Endometriosis is a condition that can affect females. It happens when tissue that is similar to that of endometrial tissue grows outside the uterus. It can be difficult to diagnose and carries several complications.

The tissue responds to hormones that affect the menstrual cycle in the same way that endometrial tissue does. It swells and bleeds like endometrial tissue, but there is nowhere for the waste tissue and blood to go.

The tissue is not cancerous, but it can lead to scarring and adhesions. It can block the fallopian tubes, and cysts can form due to trapped blood. Tissues can fuse, leading to changes in the reproductive organs.

Symptoms include pain and unusual bleeding. It may affect a person’s chances of becoming pregnant.

This article explores what endometriosis is in more detail, including its causes, symptoms, diagnosis, and treatment.

A note about sex and gender

Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Learn more.

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Endometrosis occurs when tissue, similar to the lining of the endometrium, grows outside the uterus. The tissue that grows outside the uterus in endometriosis is not the same as endometrial tissue, but they have some features in common.

The tissue can develop anywhere in the body, but it usually affects the pelvic area, including:

  • the ovaries
  • the fallopian tubes
  • tissues that support the uterus
  • the outside of the uterus

Endometrial tissue can also develop in other areas, including the digestive tract, the lungs, and around the heart.

The body usually expels this type of tissue during menstruation, but the tissue that forms in endometriosis may remain in the body, which can lead to inflammation. As tissue decomposes, scar tissue can form.

Endometriosis can significantly affect a person’s quality of life. In addition to the pain, they may experience pressures relating to:

  • chronic pain
  • employment
  • the cost of medical care
  • relationships
  • difficulty maintaining a social life
  • concerns about not being able to become pregnant
  • stress, anxiety, and depression

A 2019 study notes that previous research has indicated that, globally, there is an average delay of 7 to 9 years to receive an accurate endometriosis diagnosis.

Experts do not know exactly why endometriosis happens.

Two known risk factors are starting menstruation before the age of 11 years and heavy and prolonged menstruation, but other factors may play a role.

These include:

  • genetic factors, as it appears to run in families
  • problems with menstrual flow, resulting in blood and tissue not leaving the body
  • immune system problems, in which the immune system does not eliminate unwanted tissue
  • high levels of the hormone estrogen in the body
  • surgery to the abdominal area, such as a cesarean delivery or hysterectomy
  • shorter menstrual cycle
  • alcohol and caffeine consumption

Experts have linked some health conditions with endometriosis. These include:

Researchers have also found links between endometriosis and exposure to phthalates, particularly during fetal development. Phthalates are a group of chemicals that help make plastics flexible and durable.

Symptoms of endometriosis include:

Pain is the most common indication of endometriosis, but the severity of the pain does not always correlate with the extent of the disease.

Pain often disappears after menopause, when the body stops producing estrogen. However, if a person uses hormone therapy during menopause, symptoms may persist.

Pregnancy may provide temporary relief from symptoms.

Diseases with similar symptoms

Endometriosis can be difficult to diagnose. One reason for this is that other medical conditions have similar symptoms. These include:

Complications of endometriosis include:

Monitoring symptoms and seeking help may help prevent long-term complications. People should let their doctor know if they experience severe pain or unexpected bleeding.

It can be difficult for a medical professional to diagnose endometriosis because no specific test can confirm it, and the symptoms may be hard to see. The symptoms can also resemble the symptoms of other conditions.

Possible diagnostic strategies include:

Surgical laparoscopy is the only way to confirm a diagnosis of endometriosis. This is a minimally invasive procedure in which a doctor inserts a laparoscope through a small incision in the pelvic area. This provides images of tissue changes.

There are different ways of staging endometriosis. In 1996, the American Society of Reproductive Medicine (ASRM) set out four stages to describe the severity of endometriosis, ranging from minimal to severe:

  1. Minimal: Features include isolated implants and no significant adhesions.
  2. Mild: Features include superficial implants on the peritoneum and ovaries, with no significant adhesions.
  3. Moderate: Features include multiple implants, both superficial and deeply invasive. Adhesions may be present about the tubs and ovaries.
  4. Severe: Features include Multiple superficial and deep implants and large ovarian endometriomas. Also, there are dense, filmy adhesions in most cases.

The stages of endometriosis are not specifically linked to levels of pain, the impact on mental health, and other factors.

Research from 2022 found that severe endometriosis negatively effects developing egg cell quality, ovarian response, and embryos. However, the researchers found no difference in fertilization rate between the different endometriosis stages.

There is controversy regarding the stages. Some experts say they do not help doctors decide which treatment to offer, as they do not adequately reflect how the disease affects an individual.

There is currently no cure for endometriosis, but various treatment options may help manage symptoms. They include:

Pain relief

Medications can help manage pain. They include nonsteroidal anti-inflammatory drugs such as ibuprofen (Advil, Motrin IB, others) and drugs to relieve painful menstruation.

If over-the-counter options do not help, a doctor may prescribe stronger drugs.

Hormonal treatment

A doctor may recommend birth control pills or other hormonal methods of birth control, such as the Mirena device. In some cases, they may recommend gonadotrophin-releasing hormone.

These may reduce estrogen levels and help limit the development of unwanted tissue. However, they cannot repair adhesions or improve fertility.

Surgery

If other treatments do not work, a doctor may recommend surgery to remove unwanted tissue. In some cases, a hysterectomy with removal of both ovaries may be necessary.

Fertility treatment

If endometriosis affects fertility, in vitro fertilization may be an option.

According to older 2014 research, some complementary and alternative treatments and lifestyle choices may help manage endometriosis symptoms alongside medical treatment. They include:

Some people may find these methods help, but there is little scientific evidence to show that they are effective. They will not cure endometriosis or reverse any damage that has occurred.

Various dietary factors may affect the risk of developing endometriosis, the way a person experiences symptoms, and their overall sense of well-being.

A 2020 interview study involving 12 people concluded that focusing on dietary factors helped relieve pain and fatigue. This may be partly due to an enhanced awareness of endometriosis and an increased focus on diet and well-being overall.

Dietary factors that may be beneficial include:

  • removing gluten and dairy products from the diet
  • increasing the consumption of fruits and vegetables
  • avoiding junk food
  • preparing meals using fresh ingredients
  • avoiding caffeine and alcohol
  • following a low-FODMAP diet

However, the studies that produced these suggestions were small, and there is no information regarding the race or ethnicity of participants. Researchers have not yet found enough evidence to confirm that any dietary steps will affect the risk or impact of endometriosis.

Endometriosis is a condition in which tissue resembling that which grows in the uterus develops in other areas of the body. It can lead to tissue damage and pain, and it can affect fertility.

There is currently no cure for endometriosis, but there are ways to relieve the pain and discomfort. Some people may need surgery.