Endometriosis develops when tissue resembling the endometrium grows on the ovaries, bowel, and the tissues that line the pelvis. While it is uncommon for this endometrial-like tissue to extend beyond the pelvic region, it is not entirely impossible. The presence of such tissue outside the uterus is referred to as an endometrial implant.

The hormonal fluctuations during your menstrual cycle impact the displaced endometrial-like tissue, resulting in inflammation and pain in the affected area. Consequently, the tissue undergoes growth, thickening, and subsequent breakdown.

However, since this broken-down tissue has no means of exiting the body, it becomes trapped in the pelvis. These trapped tissues in the pelvic area can irritate, forming scar tissue, fertility issues, and intense menstrual pain.

Endometriosis is categorized into different types based on the areas it affects, and four main types of endometriosis are important to know.

1. Superficial peritoneal endometriosis

The peritoneum, a thin membrane lining the abdomen and pelvis and covering many organs within these cavities, is the attachment site for the endometrial tissue in this type of endometriosis. This form is considered the mildest or least severe.

2. Endometriomas

These are cysts filled with dark fluid, commonly called chocolate cysts. They can be found in various areas of the pelvis or abdomen but are predominantly seen in the ovaries. These cysts can vary in size.

3. Deeply infiltrating endometriosis

In this particular type, the endometrial tissue has infiltrated the organs within and outside the pelvic cavity. This invasion can involve organs such as the ovaries, rectum, bladder, and bowels. Although it is uncommon, there are instances where scar tissue may bind these organs together, resulting in a condition known as a frozen pelvis. However, it’s important to note that this occurrence is observed in only a small percentage, ranging from 1% to 5%, of individuals with endometriosis.

4. Abdominal wall endometriosis

In certain situations, endometrial tissue has the potential to develop on the abdominal wall. These cells may adhere to a surgical incision, such as one created during a C-section.

Endometriosis symptoms

The symptoms of endometriosis can range from mild to severe. It’s important to note that even mild symptoms can still experience significant discomfort, whereas severe symptoms may not always be accompanied by intense discomfort.

It is possible to be unaware of the symptoms, so we have compiled a list of signs you might be experiencing.

  1. Pelvic pain is the most common symptom of endometriosis
  2. painful periods
  3. cramps 1 or 2 weeks around menstruation
  4. heavy menstrual bleeding
  5. infertility
  6. pain during sexual intercourse
  7. discomfort with bowel movements
  8. lower back pain that may occur at any time during your menstrual cycle

Endometriosis Treatment

The majority of endometriosis cases can be managed with conservative treatments. However, in situations where there is no improvement, surgical intervention may be necessary.

The doctor needs to conduct tests to determine the most suitable treatment approach. Below are some of the treatments that may be recommended.

1. Pain Medications

Many individuals opt for pain relief medications like ibuprofen, but it is generally not recommended and may not be effective in most cases.

2. Hormone Therapy

In certain cases, supplemental hormones can relieve pain and halt endometriosis progression. Hormone therapy assists in regulating the hormonal fluctuations that occur during the menstrual cycle, contributing to tissue growth in endometriosis.

3. Hormonal Contraceptives

Hormonal contraceptives can reduce fertility by inhibiting the monthly growth and buildup of endometrial-like tissue. Birth control pills, patches, and vaginal rings can alleviate or potentially eliminate pain associated with milder cases of endometriosis.

Another effective option is the medroxyprogesterone (Depo-Provera) injection, which ceases menstruation and hampers the growth of endometrial implants. This injection provides relief from pain and other symptoms. However, it may not be the preferred choice for everyone due to potential side effects such as weight gain, reduced bone production, and an increased risk of depression in certain cases.

4. Gonadotropin-Releasing Hormone (GnRH) Agonists And Antagonists

Gonadotropin-releasing hormone (GnRH) agonists and antagonists are utilized to suppress estrogen production. Estrogen is crucial in stimulating the ovaries and developing sexual characteristics in individuals assigned to females at birth. By blocking estrogen production, menstruation is prevented, and an artificial menopause state is induced.

5. Danazol

Danazol is an alternative medication to halt menstruation and alleviate symptoms associated with endometriosis. It is important to note that even while taking danazol, the disease may still progress. However, this medication can have certain side effects, such as acne and hirsutism, characterized by excessive hair growth on the face and body.

6. Conservative surgery

Conservative surgery is commonly employed for individuals who desire to conceive or suffer from severe pain when hormonal treatments have proven ineffective. Conservative surgery aims to eliminate or eradicate the endometrial growths while preserving the integrity of the reproductive organs, minimizing the potential for damage.

