce inflammation and pain. Regular exercise and taking warm baths are common at-home remedies for alleviating pain also.

Often, more aggressive methods to treat endometriosis are needed however. A variety of contraceptives can be used to reduce the pain of endometriosis such as vaginal rings, birth control patches and birth control pills. These types of contraceptives will release hormones and regulate the way endometrial tissue builds up.

There are also medications women can take which will block hormones altogether, essentially stopping menstruation. Hormone blockers can throw the body into early menopause however. Low grade estrogen replacement therapy may be needed in addition to taking a hormone blocker.

Medroxyprogesterone, most commonly used for birth control purposes, is a shot which can also mean fewer endometriosis symptoms to have to deal with. A specific drug, called Danazol, blocks menstruation, pain and hormones associated with endometriosis, but has severe side effects including hirsutism.

Unfortunately, sometimes endometriosis can be very damaging to a woman’s reproductive organs. A full hysterectomy is the only option in rare cases, but is considered extreme as it means pregnancy isn’t feasible. In vitro fertilization is a possible, yet costly, method to become pregnant while facing endometriosis prior to a hysterectomy as well.

It has been said that acupuncture is another alternative to traditional therapy to relieve the side effects of endometriosis. However, the information regarding any kind of alternative therapy is vague at best.

Prevention & Prophylaxis

Unfortunately, there is no way that endometriosis can be prevented that any doctor is yet aware of. Symptoms can be halted or slowed down for a short period of time and the pain level may be lessened if birth control is used or if the woman becomes pregnant. There is no guarantee a woman will develop endometriosis in her lifetime and methods to detect whether she will get it have yet to be established.