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Understanding the Causes and Symptoms of Endometriosis

Written by
Brooke McKelvey
Team Nutrisense
Reviewed by
Heather Davis
MS, RDN, LDN
a person having a stomach-ache

Do you get severe pain during your periods? Do you also experience nausea, lower back pain, and heavy bleeding? You may think these are just the usual side effects of a ‘bad period,’ but you don’t have to suffer through them! They can be symptoms of or increase your risk factors for various conditions, including one affecting the endometrium or lining of the uterus.

It’s called endometriosis, and it’s a common yet often misunderstood disorder, even though it affects millions of women. Often dismissed as bad menstrual cramps, it has debilitating symptoms that dramatically impact your quality of life. The condition affects an estimated two to 10 percent of women between 25 and 40.

Unfortunately, like many women's health issues, endometriosis is under diagnosed or undiagnosed. It happens due to several factors—there’s not enough research, some gynecologists are wary of diagnosing it too quickly, and many women are unaware of the symptoms of endometriosis. You may think the endometriosis-associated menstrual blood, cramps, and severe pain is simply a painful period because that’s what we’ve all been taught to believe!

But the early diagnosis of endometriosis is essential because if it’s left untreated, it can lead to infertility. If you think you have any of the symptoms, it’s crucial to get evaluated as early as possible. But, since treatment of endometriosis can be as elusive as the diagnosis itself, the first and most vital step is to understand the condition.

Since March is Endometriosis Awareness Month, we thought we’d spend some time explaining the condition and its effects on women’s health. We've also got a couple of firsthand accounts from some of our team members to shed more light on the subject. Read on to learn more.

What is Endometriosis?

a doctor examining patient's stomach

Endometriosis is a chronic condition where endometrial tissue, typically on the inside lining of the uterus, grows outside it. It’s a common gynecological disease that affects women of reproductive age.

To explain it a little further, it occurs when the cells lining the uterus (endometrium) inside grow outside of the uterus. It is most commonly on the ovaries, fallopian tubes, and space around the bladder and rectum. Endometriosis can cause severe pain and increase your risk factors for health problems like infertility. 

What Are the Causes of Endometriosis?

a doctor making notes

Researchers and healthcare professionals are still trying to figure out the exact causes of endometriosis. They know it affects the immune cells, red blood cells, and endometrial cells, so there is some evidence and research on how it affects women’s health. But research on what really causes endometriosis is still ongoing.

Some researchers believe the cause of endometriosis, which affects menstrual periods, has something to do with menstrual flow. In particular, retrograde menstruation. Retrograde, or reverse menstruation, occurs when (as the name suggests) your flow moves in the wrong direction. It flows through your fallopian tubes into areas of your body like the pelvic cavity. Most women experience this at some point, but increased instances of retrograde menstruation may increase your risk of endometriosis.

Other risk factors for the condition include your genes and altered immune function. For example, if your immune system is working well, it may be more capable of destroying endometrial tissue adhesions outside the uterus.

Your hormones can also play a role here. There’s some research on whether diseases like endometrial cancer have a link to hormones like estrogen. Some surgeries like cesarean births and hysterectomies can cause scar tissue issues. In these instances, it can affect endometrial tissue and increase your risk of endometriosis.

What Are Some Common Symptoms of Endometriosis?

a person having a stomach-ache

Endometriosis affects an estimated one in 10 women of reproductive age. Although there are treatment options and ways to manage your symptoms, it’s a lifelong condition that requires daily self-care and monitoring. Knowing some of the most common symptoms of endometriosis is an excellent first step to understanding the condition.

Common Symptoms of Endometriosis

  • The most common symptom of endometriosis is a painful period. The severe pain often begins before a menstrual period and extends into the menstrual cycle. The pain may also include severe lower back and stomach pain. 
  • Another common symptom women experience is pain during (and sometimes after) sexual intercourse. Sometimes this pain starts as a dull pain; other times, it's a severe pain that makes maintaining a healthy intimate life challenging for many women.
  • Some women experience fatigue before and during their menstrual cycle. In extreme cases, this can develop into chronic fatigue. 
  • Many women report stomach complications like constipation, bloating, diarrhea, and nausea during their menstrual cycles. 
  • Endometriosis can cause painful bowel movements and urination in some women. It is usually related to the menstrual cycle. 
  • If left untreated, endometriosis can lead to infertility. Unfortunately, this is often how many women discover they have the condition. 
a diagram of some complications caused by endometriosis

How to Treat Endometriosis

a doctor talking to a patient and making notes

 The diagnosis of this condition can be a challenge, but if you think something is wrong, listen to your body and insist on getting the required tests. Ask for a pelvic exam, an ultrasound, or even an MRI to check various parts of your body, including your reproductive organs. If you get a diagnosis, remember that there is no one-size-fits-all treatment. Here are some of the most common ones:

Laparoscopy: A laparoscopy is a minimally invasive surgical procedure, sometimes used to diagnose definitively and then treat endometriosis.

