The lining of the uterus (or womb) is called the endometrium. When a tissue similar to the endometrium grows outside of the womb, the condition is called endometriosis. It is often found on pelvic organs like the uterus's outer surface, fallopian tubes, and ovaries. Still, it can grow on other parts of the body such as the vagina, cervix, and rectum as well. There is no known cause of endometriosis; however, it has a significant impact affecting 10–15% of all women of reproductive age, 70% of women who suffer from chronic pelvic pain, and approximately 176 million women in the world. 

What are the Symptoms of Endometriosis?

Not every woman with endometriosis will have symptoms. Pelvic pain is the most common symptom, but pain levels do not indicate the severity of the condition, and it can be mistaken for normal menstrual pain. Common signs and symptoms of endometriosis include:

• Pain - and pelvic pain can present in different ways. Painful menstruation can start several days before your period and continue throughout. Period pain is usually described as being far worse than normal or that the average person experiences. Pain can also be in the form of lower back pain, abdominal pain, intestinal pain, and pain during sex. Some women do not have any pain, some find they only experience pain around menstruation, and others suffer from chronic debilitating pain daily. 
• Bleeding - can be much heavier during menstruation, and bleeding between periods may also occur. 
• Bowel problems - can present in the form of abdominal pain, nausea, diarrhea, constipation, or bloating. Most frequently, bowel symptoms are experienced during menstruation. 
• Painful urination - can also occur, usually in conjunction with menstruation. 
• Infertility - is a complication that can arise from endometriosis. 

Although these are the most common symptoms, other problems such as fatigue, infrequent periods, and rectal bleeding with significant bowel involvement can occur. 

Why does Endometriosis Often Cause Pain?

Usually, during the menstrual cycle, the endometrium (lining of the uterus) thickens, detaches, and is removed from the body through bleeding every month. However, when endometriosis occurs, the linings that grow outside of the womb goes through the same process but has nowhere to exit the body.  

The tissue that the body has shed leads to; inflammation (swelling), irritation, ovarian cysts, scar tissue formation, adhesions (scar tissue that can bind organs together), and problems with the intestines and bladder. These problems can all cause the pain that some women experience with endometriosis. 

Why is Endometriosis associated with Infertility?

Infertility affects 30-50% of women with endometriosis, and infertile women are 6-8 times more likely to have endometriosis than fertile women. Although the link between endometriosis and infertility is not entirely clear, it is thought that infertility is caused by:

• The formation of scarring and adhesions that can block the uterus and fallopian tubes.
• The growth of endometrium on the ovaries preventing the release of an egg. 
• The production of cytokines following inflammation. Cytokines are a type of protein released by the body during the inflammatory process that can damage the sperm or the egg. 

Endometriosis can also make pregnancy more complicated. However, many women with endometriosis conceive and carry a pregnancy to full term despite the risk of infertility or pregnancy problems. 

What are the Best Ways to Manage Symptoms of Endometriosis?

Endometriosis symptoms are different for every woman; therefore, so are the best ways to manage those symptoms. It can be trial and error to find strategies that work for you; however, here are a few recommended ways to ease the symptoms.

Natural symptom relief:

• Apply Heat. Heat can help to relax your muscles and ease the pain. Applying a heat pad to the painful area or having a warm bath can help to ease cramps, aches, and pains. 
• Try a TENS machine. A Transcutaneous electrical nerve stimulation (TENS) unit can be provided by a physical therapist or purchased for home use. TENS machines use a low voltage electrical current to provide pain relief and relax muscles. 
• Stay Hydrated. Hydration can help with the symptoms of bloating, constipation, and cramping. Drink plenty of water to stay hydrated, especially during your menstrual cycle. 
• Maintain a Healthy Diet. Ensuring a healthy diet will help keep you energized, and consuming vegetables that are high in fiber will help with digestion problems. 
• Get Regular Exercise. Exercise is a natural stress reliever and can help you cope with the worry and anxiety you may experience alongside endometriosis. Yoga not only helps to relieve stress but helps manage the pain associated with endometriosis. 
• Acupuncture. Studies have found acupuncture to be a safe, alternative treatment to managing pain due to endometriosis. 
• Massage. Physical therapy techniques and massages can help relieve muscle stress and reduce pain. 

Medical Symptom Relief:

• Non-steroidal anti-inflammatories (NSAIDs)- such as ibuprofen, aspirin, or naproxen, can be prescribed to help control pain and discomfort. This type of medication is usually the first line of treatment for pain related to endometriosis. 
• Gonadotropin-releasing hormone analogs- are a type of drug that blocks the production of ovarian-stimulating hormones. This then prevents ovulation, menstruation, and the growth of endometriosis. Essentially, Gonadotropin-releasing hormone analogs cause an artificial menopause. However, periods and the potential to get pregnant return when the medication is stopped. 
• Birth control pills- can help control the hormones that cause endometriosis to build up. They can also help make periods shorter, more regular, and lighter and provide some pain relief. 
• Aromatase inhibitors- reduce the amount of estrogen in your body by blocking the estrogen formation within the endometriosis tissue. They can be prescribed alongside other medications to treat endometriosis. 
• Progesterone and progestin therapy- may be in the form of an intrauterine device (IUD), contraceptive implant, contraceptive pill, or contraceptive injection. They can improve symptoms by reducing periods or stopping menstruation altogether. 
• Surgery- can be considered if the pain for endometriosis is very severe, or you are trying to get pregnant. A surgeon can remove patches of endometriosis, scar tissue, and adhesions during surgery. Surgical treatments differ on a case by case basis, and as not all surgery is reversible or has a permanent effect, it must be discussed in detail with your healthcare provider. 

Endometriosis can sometimes be challenging to diagnose as it has similar symptoms to problems such as heavy periods or irritable bowel syndrome. If you are concerned that you may have endometriosis symptoms, you are suffering from pain, or you are having difficulty getting pregnant, then speak to your OBGYN. 

Colorado Obstetrics & Women's Health is a premier Colorado Springs OBGYN provider. Our local practice provides cutting-edge services to support you through any women's health problem. If you are concerned that you may have endometriosis, please contact us today at (719) 634-8800 to schedule an appointment or click here to find out more details.