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All You Need to Know About Endometriosis

Medically reviewed by Mary Rani Cadiz, MD · Obstetrics and Gynecology

Written by Louise Nichole Logarta · Updated Sep 16, 2020

All You Need to Know About Endometriosis

What is Endometriosis?

Endometriosis is a condition wherein tissue that is identical to the tissue lining the walls of the uterus, otherwise known as the endometrium, grows outside the uterus.

Oftentimes, endometriosis is a painful condition that affects the ovaries, fallopian tubes, and the tissue lining the pelvis.

In rare cases, it can spread beyond the pelvic region. What are the first signs of endometriosis?

The endometrial-like tissue behaves as real endometrial tissue would: thickening, breaking down, and bleeding with every cycle.

The problem arises when this tissue has no way of leaving the body. The tissue accumulates.

When it involves the ovaries, “endometriomas”, or cysts, can develop, and cause the surrounding tissue to scar and form adhesions, which can glue pelvic tissue and organs together.

How common is endometriosis?

Endometriosis occurs in women of reproductive age. 90 to 99% of them are between the ages of 20 and 50, regardless of ethnicity and socioeconomic situation.

Worldwide, endometriosis affects an estimated 89 million women.

Signs and Symptoms

What are the first signs of endometriosis? The major symptoms are pain in your pelvic area which usually happens with menstruation.

How to Manage Severe Menstrual Pain and Heavy Bleeding

Those with endometriosis describe their pain to be worse than menstrual cramping.

Read on to find out what are the first signs of endometriosis:

Dysmenorrhea, or painful periods

Cramping and pain in your pelvic area can start a few days before your period and continue several days into it. You may also feel pain in your abdomen and lower back.

Pain during sexual intercourse

Pain during and after sex is not uncommon in women with endometriosis.

Painful urination or bowel movements

These symptoms typically happen along with your menstrual period.

Excessive bleeding

This can come in the form of heavy menstrual periods or inter-menstrual bleeding (or bleeding in between periods).


This is one of the most common effects of endometriosis. Endometriosis can be diagnosed when people consult with experts to treat infertility.

Other symptoms of this condition include fatigue, diarrhea, constipation, bloating, and nausea which occur together with your menstrual periods.

Diarrhea During Menstruation: What You Need to Know

The level of pain you may be experiencing does not necessarily indicate how serious your condition is.

Some women can have mild endometriosis with extreme pain while others can have advanced endometriosis with little to no pain.

Sometimes, endometriosis is confused for other problems like pelvic inflammatory disease (PID) or ovarian cysts, which both cause pelvic pain.

It is sometimes mistaken for irritable bowel syndrome (IBS) which causes periods of diarrhea, constipation and abdominal diagnosis. When IBS presents with endometriosis, the diagnosis becomes more complicated.

When should I see my doctor?

You should consult your doctor if you are concerned and showing what are the first signs of endometriosis.

Undoubtedly, endometriosis is difficult to manage but it is doable with early diagnosis, a thorough understanding of your diagnosis, and sound medical advice.

Causes and Risk Factors

The defining factor that causes endometriosis is not yet known, although there are several possible causes listed below:

  • In retrograde menstruation, menstrual blood having endometrial cells backflows through the fallopian tubes to the pelvic cavity instead of exiting the body. The endometrial cells attach to the walls and surfaces of pelvic organs and continue growing, thickening, and bleeding each cycle.
  • A concept called “induction theory” proposes that hormones or immune factors allow the cells lining the abdomen – the peritoneal cells – to develop into endometrial-like cells.
  • Hormones (e.g., estrogen) can convert embryonic cells into endometrial-like cells in a woman’s puberty phase.
  • Surgery can increase the risk of endometrial cells attaching to the surgical incision.
  • Endometrial cells may travel to different parts of the body via the blood vessels and/or the lymphatic system.
  • You may have an immune system disorder preventing the body from identifying and destroying endometrial cells growing outside the uterus.

