Endometriosis Symptoms: What Are They? How Can You Treat Them?

What is endometriosis?

Endometriosis is the abnormal growth of endometrial cells. They should normally be only located in the uterus, but in this case, they grow beyond the uterine cavity. Almost 200 million women worldwide are diagnosed with the disease.

Abnormal endometrial cells can be located on the ovaries, outer uterine walls, and fallopian tubes. They can even grow to the peritoneum, intestines, and other organs.

Endometriosis diagnosis is complicated and even invasive at times: it often requires complex examination or even surgical intervention. Relieving endometriosis symptoms and curing the disease is also hardly a walk in the woods. It may cause a great deal of pain and discomfort.

If you face this disease, find a doctor who specializes in its treatment.

Who is at risk?

Endometriosis can affect any woman from the time she starts menstruating until she enters menopause. Childbirth doesn’t give immunity to this disease.

Often, endometriosis “chooses” the places that were previously operated on: the scar after a cesarean section or an episiotomy (a cut in the perineum); the area where a polyp or myoma was removed; an abortion or curettage was performed. 

Unfortunately, signs of endometriosis can be seen only during a diagnostic operation such as laparoscopy or hysteroscopy.

A doctor assesses the need for surgical intervention in each individual case, but if you are concerned about atypical pain in the pelvic area before and during menstruation and/or pain during sex, you should consult a gynecologist.

Why does endometriosis get aggravated during menstruation?

Endometriosis pain appears long before menstruation, becomes unbearable during menstruation, and fades after it ends.

Endometriosis is the abnormal growth of the endometrium, the tissue that should be located exclusively in the uterus, but has grown outside the uterine walls. Consequently, wherever this tissue is located, it goes through the same phases during the cycle as the endometrium in the uterus. 

It reacts to hormonal changes and is rejected during menstrual periods. This causes a great deal of pain.

The most typical manifestations of endometrial pain are:

• During menstruation: it embraces the entire pelvic region (genitalia, intestines, sacrum area).
• During sexual intercourse: it can be so severe that a woman eventually begins to avoid sex.
• During ovulation: the pain is moderate (bearable), but it gets worse as menstruation approaches.
• During urination: the pain occurs if endometriosis is already widespread.

Endometriosis pain is the body’s signal for help. Don’t ignore it. Consult a specialist for diagnosis and proper treatment.

Why does endometriosis develop and how can it be avoided?

To date, there is no clear answer as to what causes endometriosis. Several factors contribute to its development.

• Retrograde menstruation. Blood flows in the opposite direction from the uterus to the pelvic organs, where endometrial cells can grow.
• Heredity. Scientists suggest that endometriosis can be passed on genetically.
• Immune and endocrine system. Problems can arise due to environmental influence.
• Metaplasia. One tissue replaces another or turns into it (for example, endometrial cells replace peritoneal cells, and are rejected during menstruation in the same way as in the uterus).
• Sex during menstruation with orgasm or profuse menstrual bleeding.
• Constantly using and/or rarely changing tampons. This keeps menstrual blood in the vagina.

The risk of developing endometriosis is significantly reduced with repeated pregnancies, childbirth, and long-term breastfeeding, but not every woman is ready to choose this life scenario.

Endometriosis treatment: hormonal therapy for relieving symptoms

For efficient endometriosis pain relief, the doctor may prescribe hormonal medications. It is important to know that when they are withdrawn, the symptoms return.

The methods that have proved effective are:

• progestins, which stop menstruation and prevent the egg from ripening, at the same time preventing the endometrial foci from growing and decreasing pelvic inflammation
• agonists, which are taken in case of severe disease, as they cause temporary artificial menopause
• the hormonal intrauterine device Mirena, which shows positive results in treating uterine endometriosis (adenomyosis)

When choosing an endometriosis treatment strategy, the doctor will take into account how ready you are for changes in the body associated with a temporary absence of menstruation.

Endometriosis is a real and very unpleasant condition to deal with. But it’s not the end of the world. Consult your doctor if you suspect it, and even if you’re diagnosed, you can still live an active life, get pregnant if you want, and be happy!

Are there any lifestyle changes that a woman can make to relieve the disease?

The answer is provided by Professor Christian M. Becker - Co-director of the Oxford Endometriosis CaRe centre and medical consultant at Flo.

Endometriosis and adenomyosis are associated with inflammation. I have had women who changed to an anti-inflammatory diet, cut out gluten or dairy products and got better. These cases may support that there is often not a single cause of pelvic pain, but that other organs or systems such as the gut are involved.

The problem with these changes in diet is that its very difficult to do studies on those because we know what type of the world we live in. It's very difficult to function in this world and really be strict with your regimen. Imagine you are invited to dinner somewhere, and who knows what's in the food there, and you can not say “Well, sorry, I cannot eat because I'm not on this, and this, and that”. 

Keeping a strict diet is very difficult, whereas if you have a drug, you take the drug or you don't take the drug which makes it much easier. It remains to be seen if we will ever get proper data on the potential benefits of lifestyle or dietary changes to treat endometriosis or adenomyosis.

What we do often see is that patients with chronic pelvic pain, and it is true for endometriosis, they often have a quite tense pelvic floor. So we usually suggest physiotherapy as well, which is not for everybody but it has helped quite a few patients. So that's something to think about, to have a proper assessment with a physiotherapist who knows about the pelvic floor well and they can help with some aspects of pain.