Endometriosis, also known as “Endo,” is a medical condition where the lining of the uterus grows outside the uterus rather than inside it. The name comes from the endometrium, the tissue that normally lines the uterus. This tissue can also grow on other areas of the body. Most commonly, it’s found on the ovaries, fallopian tubes, tissues that hold the uterus in place, and the outer surface of the uterus.
But it can also be found on or in the cervix, vulva, vagina, bladder, bowel, or rectum. In rare instances, it can also be found on the skin, brain, or lungs. Endometriosis affects more than 11% of American women between the ages of 15 and 44. Most commonly, it is found in women in their 30s and 40s, and they often have difficulty getting pregnant as a result of it. There are a variety of symptoms, including pain, bleeding or spotting between periods, digestive issues, and infertility.
1. Lower abdomen pain
Lower abdomen pain is a common sign of endometriosis. This pain is typically felt with periods, but can be felt at other times, like ovulation, as well. Lower abdominal pain may be felt in the center of the abdomen, or it may be on one or both sides. It can also radiate to the lower back, rectum, or thighs, and can lead to pelvic pain when making certain movements or sudden actions.
Lower abdomen pain may also be accompanied by nausea, intestinal cramping, constipation, diarrhea, vomiting, or dizziness.
There is no one description of the pain level. It has been described as any of the following: dull, deep, burning, stabbing, persistent, gnawing or grinding, among others. The pain may be intermittent or continuous, but it often occurs before and during menstruation, and during or after sexual activity. The location and level of pain does not indicate the extent of the growth of endometrial tissue. Women with lots of growth may have no symptoms, while women with very little growth can have severe signs. A lot of women describe the pain as being something that interferes with daily life, or that they have to plan life around their periods to account for the pain.
2. Abnormal menstruation
Normal menstruation varies from woman to woman, but is typically described as a period every 28 days that lasts for 2-7 days. Abnormal menstruation, with endometriosis, can mean anything from irregular and unpredictable periods, heavier than usual bleeding, painful, or bleeding between periods. There may also be large clots in the menstrual blood. Abnormal menstruation could include any combination of those, including just one or all.
Abnormal menstruation can also be caused by pregnancy, stress, menopause, excessive exercise, some medications, and many other medical conditions. A single abnormal period by itself may not indicate endometriosis, unless other symptoms are also present.
3. Infertility
30-40% of infertile women have endometriosis. There is no cause and effect relationship between mild endometriosis and infertility. Severe endometriosis, however, can cause pelvic scarring and pelvic anatomy distortion. The fallopian tubes can become blocked or damaged. The ovaries often have cysts, and might become adherent to the uterus, pelvic side wall, or bowel. Any of these anatomic distortions could be the cause of infertility. Additionally, the eggs inside the ovaries may become damaged, leading to fewer eggs. The reduced egg quantity and quality is also indicative of infertility. Inability to get pregnant, combined with other signs, may indicate endometriosis.
4. Pelvis pain
Pelvis pain related to endometriosis tends to be chronic. It can include lower back pain. It’s quite common with endometriosis to have scarring around the peritoneum, and these adhesions are most common in the immobile pelvic structures, such as the pelvic sidewalls, between the sigmoid bowel or colon, behind the uterus, and on the back of the uterus and cervix. These adhesions and their location cause the pelvic pain with sudden or unexpected movement and certain movements, as they make the pelvic organs “fixed” in place. It’s also believed that small areas of surface endometriosis rupture, and/or that chemical changes that occur in the peritoneal fluid contribute to the pain.
5. Abdominal fullness
Abdominal fullness, or abdominal bloating, is another common sign. It’s believed to be caused by inflammation in the pelvic cavity from the endometriosis implants. It may feel like you permanently have extra weight just sitting in your abdominal cavity, and it may feel swollen or sore. For most women with endometriosis, this is a permanent feeling, but for some, it can be only at certain times of the month.
Poor digestion is a common side effect of the condition, leading to constipation, which can also contribute to the feeling of abdominal fullness.
Irritable Bowel Syndrome (IBS) can also cause abdominal bloating or fullness, as well as pelvis pain.
6. Constipation
Constipation is one of many potential gastrointestinal signs that may be present with endometriosis. Bowel signs can include constipation or painful bowel movements, as well as alternating between it and diarrhea. Rectal pain and bleeding is also a possibility.
When it’s is present, it can also lead to the feeling of abdominal fullness mentioned previously. These signs are often more problematic during periods or premenstrually.
It can also be caused by IBS or Crohn’s disease. A small percentage of endometriosis patients will also be diagnosed with IBS eventually. For some women with endo, an early misdiagnosis of IBS led to a prescription for antibiotics, which can further weaken the system and cause it.
7. Nausea
You may experience nausea as a result of endo, and it may be worse with menstruation. It’s important to note that nausea is the feeling of sickness, like you want to vomit, but is not actually vomiting. You may vomit from the feeling, or you may not, depending on severity. The feeling may be continuous or intermittent, and it can come on suddenly.
For some women, the feeling is so extreme they find it difficult to leave the house. It can also lead to vomiting that causes weight loss. Some women find relief with nausea-preventing medications and that some supplements can also prevent it.
8. Cramping
Minor cramping just before or during your period, that can be treated with over-the-counter remedies, is normal. It’s called dysmenorrhea, and it’s caused by inflammatory hormones. The cramping that results from endo is often referred to as “killer cramps” because it is so severe that it can make it impossible to go about daily life. These cramps may prevent you from going to work, caring for your children, or even getting out of bed. Some women even describe the pain as being more severe than the pain you might feel after a major surgery. It can also worsen as you age.
