Endometriosis: A Painful Condition Linked to Infertility that Affects One in 10 Women

​This article was previously published on Atrium Health's Daily Dose

​Endometriosis is a relatively common condition in women that causes pelvic and abdominal pain. It can even lead to fertility issues. Learn more about the symptoms, risk factors and treatment options for endometriosis.

​Endometriosis is a condition where the tissue that lines the uterus — the endometrium — grows elsewhere in the body, leading to chronic pain, heavy periods and even infertility, significantly impacting quality of life. It's estimated that 6.5 million women (about one in 10) in the United States have endometriosis.

In females with endometriosis, the endometrial lining can grow in places like the:

• Back and outer surface of the uterus
• Ovaries
• Fallopian tubes
• Bladder
• Ureters (the ducts where urine passes from the kidneys to the bladder)
• Lining of the pelvis and abdomen (peritoneum)
• Cervix
• Vagina
• Intestines
• Rectum

In rare cases, endometriosis can grow in the brain, lungs or skin.

The following can be signs of endometriosis:

• Intensely painful menstrual cramps
• Pain during or after sex
• Chronic pain in the pelvis and lower back
• Intestinal pain
• Pain during bowel movements or urination during periods
• Bleeding or spotting between periods
• Infertility
• Constipation, bloating, nausea or diarrhea, particularly during periods
• Fatigue
• Depression or anxiety

"One of the most common things I ask patients is how high school was in regard to their period pain," says Dr. Kevin Stepp, an OB-GYN and endometriosis specialist at Atrium Health Women's Care Urogynecology & Pelvic Surgery. "Patients who have endometriosis remember missing school and staying home with a heating pad. Endometriosis can hurt with menstrual cycles, it can hurt with day-to-day activity and it can hurt during sexual relations. It can really affect a person's quality of life."

Endometriosis is most common in women between ages 25 and 40, though it can also occur in teenagers. Some people experience relief from endometriosis symptoms once they are in menopause.

You may be at higher risk of having endometriosis if you:

• Have a family history of endometriosis
• Have defects in your fallopian tubes or uterus
• Began your period before age 11
• Never had children
• Have menstrual periods that are longer than seven days
• Have short menstrual cycles (27 days or fewer)

The cause of endometriosis is still unknown, though researchers are exploring the following possible factors:

• Menstrual flow problems
• Hormonal issues
• Genetics
• Surgery to the abdominal area, such as a hysterectomy or cesarean section (C-section)

It's still possible to get pregnant if you have endometriosis, but it may be more difficult. Researchers estimate one in two women with infertility may have endometriosis.

Currently, there are no known ways to prevent endometriosis. However, you may be able to lower your risk by reducing estrogen levels in your body. The following can help you maintain lower estrogen levels:

• Avoiding large amounts of caffeinated and alcoholic beverages
• Exercising regularly (ideally more than four hours per week)
• Maintaining a low percentage of body fat

The following can be used to diagnose endometriosis:

• A pelvic exam
• An ultrasound
• An MRI
• Laparoscopic surgery

While there's no cure for endometriosis at this time, there are several ways to treat endometriosis, including:

• Hormonal birth control pill or shot to help reduce or eliminate pain and stop bleeding (if you're not trying to become pregnant).
• Intrauterine device (IUD) to help with pain and bleeding (if you're not trying to become pregnant).
• Gonadotropin-releasing hormone (GnRH) medications, which can cause temporary menopause, but also helps control the growth of the condition. Once you stop taking the medicine and your menstrual cycle returns to normal, you may have an increased chance of getting pregnant.
• Pain medications, like naproxen and ibuprofen, to help manage pain.
• Surgery to remove endometriosis patches. This is usually only used for severe symptoms or those with fertility issues.
• Surgical removal of the uterus (hysterectomy). This is usually reserved for severe cases.

You should see your health care provider if you experience any of the symptoms above, particularly if they interfere with your daily activities, or if you've been trying to conceive for more than 12 months (or more than six months if you're 35 or older). Left untreated, endometriosis can cause scar tissue, cysts and adhesions in the body.

Learn more about Atrium Health Women's Care services and how to find an OB-GYN.