What is Endometriosis? Causes, Symptoms and Treatments

What is Endometriosis?

Endometriosis is a chronic inflammatory condition where tissue similar to the uterine lining grows outside the uterus. This tissue behaves abnormally because it reacts to hormonal changes but cannot exit the body during a menstrual cycle. As a result, it causes pain, inflammation, and scar tissue formation.

Unlike the normal endometrium, this misplaced tissue often appears on the ovaries, fallopian tubes, peritoneum, and in some cases, even the bowel or bladder. These areas are not designed to handle monthly bleeding or tissue shedding, leading to discomfort, swelling, and eventually adhesions between organs.

One of the reasons endometriosis persists is due to estrogen sensitivity. The abnormal tissue produces local estrogen, fueling its own survival and triggering nerve growth, which increases pain over time. This interaction between hormones, immune response, and tissue behavior makes the condition difficult to manage.

Understanding endometriosis means focusing not only on the presence of lesions, but also on the systemic effects it creates in the pelvic environment. This includes ongoing inflammation, immune dysfunction, and pain signaling pathways that stay active even between menstrual cycles.

What Causes Endometriosis?

The causes of endometriosis are not singular. Retrograde menstruation is the most discussed theory, where menstrual blood flows backward into the pelvic cavity through the fallopian tubes. But this happens in many people who never develop endometriosis. So it’s only part of the picture.

There is strong evidence pointing to genetic predisposition. If a close relative has endometriosis, the likelihood of developing it increases. These inherited traits may include differences in hormone metabolism, immune cell function, and how the body handles cell adhesion.

The immune system plays a central role. In people with endometriosis, the body does not clear away the misplaced cells efficiently. This leads to persistent growth, supported by elevated inflammatory markers like interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α).

Another important factor is estrogen dominance, especially within the local pelvic microenvironment. The tissue creates its own aromatase enzyme, converting hormones into estrogen, which keeps the lesions active. This cycle creates a setting where inflammation and pain feed into each other over time.

What Are the Symptoms of Endometriosis?

Endometriosis causes pelvic pain that often worsens during menstruation. However, pain levels do not always match the severity or size of lesions. Some people with mild endometriosis feel extreme pain, while others with advanced disease may have minimal symptoms.

One common symptom is dysmenorrhea, or painful periods. This pain may start a few days before menstruation and continue throughout. It often spreads to the lower back and legs, creating a throbbing or sharp sensation that disrupts daily life.

Another major symptom is pain during intercourse. This is usually caused by lesions located near the uterine ligaments or the vaginal wall. The pain can persist after sex and may feel like deep pressure or stabbing in the pelvic area.

Some individuals experience digestive problems. These may include bloating, diarrhea, or painful bowel movements, especially during menstruation. If lesions affect the bladder, symptoms may resemble urinary tract infections, even when tests come back negative.

How is Endometriosis Diagnosed?

Endometriosis is diagnosed through a mix of symptom tracking, medical imaging, and in some cases, surgical confirmation. There is no single test that confirms the condition without examining tissue directly.

A common starting point is a transvaginal ultrasound, which helps identify ovarian cysts known as endometriomas. These cysts are a visible indicator of more extensive disease but may not always be present.

MRI scans are useful when doctors suspect deep infiltrating endometriosis, particularly in the rectovaginal space or bowel walls. However, small or superficial lesions often remain invisible on scans, which is why symptoms remain critical in guiding diagnosis.

When non-invasive methods are inconclusive, doctors may perform laparoscopy, a procedure using a thin camera inserted through a small incision. This allows direct viewing of internal organs and possible biopsy of suspicious tissue to confirm endometriosis.

How is Endometriosis Treated?

There is no single cure for endometriosis. Instead, treatment focuses on symptom control, hormonal regulation, and in some cases, surgical removal of lesions. The choice of treatment depends on symptoms, age, fertility goals, and how the body responds to medications.

Hormonal therapies are often the first approach. They include progestin-only pills, combined birth control, and GnRH analogues. These drugs lower estrogen levels, slowing or stopping the growth of endometriotic tissue.

When medication is not enough, doctors may suggest excision surgery. This involves removing the lesions rather than just burning or cauterizing them. Excision is preferred because it targets both the tissue and surrounding nerve-rich inflammatory zones.

Pain management can also include non-steroidal anti-inflammatory drugs (NSAIDs), pelvic floor therapy, and nerve modulation techniques. For some individuals, a condition called central sensitization occurs, where the nervous system amplifies pain signals, even after lesions are removed.

How to Manage Daily Life with Endometriosis

Living with endometriosis requires practical strategies. Understanding your body and tracking symptoms over time can help adjust your lifestyle and medical plan more effectively.

Helpful habits for managing symptoms:

• Keep a pain and symptom journal to identify patterns.
• Use heating pads during flare-ups to ease muscle tension.
• Practice gentle stretching or low-impact exercise like walking or swimming.

Stress is another trigger. High stress levels can increase pain perception and disrupt hormone balance. Daily routines that include sleep regulation, stress reduction techniques, and nutrient-dense foods may help reduce the intensity of symptoms.

Can Endometriosis Cause Infertility?

Yes, endometriosis can reduce fertility, especially when lesions affect the ovaries or fallopian tubes. However, many people with mild or moderate disease still conceive naturally.

Endometriosis can impair fertility in several ways. Lesions can block the fallopian tubes, alter ovulation, or damage egg quality. Additionally, inflammation in the pelvic cavity may affect sperm mobility and prevent successful embryo implantation.

For those trying to conceive, treatments may include timed intercourse, intrauterine insemination (IUI), or in vitro fertilization (IVF). In some cases, surgical removal of lesions improves fertility, especially if anatomical distortions are corrected.

Monitoring ovarian reserve and working with a fertility specialist helps create a personalized plan. Fertility preservation may also be an option if future pregnancy is a goal but surgery or treatment is needed soon.