Endometriosis: Symptoms and Next Steps

Do you struggle with painful menstrual cramps that impact your ability to function during your period? Maybe you experience intense pain with sex or bowel movements. These could be signs of endometriosis. Endometriosis is a chronic pain condition that occurs when tissue similar to the lining inside of the uterus, called endometrium, grows outside of the uterus. These lesions can be on the bowel, in the ovaries, or on the inner abdominal wall. Endometriosis deposits attract inflammatory cells that lead to pain, excess bleeding, and scar tissue inside the body. Endometriosis can be tricky to diagnose because surgery is often required, so it can be several years before a diagnosis is finally made. 

When your period becomes a problem, you may have concerns about having either endometriosis or fibroids. Though both of these conditions have similarities, they are actually very different. Whereas fibroids are noncancerous tumors that can cause heavy menstrual bleeding and cramping, endometriosis is typically associated with severe pain during the cycle and other times of the month. Fibroids can be detected on ultrasound, but endometriosis can usually only be seen during surgery. It is possible for someone to have both endometriosis and fibroids, which can make diagnosis of endometriosis trickier given the similar symptoms. 

So, what do you do if you think you have endometriosis?  
 
Unlike typical menstrual cramps, endometriosis pain can be debilitating. Many times, over-the-counter pain medications do not help. Also, this condition can be associated with heavy menstrual bleeding. In addition, when endometriosis deposits are on the intestines, bladder, or pelvic walls, you may experience intense pain outside of your cycle. This could include pain when having a bowel movement, abdominal discomfort with sex, or random pain with activity. If this happens to you, that is a sign to see your doctor for an evaluation. An evaluation will typically include getting a full detailed history of your experience, a pelvic exam, and likely a pelvic ultrasound.

Endometriosis can only be officially diagnosed by visually seeing the endometriosis lesions at the time of surgery. However, you can still be treated by your doctor based on a strong clinical suspicion. Treatment generally includes hormones to suppress the activity of endometriosis. Contraception, particularly birth control pills, tend to be first line. Other options include a class of medication called gonadotropin releasing hormone (GnRH) agonists and antagonists, like Lupron or Orilissa. These medications block hormone activity from the level of the brain to help decrease endometriosis pain. They can be very effective but also associated with bothersome side effects, like hot-flashes and nausea. Surgery not only diagnoses endometriosis, but also can treat it. However, patients with endometriosis are at risk of needing multiple surgeries in their lifetime. So, the goal is to start with medications prior to surgery. 

The mental health impact of having endometriosis  

The diagnosis of endometriosis can have an impact on your physical and mental health. The struggle of having recurrent chronic pain can increase risks of depression and anxiety. Studies have also shown delay in diagnosis due to some providers not believing the experience that people with endometriosis pain are describing. If you think you may have endometriosis, seek out the care of a specialist. There are gynecologists trained in endometriosis care, who can help you get a quicker diagnosis and improve your quality of life. Also, consider seeing a therapist or mental health clinician if you are struggling with sadness or feelings of depression. Though endometriosis is a lifelong condition, there are ways to manage it and improve your symptoms. 

For more information about Endometriosis or to find a culturally responsive healthcare provider, visit our partner Health in Her HUE. Health in Her HUE is a digital network of culturally sensitive healthcare providers, evidence-based health content, and community support.