Is Endometriosis Causing Your Painful Periods?

During endometriosis, the tissue lining the inside of the uterus -- the endometrium -- grows outside the uterus where it doesn’t belong. Menstruation occurs when the endometrium responds to hormonal signals, grows and sheds each month. The endometrium outside of the uterus also grows, which can cause painful irritation, inflammation, and scarring.

The most common symptom is painful periods. “We’re referring to pain where a woman is unable to go to school or work effectively, or they're taking more pain medications than is appropriate,” said Dr. Broach. Symptoms of endometriosis also include pain during sex, bloating, painful bowel movements, and pain during urination or with a full bladder. It is possible to have endometriosis without symptoms.

Endometriosis does not directly cause weight gain. However, Dr. Broach said the symptoms of endometriosis can impact a person’s ability to maintain a healthy weight. “Sometimes people in pain seek emotional comfort in food, and do not feel up to physical activity so it's a complex situation.”

Endometriosis can be investigated with a physical exam or an ultrasound, which may show scarring or an ovarian cyst due to endometriosis. However, mild and even severe endometriosis can have normal ultrasounds depending on where it’s located, which is why the condition is often misdiagnosed. “By the time I see someone, they've often seen multiple providers and have been told, ‘Oh, you just have painful periods,’” Dr. Broach said. “If you feel like something is not being addressed, advocate for yourself. Seek an expert in the field. “

If your imaging comes back normal and your doctor still suspects endometriosis, laparoscopy is the next step. 

Laparoscopy is a minimally invasive surgery used to diagnose and treat endometriosis. It allows your doctor to get a complete view of your pelvic area. During the procedure, your surgeon makes a small incision in the belly button, inflates your abdomen with gas, and inserts a lighted camera through the incision to inspect the pelvic area and appendix. Your surgeon will have a clear view to identify, remove, or destroy endometriosis lesions, cysts, and scar tissue without harming the healthy tissue around it.

There are four stages of endometriosis based on how deep the tissue has penetrated, how widespread it is, and where it is located. During stage one, spots of endometriosis are smaller and shallower. Stage four means spots are deeply rooted into the tissue and are usually on important organs like the ovaries, colon, or bladder. Pain is not a consideration when staging endometriosis and a higher stage doesn’t mean your symptoms are more severe.

Birth control pills and over-the-counter anti-inflammatories such as ibuprofen are usually tried first. If that doesn’t work, Dr. Broach said progesterone-only hormonal therapy given via pills, injections, or intrauterine devices (IUDs) is typically the next step. “A lot of people respond well to the intrauterine device,” she said.

According to Dr. Broach, stronger medications are available for people with more severe endometriosis, which creates a “menopause-like scenario.” “The brain and the ovaries are still talking to each other but at a much lower volume,” she said. These medications are taken by mouth and lower hormone levels to reduce menstrual bleeding and pain. They are tried before the strongest medication used to treat endometriosis, leuprolide. Leuprolide is an injection that completely blocks the communication between the brain and the ovaries, temporarily stopping your periods. Your period will return once you stop taking the medication.

Laparoscopic endometriosis surgery is usually preferred for women trying to get pregnant. “Doing surgery and resecting or treating some of the disease increases a woman’s ability to become pregnant for about six months after surgery,” said Dr. Broach.