What You Need to Know About Endometriosis

Severe period cramps and uncomfortable sex may be endometriosis red flags.

Medically reviewed in April 2021

About 5 million American women are living with endometriosis. Endometriosis happens when the tissue that lines your uterus, called the endometrium, starts growing outside of your uterus. Patches of tissue may appear on:

   • Your ovaries or fallopian tubes
   • The outside of your uterus
   • Your bladder or intestines
   • Other organs in rare cases

Uterine tissue tends to bleed every month when you get your period—no matter where it is in your body. Without the vagina to escape through, the blood can irritate those areas, causing swelling, scarring and pain.

Symptoms of endometriosis
Pain is the number one symptom of endometriosis, but the pain can affect women in different ways. You might experience:

  • Severe period cramps
  • Back or pelvic pain
  • “Deep” pain in your belly during or after sex

If uterine tissue grows on your intestines or bladder, you might also feel pain when you urinate or have a bowel movement, especially during your period.

Other symptoms can include:

  • Constipation or diarrhea
  • Upset stomach
  • Exhaustion
  • Unusually heavy blood flow during your period or bleeding between periods

Bleeding between periods can be a red flag for other conditions like ovarian cancer, so tell your OBGYN if you have this symptom.

Endometriosis can take an emotional toll and can contribute to anxiety and depression. You may feel depressed if your symptoms keep you from enjoying life, cause you to miss work or make it harder to get pregnant. If you’re struggling emotionally and need someone to talk to, reach out to a counselor or find support through the Endometriosis Association at

Don’t ignore the signs
The number of women with endometriosis is likely much higher than reported because:

  • Some healthcare providers assume that severe period pain is “normal,” expected or purely psychological
  • Symptoms can mimic other conditions like irritable bowel syndrome or premenstrual dysphoric disorder (PMDD), making a diagnosis difficult
  • Healthcare providers might think that pre-teens and teens are too young to have endometriosis

What’s more, other symptoms like pain with bowel movements or discomfort during sex can seem too embarrassing to talk about openly, even with an OBGYN. For these reasons, endometriosis may get overlooked for years or all together.  

If you suspect that you have endometriosis, make an appointment with your OBGYN. No one should suffer in silence, plus the blood that builds up outside of your uterus can create other health problems like:

  • Ovarian cysts: or sacs of fluid that form in your ovaries. An ovarian cyst can turn into a medical emergency if it suddenly breaks open, causing heavy internal bleeding.
  • Adhesions: or a type of scar tissue that binds organs together. Adhesions can form as your tissues heal after an episode of bleeding. Scar tissue may block off your intestines or make it harder to get pregnant.
  • Infertility: endometriosis can make it harder to get pregnant. About 30 to 40% of women with endometriosis have problems with fertility, according to some estimates.

If you’d like to start a family, ask your doctor about a treatment plan to increase your chances of getting pregnant. He or she may recommend:

  • Medications to help you ovulate, or produce an egg each month
  • In vitro fertilization (IVF), a procedure in which a sperm and an egg are joined in a dish and then planted in your uterus

In some cases, surgery might be needed to remove endometriosis patches that are blocking a pregnancy from forming.

Diagnosing endometriosis
The first step in diagnosing endometriosis is typically a pelvic exam. To do a pelvic exam, your doctor will feel for changes to your ovaries from inside your vagina using gloved, lubricated fingers. At the same time, they’ll gently press on your belly to feel for pockets of blood or scars from above.

Your doctor may also recommend an ultrasound or a trans-vaginal ultrasound. To do a trans-vaginal ultrasound, he or she will place a wand, called a transducer, inside your vagina. The transducer uses sound waves to create images of your ovaries and uterus on a screen.

The only way to know for sure that you have endometriosis is to undergo a type of surgery called laparoscopy. For a laparoscopy, a surgeon will make small cuts on your belly, and then send a narrow tube with a camera on the end through the openings. The camera is used to get close-up views of painful tissues. Your surgeon can also remove samples of tissue, and then take a closer look at them under a microscope, called a biopsy.

How is endometriosis treated?
There’s no known cure for endometriosis, but medications can help ease your symptoms.

  • Hormone medications: hormone drugs including certain birth control pills, patches or a hormonal intrauterine device (IUD) can help you have fewer periods or stop them all together.
  • Pain medications: your pain level and other medications will help your doctor decide which pain pills to give you.

When medications don’t offer relief, some women opt for surgery to remove painful patches of tissue. If you undergo surgery, you may need to keep taking hormone medications afterwards to keep the tissues from growing back.

Ways to lower your risk of endometriosis
There’s no way to prevent endometriosis, but you can lower your risk by:

  • Exercising regularly: Exercising three-to-four times a week and having less body fat can help keep endometriosis at bay or control its symptoms. That’s because body fat makes the hormone estrogen, and high levels of estrogen lead to heavier periods.
  • Cutting down on caffeine and alcohol: both alcohol and caffeine, especially green tea and sodas, raise estrogen levels too.

Don’t let pain from endometriosis keep you from living your life. If you’re having symptoms, make an appointment with your OBGYN. They can confirm your diagnosis and make a treatment plan that’s right for you.

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