Endometriosis: Ignored Too Often

Unfortunately, many people who experience endometriosis symptoms may not discuss them with their health care providers for a long time. So, I’d like to make sure you understand what endometriosis is, its symptoms, and its treatments.

What is Endometriosis?

is a disease in which tissue similar to your uterine lining grows elsewhere in your body — such as around your ovaries or fallopian tubes, the lining of your pelvic cavity, or the outside of your uterus. It may affect more than 11 percent of American women of ages 15 – 44. It’s especially common among people in their 20s, 30s, and 40s, and it may make it harder for them to get pregnant.

Endometriosis growths may swell and bleed, just like your uterine lining does every month during your menstrual period. That can be painful, because inflammation and bleeding are happening in a part of your body where they shouldn’t be.

Endometriosis Causes and Risk Factors

The causes of endometriosis aren’t fully understood. But here are some that have been identified:

Retrograde menstruation: Menstrual blood flows up from the uterus, through the fallopian tubes, and into the pelvic cavity instead of flowing out of the body. Inside the pelvic cavity, the endometrial cells grow, thicken, and bleed with every menstrual cycle. Retrograde menstruation can be caused by increased estrogen production; fibroids or polyps; abnormalities or obstructions in the uterus, cervix, or vagina; or abnormal uterine contractions.
Surgical scarring: Endometrial cells attach themselves to a surgical incision site after an operation (such as a hysterectomy or C-section).
Cell transformation: Hormones (especially estrogen) or immune factors transform the cells outside the uterus into endometrial cells.

These risk factors may make someone more likely to get endometriosis:

A family history of endometriosis
Getting menstrual periods every 27 days or less; starting a first period before age twelve; or having periods that last seven or more days every month
Immune disorders, which can stop the body from recognizing and attacking endometrial cells where they don’t belong
Abdominal surgery, like a hysterectomy or C-section
Age – endometriosis happens most frequently to people in their 20s – 40s

If you have one or more of these endometriosis risk factors, you may want to watch carefully for its symptoms.

Endometriosis Symptoms

Endometriosis affects people different ways. Its symptoms can include:

Pain, the most obvious symptom, such as very painful menstrual cramps, pain in the lower back and pelvis, pain during and after sex, and intestinal pain
Bleeding or spotting between menstrual periods; this can also be caused by something other than endometriosis, so if it happens often, you should see your doctor
Infertility, being unable to get pregnant
Stomach (digestive) problems such as diarrhea, constipation, bloating, or nausea, especially during menstrual periods
Painful bowel movements or pain when urinating during menstrual periods, sometimes with blood in your stool or urine

The chronic, debilitating pelvic pain associated with endometriosis can affect every aspect of a person’s life, including mood, sleep, relationships, work, and school attendance.

That’s why awareness is so important. The sooner endometriosis can be diagnosed, the sooner it can be managed to minimize its impact on your life.

Delays in Diagnosis

Endometriosis often goes undiagnosed for many years. Many people don’t report their symptoms to health professionals because they:

Believe they’re just having severe menstrual cramps
Are embarrassed to talk about anything related to menstruation
Are concerned that their symptoms will be dismissed and downplayed

Also, marginalized populations tend to receive inferior medical care when it comes to endometriosis. Research shows that:

If you’re experiencing endometriosis symptoms, please talk to your health care provider. Insist on having your symptoms taken seriously and investigated.

How Endometriosis is Diagnosed

Here’s what doctors do to confirm a diagnosis of endometriosis:

Perform a pelvic exam — feeling for large cysts or scars behind your uterus
Order ultrasound or magnetic resonance imaging (MRI) studies
Try hormonal treatments (the information below); if these reduce your pain, you probably have endometriosis
Do a laparoscopic examination — a minimally invasive surgery which uses a scope to look for endometrial tissue inside your pelvic area

How Endometriosis is Treated

While there’s no cure for endometriosis, treatments are available to ease its symptoms and the problems it creates. These include:

Over-the-counter NSAIDs like ibuprofen or naproxen, which relieve both pain and the inflammation that causes it
Hormone treatments like estrogen/progesterone or progesterone-only pills, patches, or IUDs
Gonadotropin-releasing hormone (GnRH) agonists and antagonists, which lower estrogen levels and prevent menstruation
Surgery, when symptoms are very severe
Exercise such as swimming and yoga, and physical therapy

Take Action Against Endometriosis

Too many people ignore endometriosis symptoms for too long and delay seeking care. If you are experiencing these symptoms, please talk to your doctor.

Independence Blue Cross members can talk to one of our Registered Nurse Health Coaches 24/7 by calling 1-800-ASK-BLUE (1-800-275-2583) (TTY/TDD: 711). When prompted for a call reason, say “Health Coach.”