Kaitlyn Freels, National Center for Health Research
During each menstrual cycle, the lining of the uterus thickens and then sloughs off. This layer is called the “endometrium”. When someone has endometriosis, this layer of tissue also grows outside of the uterus, such as in the fallopian tubes, ovaries, and abdomen. Despite not being in the uterus, menstrual hormones still cause it to thicken and break down. It builds up and can cause irritation and inflammation, and eventually can result in scar tissue, adhesions, intestinal problems, pelvic pain, and even infertility.
About 11% of women in the U.S. have been diagnosed with endometriosis.1 However, this is probably an underestimate since many women do not have symptoms or seek treatment. The average age of diagnosis is 29 years old, although about two-thirds of these women had symptoms beginning in their teenage years.2
Who is likely to develop Endometriosis?
Forty percent of women with infertility find out they have endometriosis.3 That’s because inflammation or adhesions from endometriosis may cause damage to eggs or fallopian tubes, making it harder to get pregnant.4
Women are also more likely to develop endometriosis if they5,6:
● Have never been pregnant;
● Had her first period before age 11;
● Have a family history of endometriosis;
● Have painful cramping and/or nausea during periods (known as “dysmenorrhea”)5;
● Have short periods (less than 27 days apart)7
Women with menstrual cycles greater than 29 days are slightly less likely to develop endometriosis than women with menstrual cycles of average length.6 The type of sanitary products that a woman uses does not affect her risk.7
How is Endometriosis Diagnosed?
Symptoms of endometriosis include lower back or abdominal pain as well as pain during:
● urination, and
Endometriosis can be difficult to diagnose because endometrial tissue can be located in several different places. A pelvic exam or ultrasound in a doctor’s office can search for scar tissue or ovarian cysts caused by endometriosis, but endometriosis can only be confirmed using a procedure called a laparoscopy.
There is no cure for endometriosis, but there are ways to manage symptoms. The best-known home remedies include over-the-counter anti-inflammatory pain medications and applied heat in the areas of discomfort. More severe symptoms require an appointment with your gynecologist. Many treatments try to prevent damage to reproductive organs and improve fertility.
The most common procedure to confirm the diagnosis and treat endometriosis is laparoscopy.
In this procedure, a doctor inserts a narrow tube through a cut in the abdomen. They use a small scope to look in the areas around the uterus, and may take a biopsy to better understand your condition and rule out uterine cancer. They can also remove scar tissue or cysts to ease pain and improve fertility. Surgery is usually successful, but symptoms may come back.8 Since this treatment has no effect on hormones, it can help endometriosis patients who are trying to become pregnant.
However, if the woman does not want to become pregnant in the near future, there are medications that lower reproductive hormones to ease endometriosis pain. These include birth control pills and Orlissa, an FDA-approved drug for treating endometriosis pain.9 Hormone levels return to normal when these medications are stopped.
What Can You Do to Prevent Endometriosis?
A large study found that premenopausal women who ate more than two servings of red meat per day were more than 50% more likely to develop endometriosis than women that ate less than one serving per week on average.10 Keep in mind that a portion of meat is only about 3 ounces, so a double quarter pounder is more than 2 servings. The likely reason for the link with endometriosis is that red meat increases estrogen levels. Endometriosis risk was somewhat increased even with just 2-4 additional servings of red meat per week.11 Other dietary changes that can help prevent endometriosis includes avoiding or limiting foods that tend to increase inflammation, such as processed foods, dairy, gluten, and caffeine.
Eating citrus fruits that contain higher levels of Vitamin A, such as lemons, grapefruits, and mandarin oranges, seems to decrease the risk of endometriosis.12 Exercising regularly for more than four hours per week also lowers risk.13
The Bottom Line
Endometriosis is a relatively common health problem for women in the United States. If you have recurrent or abnormal pelvic pain, ask your doctor about endometriosis and ways to handle your symptoms. Recognizing these symptoms will help get a diagnosis early, and will help you to find ways to treat your pain.
All articles are reviewed and approved by Dr. Diana Zuckerman and other senior staff.
1. Buck, L.G.M., Hediger, M.L., Peterson, C.M., Croughan, M., Sundaram, R., Stanford, J., Chen, Z., et al. Incidence of endometriosis by study population and diagnostic method: the ENDO study. Fertility and Sterility. 2010; 96(2): 360-5.
2. Greene R, Stratton P, Cleary SD, Ballweg ML, Sinaii N. Diagnostic experience among 4,334 women reporting surgically diagnosed endometriosis. Fertility and Sterility. 2009;91(1):32-39. doi:10.1016/j.fertnstert.2007.11.020.
3. Leyland, N., Casper, R., Laberge, P., Singh, S. S., Allen, L., Arendas, K., … & Contestabile, E. Endometriosis: diagnosis and management. Journal of Endometriosis. 2010; 2(3), 107-134.
4. American College of Obstetricians and Gynecologists. (2008). Endometriosis. Washington, DC.
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8. Struthers RS, Nicholls AJ, Grundy J, et al. Suppression of Gonadotropins and Estradiol in Premenopausal Women by Oral Administration of the Nonpeptide Gonadotropin-Releasing Hormone Antagonist Elagolix. Obstetrical & Gynecological Survey. 2009;64(6):386-388. doi:10.1097/01.ogx.0000349783.36010.69.
9. Guo S-W. Recurrence of endometriosis and its control. Human Reproduction Update. 2009;15(4):441-461. doi:10.1093/humupd/dmp007.
10. Yamamoto A, Harris HR, Vitonis AF, Chavarro JE, Missmer SA. A prospective cohort study of meat and fish consumption and endometriosis risk. American Journal of Obstetrics and Gynecology. 2018;219(2). doi:10.1016/j.ajog.2018.05.034.
11. Yamamoto A, Harris HR, Vitonis AF, Chavarro JE, Missmer SA. A prospective cohort study of meat and fish consumption and endometriosis risk. American Journal of Obstetrics and Gynecology. 2018;219(2). doi:10.1016/j.ajog.2018.05.034.
12. Harris, H. R., Eke, A. C., Chavarro, J. E., & Missmer, S. A. Fruit and vegetable consumption and risk of endometriosis. Human Reproduction. 2018; 33(4), 715-727.
13. American College of Obstetricians and Gynecologists. Management of endometriosis (Practice Bulletin No. 114). Obstetrics & Gynecology. 2010; 116(1), 223–236.