Another month, another painful period. Or maybe that menstrual pain never goes away. For some women, it’s a painful life as usual. But what could be the cause of these painful cycles?

Endometriosis may be the culprit. And while the condition generally isn’t dangerous, it can be quite debilitating.

With endometriosis, the endometrial tissue that lines the inside of the uterus begins to grow outside of it in clumps called implants. The most common places for these implants are the ovaries, the fallopian tubes, the outer wall of the uterus and other pelvic areas. (It’s possible, though rare, for endometrial implants to spread beyond the pelvic area.)

Despite being relocated outside the uterus, the migrated endometrial tissue behaves as it should: thickening, breaking down and bleeding during each menstrual period. But if this tissue and associated bleeding have no manner in which to leave the body, pain and inflammation can result. Left untreated, endometriosis can have significant unwanted side effects — the most common being an increased risk of infertility, scarring of the fallopian tubes and severe pain with intercourse. But the good news is that women don’t have to suffer.

What Symptoms Am I Looking for?

Although many patients with endometriosis experience pain, the intensity of that pain isn’t a reliable indicator of just how severe or extensive the condition is. Some women have pain all the time; some experience only mild discomfort.

It’s not uncommon for symptoms to increase in severity just before and during your menstrual period. Some of the most common symptoms include:

• Painful periods, including severe menstrual cramps and pelvic pain
• Pain during or after intercourse
• Pain during bowel movements, especially during your period
• Abnormal bleeding, such as blood in the urine or stool

Another common symptom of endometriosis is infertility: Approximately 20%-40% of infertile women have endometriosis. In fact, many women are first diagnosed with endometriosis when they have trouble starting a family. Although it’s not known why endometriosis may cause infertility even in the absence of scar tissue involving the ovaries and/or fallopian tubes, there are several theories, including:

• Scar tissue develops near the implants, changing the shape or function of the ovaries, fallopian tubes or uterus.
• Implants alter the chemicals or hormones found in the fluid surrounding abdominal organs, preventing pregnancies or altering menstrual cycles.

Just as it’s impossible to predict who will have mild or severe symptoms, it’s also impossible to predict if an individual’s symptoms will increase or decrease in severity — or simply stay the same — over time.

How Do I Know if I Have Endometriosis?

Symptoms alone aren’t enough to formally diagnose endometriosis, and they’re occasionally mistaken for other conditions, like ovarian cysts and irritable bowel syndrome. If you suspect you have endometriosis, talk with your OB-GYN about having them perform a laparoscopy — it’s the only way for your doctor to diagnose the condition and know for sure.

You’ll be under general anesthesia during the laparoscopy procedure, while the doctor uses a long, thin, telescope device (a laparoscope) to look inside the abdomen for scarring on your uterus, ovaries, fallopian tubes and other organs. If the doctor does find signs of endometriosis, they may be able to remove scarring during the procedure. But it’s nearly impossible to get all the endometriosis, since many of the implants may be microscopic or buried from view.

What Causes Endometriosis (and Can I Prevent It)?

There’s currently no way to prevent endometriosis. And while doctors aren’t sure what causes endometriosis, they have some ideas:

• Retrograde menstruation, in which menstrual blood flows back through the fallopian tubes and into the pelvic cavity. The endometrial cells in the blood may then stick in the pelvic area, grow, thicken and bleed during each cycle.
• Embryonic cell transformation. Hormones may cause embryonic stem cells — which are capable of becoming almost any tissue in the body — to change into endometrial cell implants. This change occurs when a woman is actually in her mother’s womb, but it erupts into active disease during puberty.
• Immune system disorder. A problem with the immune system may render the body unable to recognize and destroy endometrial tissue that’s growing outside the uterus.

Are There Any Complications of Endometriosis?

Unfortunately, endometriosis can cause more than just pain and discomfort. Endometriosis may also cause:

• Fertility issues. Endometriosis may physically prevent the sperm from uniting with the egg.
• Ovarian cancer. While the average risk of ovarian cancer is about 1 in 100, some studies suggest this risk increases in women with endometriosis — especially in women older than 60.
• Ovarian cysts. Endometrial cysts of the ovary, also called ovarian endometriomas, can be a common complication of endometriosis. They can fill with a little more blood during each menstrual cycle and even burst with sudden movements or during sexual intercourse. Such ruptured cysts can cause severe pain and further spread the disease.

What Is the Standard Treatment for Endometriosis?

While there is no cure for endometriosis — symptoms can even remain even after menopause — there are endometriosis treatment options that can help with both pain and infertility.

• Medication. Birth control hormones or pain medications might be enough to control pain, while birth control hormones may even prevent pain symptoms from intensifying. Nonsteroidal anti-inflammatory medications — like aspirin, ibuprofen and naproxen — can help with the associate pain and menstrual cramps.
• Other treatments. Regular exercise and the application of heat to the area of discomfort might also alleviate pain.
• Surgery. This may be a consideration if other treatments don’t work and implants begin to affect other organs. In the most severe cases, hysterectomies and oophorectomies are options. But these are considered the last course of treatment and can have long-term effects on a woman’s health.

You Do Have Treatment Options

If any of these symptoms sound familiar, we encourage you to get a formal diagnosis through your OB-GYN. And if you do receive a diagnosis of endometriosis, don’t feel like your treatment options are limited.

We’re here to help with both the pain and the fertility issues associated with endometriosis. Even better: You may be a candidate for nonsurgical treatment options that are available only at our practice.

If you’ve been diagnosed with endometriosis and want to learn more about the nonsurgical treatment options that may be available to you, contact our Washington, D.C. office at (202) 293-1000 to make an appointment.