Pain Medicine: One of the most common treatments for endometriosis is medication. These are usually over-the-counter and non-steroidal anti-inflammatory drugs, like ibuprofen. Some cases of severe pain may call for opioid prescriptions. 

Contraceptives: Birth control pills are often a form of hormone therapy by doctors treating endometriosis. 

Hormone Therapy: Progestin therapy and gonadotropin-releasing hormone (GnRH) agonists are a few hormone therapy treatments that doctors sometimes utilize. 

Hysterectomy: A hysterectomy is usually considered a drastic measure. Healthcare providers don’t recommend it unless you have a severe case or develop lesions or ovarian cysts from the condition. Hysterectomies are surgeries that remove the uterus and sometimes the ovaries and fallopian tube from the body.

The Relationship Between Blood Sugar and Endometriosis

a person being applied a CGM sensor to their upper arm

The chronic condition also impacts blood sugar levels—and managing them may help manage symptoms of endometriosis. By managing your blood sugar levels, you can help reduce some of the severe pain and symptoms associated with the condition. Unregulated blood sugar has been linked to worsened symptoms of endometriosis. This is especially true of symptoms like fatigue and severe pain during menstrual cycles. 

Stories of Endometriosis Management

Dealing with and managing the symptoms of endometriosis can be an overwhelming prospect. Since the condition is under diagnosed and under researched, everything from diagnosis to treatment can be challenging. It’s a good idea to join a support group so you can talk to other women before, during, or after a diagnosis.

And, if you’re still wondering whether what you’re feeling is a symptom of endometriosis, hearing firsthand accounts can help. Here are some accounts from two members of the Nutrisense team that may be able to help.

Luz Cortazer and her quote "I assumed the severe pain I was feeling was normal..."

"I was diagnosed with endometriosis in 2017, but only after emergency surgery. I spent more than 20 years menstruating, ignoring that I had the condition. I normalized that my period would leave me in unbearable pain every month. I assumed the heavy bleeding and pelvic pain were normal, and I just needed to “man up” and get on with my life.

That’s what medical professionals would say too! “Oh, you need to take birth control to ease the pain. When you become a mother, it will get better. Don’t worry, it happens….” But then a 9-centimeter cyst got infected in my right ovary, and I had a high fever for over a week. 

I wasn’t even aware that a tennis ball lived in my uterus since women in my condition can develop a cyst over a short period. It got so bad that my appendix became infected too. The doctor decided to take me to the operating room after an unsuccessful four-day in-hospital intravenous antibiotics treatment.

Fortunately, my right ovary is still alive, and I said goodbye to a useless organ. But it was only after the intervention that my doctor explained that I had this incurable yet treatable condition. Raising awareness is one of the things we need to work on. So, since this is Endometriosis Awareness Month, I wanted to share my story to tell all you Endo Warriors out there—we're not alone. And, most of all, if you haven’t been diagnosed yet, to remind you—pain is not normal. Please listen to your body and find a doctor who listens to you!"

Check out more from Luz’s story on Instagram.

Heather Davis and her quote "I underwent multiple levels of drug therapy to "treat" this condition.

"I was diagnosed with endometriosis in my teens, and my diagnosis continued throughout the early part of my twenties. I underwent multiple levels of drug therapy, including chemically-induced menopause, to "treat" the condition. Unfortunately, all of these approaches led to worsened symptoms and additional medical conditions that continued advancing throughout my twenties. 

After spending over a decade seeking answers from every corner of the medical world (both traditional and functional/alternative) without much progress, I was beyond frustrated and felt defeated. But I didn't give up searching for answers! It was a unique approach to customized nutrition therapy that eventually led to my successful recovery. And not only from endometriosis but other diagnoses too, including PCOS, chronic fatigue syndrome, and more. 

This profound personal experience of transforming my health and regaining my hormone balance inspired me to complete my master's in nutrition science and become a dietitian to practice clinical nutrition for a living.

To date, I've worked with hundreds of women struggling with various hormonal imbalances, including endometriosis. And I've seen the incomparable power of customized nutrition offer them hope when other avenues have failed them. 

Each person is unique, so what dietary approach works for one person may not work the same for another—but understanding how to navigate and customize those experiments and tools is what's important."

a list of key takeaways


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