These requires learning what are the first signs of endometriosis.

What increases my risk for endometriosis?

Apart from identifying what are the first signs of endometriosis, it is also important to identify the factors that could make you more inclined to get endometriosis. You may get endometriosis if:

  • You have never given birth
  • You have a mother with endometriosis
  • Your cycles are shorter than 27 days with bleeding lasting more than 8 days
  • You are white or Asian
  • You have a medical condition that causes your menstrual flow passage to be irregular
  • The cells lining your pelvis have previous damage

What complications come with endometriosis?

Complications make it important to know what are the first signs of endometriosis.

Endometriosis almost always causes pain during menstrual periods and may even affect a woman’s fertility.

The reasons for this are:

  • The patches that this condition creates may obstruct or change the shape of the pelvis and nearby organs (e.g., the uterus), often causing the sperm to have difficulty finding the egg.
  • Your immune system may attack the embryo.
  • The endometrium does not develop normally.

To get pregnant, women with endometriosis should consult with their doctor on what to do.

Factors such as how advanced your endometriosis is and how long you have been trying to conceive come into play.

Women may have surgery to remove lesions and scar tissue or do in-vitro fertilization (IVF), a method that removes the obstacle of the inflammatory pelvic environment, thus allowing the sperm and egg to meet.

Diagnosis and Treatment

If you are experiencing what are the first signs of endometriosis, it is very important to talk to your doctor. To determine if you have this condition, your doctor may perform the following methods.

How to Diagnose Endometriosis

  • In a pelvic exam, your doctor will feel for cysts or thickening of the uterosacral ligaments and parametria
  • Your doctor may opt to check for ovarian cysts via ultrasound. A wand-shaped scanner will be inserted into your vagina or a scanner will be moved across your abdomen. Magnetic resonance imaging (MRI) may also be used to capture pictures of the inside of the body.
  • If the doctor does not detect ovarian cysts via ultrasound, he or she may prescribe medicine. Hormonal birth control may decrease pain in your pelvis during your period, while gonadotropin-releasing hormone (GnRH) agonists arrest the menstrual cycle and reduce the estrogen produced by your body. This can also alleviate pelvic pain. Note that medicine works only for as long as you take them and the pain may return once you stop.
  • Your doctor may also suggest laparoscopy, a kind of surgery used to check the pelvic area for endometrial tissue. Endometriosis can be confirmed by the apparent growths or else by examining a tissue sample under the microscope.

How is endometriosis treated?

Endometriosis can be treated in the following ways.

  • Non-steroidal, anti-inflammatory medication such as ibuprofen can manage the pain. Other times, medications targeting hormones are prescribed, such as oral contraceptive pills and GnRH agonists.

Surgery is another option: endometriosis lesions outside the uterus can be burned away. Scar tissue or adhesions can be removed to allow the ovaries and tubes to return to their normal location.

Surgery often improves pain symptoms and can help women get pregnant. A woman can also opt to have a hysterectomy, the total removal of the uterus and removal of cysts (cystectomy) or removal of ovary (oophorectomy) for endometriotic cysts.

After determining what are the first signs of endometriosis, one must seek medical advice.

In addition, this condition can be managed non-medically or non-surgically in the following ways.

  • 20 to 30 minutes of physical activity and exercise is recommended to ease the pain.
  • Getting quality sleep at night can boost the immune system. Reducing caffeine and alcohol intake and heavy meals at night can help you do this, as well as maintaining a regular time for sleeping and waking.
  • Stress management and relaxation techniques such as yoga, mindfulness exercises and a fixed “me-time” schedule can improve your wellbeing.


Hello Health Group does not provide medical advice, diagnosis or treatment.

Medically reviewed by

Mary Rani Cadiz, MD

Obstetrics and Gynecology

Written by Louise Nichole Logarta · Updated Sep 16, 2020


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