What you need to know about endometriosis

Despite increased awareness of the condition over the past few years, people with endometriosis still feel their pain is routinely disbelieved and dismissed. This Endometriosis Awareness Month, Maven is committed to shining a light on this under-discussed condition. We sat down with Maven OB-GYN Dr. Kathleen Green to talk about what endometriosis is, how to treat it, and how Maven can support you on this journey. 

What is endometriosis? 

Your period is made up of endometrial tissue, which is the lining of your uterus that thickens each month as it prepares for pregnancy. This tissue breaks apart and is shed each month when a pregnancy doesn’t occur. Endometriosis is a condition, affecting approximately 10% of women worldwide, where the endometrial tissue grows outside of the uterus. It can grow on the ovaries, fallopian tubes, pelvis, or other locations and can cause sharp, flaring pain in the lower abdomen, pelvis, and lower back. 

Causes of endometriosis 

The cause of endometriosis isn’t completely known, but experts believe some possible causes may include: 

• Retrograde menstruation: This is when menstrual fluid flows backward into the fallopian tubes and pelvis. The endometrial cells in this fluid then begin to grow on the pelvic lining or other organs. 
• Cell transformation: Endometriosis may be the result of hormones transforming other cells into endometrial-like cells that then grow outside of the uterus.  
• Scar tissue from surgery: Having a hysterectomy or C-section can increase the risk of endometriosis if endometrial cells attach themselves to the location of an incision.  
• Cell movement: It’s possible that endometrial cells can move outside of the uterus to other parts of the body by way of blood vessels or tissue fluids. 
• Immune system disorders: If a person has an immune system disorder—such as chronic fatigue syndrome or an underactive thyroid—this may prevent the body from being able to notice and destroy endometrial-like tissue growing outside of the uterus, leaving it unchecked. 

Symptoms you may experience with endometriosis  

“The most common symptom people present with is painful periods,” explains Dr. Green. But some people have no symptoms or they’re so mild that they’re mistaken for normal period pain. 

These are the most common symptoms of endometriosis. You may have one or several of these symptoms: 

• Painful periods 
• Painful sex
• Painful urination or bowel movements 
• Abnormal menstrual bleeding 

“Periods can be painful and uncomfortable, but they shouldn’t be debilitating,” says Dr. Green. “I see members who have had extremely painful periods that causes them to miss work and school. And they’ve seen multiple providers who tell them that’s normal. That’s not true—we need to address that.” The severity of your pain isn’t necessarily related to the severity of your condition—so if you have any of these symptoms to any degree, talk to your doctor. 

How is endometriosis diagnosed? 

Endometriosis can be difficult to diagnose because it can sometimes be mistaken for other conditions that cause pelvic or abdominal pain. Based on your symptoms, your doctor may perform the following exams: 

• Pelvis examination: Your doctor will manually feel for abnormalities in your pelvis, like cysts or scars. 
• Ultrasound: Using a wand inserted into the vagina or a device pressed against your abdomen, sound waves will create an image of your reproductive organs so your doctor can look for abnormal growths such as cysts, which can be a sign of endometriosis.  
• Magnetic resonance imaging (MRI): Your doctor may also suggest an MRI exam. Using magnetic fields and radio waves, the MRI will create a more detailed image of your organs and tissues. This can help your doctor find the exact location and size of any growths. MRIs are commonly used before surgery. 

Treatment and steps 

How your doctor treats endometriosis depends on the severity. Your treatment options could include: 

• Short-term pain relief: For short-term pain relief, it can help to take warm baths, use a heating pad, and take ibuprofen to ease cramping. 
• Birth control: Hormonal birth control, like pills, the ring, or the patch, can help regulate hormone levels and cause shorter and lighter periods. 
• Medication: Your doctor may prescribe hormone-blocking medications that lower your estrogen levels and stop menstruation, which can cause the endometrial tissue to shrink. 
• Surgery: “Once we’ve exhausted all the conservative options, we consider surgery,” explains Dr. Green. “But the more times you operate on a patient, the more scar tissue there is that can exacerbate endometriosis symptoms. So we really want to decrease the times we have to do surgery.” Endometriosis surgery is commonly performed using laparoscopy. Small incisions are made near your navel and in your lower abdomen. A laparoscope or camera is inserted to view your pelvis and reproductive organs and look for endometrial tissue. Another thin instrument is inserted through the other small incisions to remove the tissue. 

Impact of endometriosis on fertility 

As many as 50% of women with endometriosis will have trouble becoming pregnant, according to the Mayo Clinic, but many with mild or moderate cases have gone on to healthy pregnancies. Because endometriosis can cause tissue to grow in the fallopian tube, it can block sperm from meeting and fertilizing an egg. However, treatment will improve your fertility. Talk to your doctor or a Maven Reproductive Endocrinologist if you want help deciding on the best treatment options.

Impact of endometriosis on pregnancy and pregnancy outcomes 

Getting pregnant is not the same as treating endometriosis. “Sometimes we are quick to say that once a woman with endometriosis gets pregnant, it’s over,” says Dr. Green. But research shows endometriosis can increase the risk of pregnancy loss and complications with pregnancy. “We need to continue to have that conversation,” explains Dr. Green. “It makes sense because endometriosis is inflammation and inflammatory tissue outside the uterus.” If you are suffering from endometriosis and are pregnant or plan to become pregnant, make sure your providers are aware of your conditions and symptoms. 

Maven can help you manage your endometriosis 

Endometriosis can be a painful condition with long-term side effects. But there is hope with proper treatment and more openness around this condition. “I think it’s great that we’re talking more about endometriosis, and I know many women are seeking treatment because the conversation is evolving,” says Dr. Green. If you have been diagnosed with endometriosis or think you may be suffering from this condition, talk to your doctor or make an appointment with providers on Maven like OB-GYNs, Reproductive Endocrinologists, and Mental Health Specialists. To access this comprehensive, compassionate support, sign up for Maven today.