Endometriosis: Explaining the Pain Down There

Endometriosis is a treatable condition that affects millions of women, but it can be hard to diagnose. Find out if endometriosis could be causing your unexplained pain down there.

When women experience abdominal or pelvic pain, they often write it off as menstrual cramps. While cramps are certainly common, another lingering and often more painful condition called endometriosis that palgues millions of women can also be the culprit.

What is Endometriosis?

Endometriosis is a disease where cells normally found in a woman's uterus end up in other areas of the body, where they can cause inflammation, damage to and scarring in tissues in the surrounding area. That inflammation and damage can then lead to the symptoms like pain, infertility, bowel or bladder issues.

What Causes Endometriosis?

The uterus is made up of different layers, including several layers of muscle and an inner layer of cells called the endometrium. The endometrium is the part of the uterus that is full of blood vessels and that nourishes a growing fetus when a woman becomes pregnant. It's also the layer that gets replaced every month during a woman's period. The bleeding a woman experiences each month is the unused endometrium leaving the uterus.

For reasons that still aren't clear, sometimes cells from this endometrium layer end up in places outside of the uterus. While the cells aren't in the right place anymore, they still act in the same way they would in the uterus. That means that monthly hormone signals from the body still cause them to grow over the course of the month and then die and bleed at the end of the month. But unlike in the uterus, there's nowhere for the blood and dead cells to go. Instead, the gather at the center of this ball of endometrial cells, which can swell, become inflamed and irritate surrounding tissues causing pain, scarring and other problems.

Symptoms of Endometriosis

The symptoms you have will depend on where those troublesome cells have set up shop. For example, endometrium cells that have attached to a woman's Fallopian tubes might lead to infertility, whereas cells attached to part of the abdomen might cause belly or pelvic pain. Here are some symptoms you might experience, with the most common symptoms first.

  • Severe pain during your period that gets better once your period has finished
  • Pain in your pelvic area, especially pain that seems to come and go with your period
  • Heavy bleeding during your periods
  • Pain when you have sex
  • Bowel upset including regular constipation or diarrhea
  • Bowel pain or pain with bowel movements
  • Infertility or significant trouble getting pregnant
  • A mass in your pelvis, especially in the area of your ovaries
  • Pain when you urinate
  • Other trouble with urination like incontinence

Diagnosis of Endometriosis

Having one of these symptoms doesn't necessarily mean you have endometriosis. If you've been experiencing a few of these symptoms, it might be worthwhile to start a conversation about it with your doctor. For endometriosis it's important to have answers to the following questions for your doctor:

  • What are your symptoms?
  • How bad are the symptoms?
  • When do they happen? Is there a pattern?
  • Do they seem to be associated with any other issues?
  • How are they impacting your life?

Endometriosis can be difficult to diagnose because it can act like a lot of other possible conditions. Your doctor will talk you through some of the alternative explanations for the symptoms you might be having and will probably do a workup based on your symptoms to get a better sense of what's going on. That workup might include:

  • A physical exam including a pelvic exam
  • Lab tests to look for other possible causes of your symptoms
  • Imaging studies, most often using ultrasound

In situations where workup still doesn't reveal a definite diagnosis, laparascopic surgery can be helpful. The goal of this surgery is often both diagnosis and treatment. Surgeons will look for endometrium implants inside of your abdomen and pelvis and, if they find them, destroy them in hopes of stopping or reducing symptoms.

Treatment of Endometriosis

Treatment of endometriosis will depend on your symptoms and how bad they are. It's important to know that treatment helps symptoms in 80% to 90% of women with endometriosis. Some of the options for treatment include:

  • Pain medications, most often over-the-counter options like ibuprofen or acetaminophen
  • Oral contraceptive pills, which affect the hormones that can trigger endometriosis symptoms
  • Other hormonal therapies targeted to the endometrial cells
  • Surgery to diagnose and remove endometrial implants
  • Some people have found some relief with acupuncture

Your doctor might also offer you medications to treat the symptoms associated with endometriosis, like stool softeners for constipation or fertility treatments for infertility. While these may not directly treat the endometriosis, they can make the symptoms more bearable. Ultimately, the exact treatment will depend on your individual situation and what you and your doctor decide makes the most sense given your condition.

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