 7. Hysterectomy

Hysterectomy involves the surgical removal of the uterus and cervix. When other treatments fail to improve the condition, your doctor may recommend a total hysterectomy as a last resort. In addition to the uterus and cervix, the ovaries may also be removed since they produce estrogen, which can contribute to the growth of endometrial-like tissue. The surgeon also removes any visible implant lesions during the procedure.

Although a hysterectomy can address endometriosis, it is important to note that it is not a definitive cure. Being aware that fertility is no longer possible after a hysterectomy is crucial. If starting a family is a consideration, seeking a second medical opinion before agreeing to undergo surgery is advisable.

Two additional types of hysterectomies are performed depending on the specific condition being treated.

A subtotal hysterectomy, also known as a partial or supracervical hysterectomy, involves the removal of the upper portion of the uterus while leaving the cervix intact.

On the other hand, a radical hysterectomy is typically conducted when cancer is detected. This procedure involves completely removing the uterus, cervix, and the upper part of the vagina.

 Causes Of Endometriosis

The precise cause of endometriosis remains unknown. Among the earliest theories is retrograde menstruation, where menstrual blood flows back through the fallopian tubes into the pelvic cavity instead of exiting the body through the vagina.

Another theory suggests that hormonal influences cause cells outside the uterus to transform into endometrial-like cells, resembling those lining the uterine walls.

Some experts propose that endometriosis may arise when certain abdomen areas undergo a conversion process, developing endometrial-like tissue. This conversion may occur due to embryonic cells in the abdomen changing shape and behaving similarly to endometrial cells. The reasons behind this occurrence are not yet understood.

These displaced endometrial cells can be found on pelvic organs’ pelvic walls and surfaces, such as the bladder, ovaries, and rectum. They continue to grow, thicken, and bleed in response to the hormonal changes during the menstrual cycle.

In certain cases, menstrual blood can also leak into the pelvic cavity through surgical scars, such as those resulting from a cesarean delivery (C-section).

Other theories propose that endometrial cells may be transported out of the uterus through the lymphatic system or that an immune system dysfunction may contribute to the survival of errant endometrial cells.

Some researchers suggest that endometriosis may originate during the fetal period, with misplaced cell tissue that begins to respond to the hormonal changes of puberty, a hypothesis known as the Mullerian theory.

The development of endometriosis may also have links to genetic factors or exposure to environmental toxins.


Central to effectively managing your pain is obtaining an accurate diagnosis. It is crucial to recognize that the diagnostic process can differ, and, in some cases, it may take several years, ranging from 4 to 11 years, from the initial appearance of symptoms to reaching a diagnosis.

During this time, remaining patient with yourself and the process while collaborating with your healthcare team is important.

Your doctor will conduct one or more tests as part of the diagnostic evaluation.

1. Detailed history

Your doctor will carefully observe your symptoms and inquire about your personal and family history of endometriosis. A comprehensive health assessment may also be conducted to identify any additional indications of a chronic condition.

2. Physical Exam

As part of a pelvic exam, your doctor will utilize a speculum and a light source to examine the inside of your vagina and cervix visually. Additionally, they will manually palpate your abdomen to detect cysts or scars behind the uterus.

3. Ultrasound

Your doctor may employ a transvaginal or abdominal ultrasound as a diagnostic tool. During a transvaginal ultrasound, a probe is inserted into the vagina to obtain images of the reproductive organs.

Both types of ultrasounds can assist your doctor in identifying cysts that may be indicative of endometriosis. However, they are not entirely conclusive in ruling out the presence of the disease.

4. Laparoscopy

Direct visualization through a minor surgical procedure called laparoscopy is currently the only definitive method for diagnosing endometriosis. During laparoscopy, the endometrial tissue can be observed directly and if necessary, removed during the same procedure.

Risk Factors

Endometriosis typically manifests several years after the onset of menstruation and often involves significant pain. Nevertheless, being aware of the risk factors associated with the condition can aid in assessing your likelihood of developing it and determining when it is appropriate to consult with your doctor.

1. Age

Endometriosis can affect women of various age groups, with a higher prevalence observed among women in their 30s and 40s. However, it’s important to note that symptoms of endometriosis can commence as early as during puberty.

2. Family History

A potential genetic component to endometriosis suggests that it can be inherited within families. Suppose you have a family member who has been diagnosed with endometriosis. In that case, discussing this with your doctor is advisable, as it may indicate a higher risk of developing the condition yourself.

3. Menstrual History

Having a shorter menstrual cycle, experiencing heavy and prolonged periods, and starting menstruation at a younger age are potential risk factors for developing endometriosis.