Endometriosis is a condition in which endometrium, the tissue that typically lines the interior of your uterus, develops outside of your uterus. It is a painful condition. The tissue lining your pelvis, fallopian tubes, and ovaries are all frequently affected by endometriosis. Occasionally, tissue resembling endometrium may be seen beyond the region around the pelvic organs.

Endometrial-like tissue that has endometriosis behaves like endometrial tissue would: it swells, degrades, and bleeds with each menstrual cycle. Yet, this tissue becomes imprisoned since it has nowhere to go but inside your body. Endometriomas, or endometrial cysts, can develop when endometriosis affects the ovaries.

Scar tissue and adhesions, bands of fibrous tissue that can cause pelvic tissues and organs to adhere to one another, can form when nearby tissue becomes inflamed.

Pain from endometriosis, which can occasionally be severe, is common, especially during menstruation. Moreover, fertility issues might arise. Thankfully, some solutions work.

Endometriosis: Causes

The following are the important causes of developing endometriosis −

  • Menstruation in retrograde. Menstrual blood with endometrial cells travels back through the fallopian tubes and into the pelvic cavity during retrograde menstruation as opposed to leaving the body. These endometrial cells adhere to the surfaces of the pelvic organs and pelvic walls, where they develop throughout each menstrual cycle, thickening, and bleeding.

  • Cell transformation in the peritoneum. According to the "induction theory," which has been put out by researchers, hormones or immunological factors encourage peritoneal cells, which line the inside of your belly, to change into endometrial-like cells.

  • Cell transformation in embryos. During puberty, hormones like estrogen may cause embryonic cells, which are still in the early stages of development, to grow into endometrial-like cell implants.

  • Implanting a scar following surgery. Endometrial cells may adhere to an incision following surgery, such as a hysterectomy or C-section.

  • Transport of endometrial cells. Endometrial cells may be transported to different areas of the body through blood vessels or the tissue fluid (lymphatic) system.

  • An immune system condition. The body may not be able to identify and eliminate endometrial-like tissue that is developing outside the uterus if there is a problem with the immune system.

Endometriosis: Symptoms

The main sign of endometriosis is pelvic discomfort, which is frequently related to menstruation. Although many women suffer cramps throughout their periods, individuals who have endometriosis frequently have significantly more severe menstrual pain than usual. With time, pain may potentially get worse.

The following are typical endometriosis symptoms and signs −

  • Difficult times (dysmenorrhea). Before and for a few days after a period, pelvic discomfort and cramps are common. Furthermore, lower back and stomach aches are possible.

  • Intercourse pain. Endometriosis often causes pain during or after intercourse.

  • Discomfort when urinating or using the restroom. These symptoms are most likely to occur during a menstrual cycle.

  • Bleeding too much. Periodically, you could have thick periods or bleed between periods (intermenstrual bleeding).

  • Infertility. When a person seeks therapy for infertility, endometriosis is occasionally discovered for the first time.

  • Additional symptoms and indicators. Especially during menstrual cycles, you can have lethargy, diarrhea, constipation, bloating, or nausea.

Your condition's severity may not always be accurately predicted by how much pain you are in. Endometriosis can be moderate and cause considerable pain, or it can be advanced and cause little to no pain.

Endometriosis is commonly confused with other medical disorders, such as pelvic inflammatory disease (PID) or ovarian cysts, that can also cause pelvic pain. It could be mistaken for irritable bowel syndrome (IBS), which also produces stomach cramps, constipation, and episodes of diarrhea. Endometriosis and IBS can coexist, which makes a diagnosis more difficult.

Endometriosis: Risk Factors

Several factors play an important role in the development of endometriosis which includes −

  • Never having children

  • Having your first menstruation at a young age

  • Having a later onset of menopause

  • Shorter than 27-day menstrual periods, for example

  • Heavy, longer-than-seven-day menstrual cycles

  • More lifetime exposure to the estrogen your body generates or higher body estrogen levels

  • A low body mass index

  • Endometriosis in one or more family members (mother, aunt, or sister)

  • Any medical ailment that interferes with the body's ability to expel blood during periods

  • Issues with the reproductive system

Endometriosis: Diagnosis

The diagnosis of endometriosis is mainly done based on history and some of the tests may be required for confirmation and to rule out underlying causes

  • Examination of the pelvis. Your doctor will physically feel (palpate) various parts of your pelvis during a pelvic exam to check for any abnormalities, such as cysts on your reproductive organs or scars behind your uterus.

  • Ultrasound. High-frequency sound waves are employed in this examination to produce pictures of the interior of your body.

  • Imaging with magnetic resonance (MRI). An MRI is a test that produces finely detailed pictures of your body's organs and tissues using a magnetic field and radio waves.

  • Laparoscopy. Your doctor may occasionally recommend that you see a surgeon for a procedure that will enable the surgeon to see within your abdomen (laparoscopy). Your surgeon inserts a thin viewing tool via a small incision near your navel while you are unconscious and under general anesthetic (laparoscope).

Endometriosis: Treatment

The treatment is based on the severity of the symptoms. Your doctor may advise conservative or surgical treatment.

Conservative Treatment

Conservative treatment includes −

  • Hormonal birth control. Birth control pills, patches, and vaginal rings assist regulate the hormones that cause the monthly accumulation of endometrial tissue.

  • Agonists and antagonists of gonadotropin-releasing hormone (Gn-RH). These medications suppress estrogen levels and stop menstruation by blocking the synthesis of ovarian-stimulating hormones.

  • Hormone treatment

  • Anti-aromatase drugs

Surgical Treatment

Surgical treatment may be required in severe cases. If you have endometriosis and are attempting to get pregnant, you may have a better chance of success if you have "conservative surgery" to remove the endometriosis implants while keeping your uterus and ovaries. While endometriosis and pain may return after surgery, it may help if you have severe endometriosis-related discomfort.

Your doctor may do this treatment laparoscopically or, in more severe circumstances, by standard abdominal surgery. The majority of endometriosis cases may be managed with laparoscopic surgery, including those that are severe.

Endometriosis: Prevention

Some of the measures that can help to prevent endometriosis include −

  • Regular exercise (more than 4 hours a week).

  • Don't consume a lot of booze.

  • Drinks containing a lot of caffeine should be avoided.


Although much research has been done and novel medical therapies have been created, endometriosis still has a high comorbidity rate. While working with patients who have endometriosis suspicions, medical practitioners must band together and collaborate. The average time it takes to receive a conclusive diagnosis of endometriosis is around ten years, which is not a coincidence.

Women of reproductive age should be made aware of the signs and symptoms of endometriosis through public health initiatives so that they can seek treatment at an early stage of the condition.

Dr. Durgesh Kumar Sinha
Dr. Durgesh Kumar Sinha


Updated on: 18-Apr-2023


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