March is National Endometriosis Awareness Month. Endometriosis is a disorder in women in which tissue similar to the endometrium that lines the uterus grows outside of the uterus. This tissue, called an endometrial implant, is most often found on other reproductive organs, such as the ovaries and fallopian tubes. But sometimes, endometrial implants can be found in other areas, such as the intestines, rectum and bladder. 

During a woman’s menstrual cycle, the hormone estrogen stimulates the buildup of the endometrium in preparation for the implantation of a fertilized egg. If she doesn’t get pregnant, the built up tissue breaks down and exits the uterus through the vagina, resulting in a menstrual period.

Endometrial implants also respond to estrogen, but the built up tissue has no place to exit and remains within the pelvic cavity. This leads to inflammation, swelling and the formation of scar tissue on the normal organs and tissues surrounding the implants.

Endometriosis is common, affecting 3 to 10 percent of women of childbearing age. About 5 million women in the US have the disorder. It is most common in women between the ages of 25 and 40, but symptoms can begin earlier. Endometriosis is the cause in 40 to 80 percent of cases of pelvic pain and 20 to 50 percent of infertility in women.

The most common symptom of endometriosis is pelvic pain, including severe menstrual cramps. Other endometriosis symptoms include lower back pain, heavy bleeding during periods, pain during sex, blood in urine or stool, discomfort during bowel movements, spotting or bleeding between periods, periods longer than seven days, enduring fatigue and difficulty becoming pregnant.

The cause of endometriosis is unknown, but there are several risk factors. These risk factors include having a family history of endometriosis, having begun your periods before age 11, having a high level of estrogen in your body, having menstrual cycles less than 27 days and drinking a lot of alcohol and caffeine.

Endometriosis can be difficult to diagnose because its symptoms resemble those of other disorders such as pelvic inflammatory disease (PID), ovarian cysts and irritable bowel syndrome. As a result, it can take anywhere between four and 11 years for women to receive a correct diagnosis. What’s more, as many as six out of every 10 cases of endometriosis may remain undiagnosed.

The evaluation for endometriosis begins with a thorough medical history and physical exam, including a pelvic exam. Your doctor may use certain tests to assist in making the diagnosis. These include imaging tests such as ultrasound, CT or MRI. But the only definitive way to diagnose endometriosis is through a minimally invasive procedure called laparoscopy.

During laparoscopy, the doctor inserts a thin instrument called a laparoscope that has a camera attached to it through a small incision in the abdomen. In this way, the doctor can examine the organs and visualize the endometrial implants. The doctor may take a sample of tissue for examination under a microscope. This is called a biopsy.

To treat endometriosis, your doctor may recommend medication such as non-steroidal anti-inflammatory drugs (NSAIDS) to ease pain or hormonal therapy to lower the amount of estrogen in your body. Hormonal therapy minimizes or stops your periods so there is less bleeding. As a result, there’s less inflammation, swelling and scar tissue formation due to endometrial implants.

Your doctor can remove the endometrial implants on your pelvic organs during laparoscopy. In severe cases of endometriosis, the doctor may recommend a hysterectomy to remove your uterus, ovaries and cervix. Following a hysterectomy, you will not be able to get pregnant.   

There are some things you can do to ease endometriosis symptoms, such as using warm baths, hot water bottles or heating pads to reduce pain. Certain lifestyle factors can also help lessen symptoms and help you cope with them. These include eating a diet rich in fruits and vegetables, exercising regularly and managing stress.