Endometriosis is often thought of as a painful condition that women experience with their periods. This condition affects between 10-15% of women, but there is still a lot we don’t know about it . While only some of the mechanism is understood, there are many theories on how it originates, few tools for diagnosis, and only limited options for treatment.
With each regular menstrual cycle, the uterus builds and expels its inner lining, called the endometrium. As hormones rise and fall, the endometrium will grow and thicken in anticipation of ovulation. If there is no pregnancy, the endometrium will be shed and leave the body as blood during a period, and the cycle will begin anew. The uterus is designed to sustain and shed this type of tissue, but the rest of the body isn’t. Endometriosis happens when endometrial type cells are found in areas outside of your uterus.
This tissue can be found in many places: on the ovaries, the fallopian tubes, the outside of the uterus, on the bladder, colon, appendix, and can even be found in areas outside of the pelvis . Although these endometrial cells are not in the uterus, they can continue to respond to the body’s hormones, and grow and shed just as they would in the uterus . It is essentially like having a small period in another part of the body, but there is nowhere for the blood to go. The body will identify this as abnormal and create inflammation and send in the immune system to clear it out. This inflammation can lead to severe pain, which is a common feature of endometriosis.
The immune system is unable to completely clear these lesions in endometriosis . Over time, frequent immune reactions can lead to scar tissue and adhesions in the pelvis, which can further progress the severity of pain . Recurrent immune reactions can further the inflammatory processes in the pelvis, leading to chronic inflammation . These adhesions, chronic inflammation, and the location of the endometrial lesions, such as the fallopian tubes, can increase the risk of infertility in women with endometriosis .
Standard treatments often include pain relief medications, hormonal birth control, and surgery, with varying degrees of success . However, there is currently no cure for endometriosis. Surgery can effectively clear away the endometrial cells, but they are likely to recur over time . A focus on supporting healthy immune function and the body’s anti-inflammatory mechanisms may be beneficial . Working with nutrition, lifestyle, ensuring adequate vitamins and minerals, and anti-inflammatory nutrients can be supportive, but the research is limited.
The two main symptoms that patients seek medical support for are pelvic pain and reduced fertility, but it’s also important to note the psychosocial impact of endometriosis. Many patients report higher levels of anxiety and depression, and the severity of the condition can take a toll on social relationships, sexuality, and emotional wellbeing . Addressing these concerns is an important aspect of holistic care for an individual with endometriosis.
Researchers still don’t understand exactly how endometriosis originates, but there are several theories. The most accepted theory is called retrograde menstruation, which suggests that menstrual fluid flows back through the fallopian tubes and enters the pelvic space . However, this happens in about 90% of women, but only 10% of those women develop endometriosis . Other theories can involve immune function, genetics, hormones, cell factors, environmental disruptors, and the list goes on . There is a general lack of understanding about endometriosis, which can have an impact on patient care. In fact, there is an average delay of 6-7 years in getting a diagnosis . This may sound like a long time, but there are a few reasons.
First, period cramps are so normalized, that many women don’t know that something else may be going on . Second, the symptoms of endometriosis can show up in a few different ways. These can include pelvic pain with menstruation, a heavier period, spotting, pelvic pain all throughout the cycle, pain with intercourse, pain with bowel movements, or no pain at all!  Some women only discover they have endometriosis when they are undergoing fertility assessments . And third, the gold standard for diagnosis is through a laparoscopy, which is a surgical procedure . Surgery is a more invasive and costly test than a blood test or an ultrasound, though other tests are generally not successful in diagnosing endometriosis .
Taken together, these factors can slow down the diagnosis, which can have negative impacts on health, quality of life, and fertility. Researchers are exploring other options for testing, while some clinicians are arguing for a different approach to diagnosis. One suggestion recommends classifying endometriosis as a chronic inflammatory disease, and focusing on an algorithm for signs, symptoms, and clinical findings rather than surgery for diagnosis . Together with an increase in patient education, this approach could reduce the time to diagnosis, and the time to treatment .
Period pains are quite common among menstruating women. So common, that many women may not feel the need to discuss them with their health care practitioner. But please do. An earlier diagnosis could potentially prevent the progression of the condition, improve pain severity, and preserve fertility. So be sure to talk to your doctor, or naturopathic doctor, about your period pains.