Do you suffer from chronic or frequent pain in your lower abdomen and pelvis? You may be suffering in silence, but you’re not suffering alone. Around 1 in every 7 US women is affected by chronic pelvic pain, a condition that can significantly impact the quality of daily life. While pelvic pain can have many different causes, researchers estimate that up to 80% of premenopausal women with chronic pelvic pain have some degree of endometriosis.

What is endometriosis?

The endometrium is the inner lining of your uterus. Each month, the endometrium gradually gets thicker, until it begins to break down and is shed as menstrual blood flow. Usually, endometrial cells are only found along the inner surface of the uterus. In some women, however, clumps of endometrial tissue are found outside of the uterus, most often on the ovaries and other adjacent structures. These clumps, called implants, are diagnostic of endometriosis.

What causes endometriosis?

No one knows exactly what causes endometriosis. One theory is that blood and endometrial cells flow backwards out of the fallopian tubes into the pelvic cavity, rather than out through the vagina; this is called ‘retrograde menstruation’. Women with endometriosis also have higher rates of autoimmune diseases like asthma, suggesting that their immune systems may have a harder time recognizing and eliminating endometrial implants.

Do I have endometriosis?

The most common symptom of endometriosis is pain in the pelvis, which may come and go or be constant. The pain may get worse during sexual intercourse or menstruation. Endometriosis can cause abnormal bleeding, in between normal menstrual periods. If implants involve the colon or urinary bladder, you could see blood in your urine or stool.

The only way to know for sure if you have endometriosis is to have surgery to look for endometrial implants in the pelvis. However, based on your symptoms and clinical exam, your doctor or midwife may suspect endometriosis, and start treatment to relieve your pain.

How do I treat endometriosis?

The first important step is to see your doctor or midwife. A detailed history of your problems, particularly symptoms of pelvic pain and abnormal bleeding, is helpful in deciding if endometriosis could be the cause. A physical exam is also performed, to localize any tenderness and exclude other possible sources of pain, including fibroids and infections.

If your history and physical exam are suggestive of endometriosis, you may be given a three to six month trial of medical therapy with anti-inflammatory drugs (e.g. ibuprofen) and oral contraceptive (birth control) pills. If these are unable to control your symptoms, other hormone-based medications are available.

If your symptoms remain untreated with medical therapy or are severe and affect everyday life, your doctor may consider surgical therapy. Laparoscopy (keyhole) surgery is performed through small incisions in the skin. Your surgeon will locate and remove as many endometrial implants as possible, and also remove any associated scar tissue in the pelvis.