What is Endometriosis?

Endometriosis is a chronic inflammatory disease that affects women of all ages. It can be difficult to diagnose because the symptoms vary widely from patient to patient and can occur at any stage of a woman's fertile life. Often times, diagnosis is delayed because the patient doesn't recognize the symptoms as abnormal, doctors attribute symptoms to a different condition, or in some cases, the patient doesn't have any symptoms at all. 

It’s estimated that up to 10% of women in the United States have endometriosis. This disease usually causes pelvic pain,  discomfort, fertility issues, and more.

Pelvic pain isn't normal.

Endometriosis occurs when the lining of the uterus (the endometrium) is found growing outside of the uterine cavity where it doesn't belong. The endometrium tissue forms cysts called implants that can be found on the ovaries, fallopian tubes, or elsewhere within the abdominal cavity.

This endometrium tissue responds to the hormonal changes of the menstrual cycle, building up and breaking down just like the uterine lining.  With nowhere to go, this tissue isn't able to be expelled and can lead to pain, swelling, irritation, and adhesions surrounding the implants.

Do I have Endometriosis?

Are you unsure whether or not you may be experiencing endometriosis?  Consider the questions below:

  • Do you have pain that resembles severe menstrual cramps in your abdomen and/or lower back?
  • Does severe pain keep you from participating in everyday activities?
  • Are you experiencing pain during intercourse?
  • Do you have an abnormally heavy menstrual flow nearly every period?
  • Do you experience painful urination or bowel movements during periods?
  • Are you experiencing unexplained infertility?


Symptoms and Types of Urinary Incontinence

Every woman's experience with endometriosis is unique. It is not uncommon for a woman in stage one to experience extensive pain, while a woman in stage four may be asymptomatic. While endometriosis can be difficult to identify without surgical diagnosis, there are some symptoms that often accompany an endometriosis diagnosis

The most common symptom of endometriosis is pain, which can take the form of extreme menstrual cramps, chronic lower back and pelvic pain, deep set pain during intercourse, or painful bowel movements. 

Some additional signs that you may be experiencing endometriosis:

  • Bleeding or spotting between menstrual periods
  • Digestive issues
  • Infertility

While these symptoms on their own are not indicative of endometriosis, if you are experiencing one or more of these symptoms, it may be time to reach out for assistance. 

Endometriosis and Infertility

Between one-third and one-half of the women who experience endometriosis suffer from fertility issues. Those with mild or moderate endometriosis may still conceive and carry to term, but if the endometriosis affects the fallopian tubes, it may be more difficult to conceive.


What causes endometriosis?

Although the research is still in progress, there are a few factors that have been identified as a possible cause for endometriosis.

The most likely cause of endometriosis is retrograde menstruation. This is where menstrual blood in the uterus flows back into the fallopian tubes, distributing endometrial cells into other areas of the body, such as the pelvis.

Another possible cause is transplantation of endometrial cells outside the uterus during surgeries such as hysterectomies or C-sections. This may be exacerbated if a patient has immune system issues which prevent the body from finding and destroying cells that are growing in the wrong place. 

Finally, it is thought that endometrial cells may transport throughout the body via the lymphatic system, or that embryonic cells still present during puberty may transform into endometrial cells.

What is the risk of having endometriosis during your lifetime?

Endometriosis affects an estimated 2 to 10 percent of American women of childbearing age. Risk factors for developing endometriosis include:

  • Having never given birth or giving birth for the first time after age 30
  • Family history of endometriosis
  • Starting menstruation at an earlier age
  • Experiencing shorter menstrual cycles (less than 27 days)
  • Having a lower body mass index
  • Having higher estrogen levels in your body
  • Medical condition that reduces a normal menstrual flow
  • Abnormal uterine conditions


Avoiding pelvic health discussions with your provider? Many women who experience pelvic pain suffer in silence. Our guide outlines common pelvic health conditions, how to start the conversation with your provider, and much more.


Diagnosing Endometriosis

Diagnosing endometriosis begins with visiting an urogynecologist or a healthcare provider who has a specialty in female pelvic health and restoration. From there, the provider will evaluate symptoms, medical history, and conduct both a physical exam as well as a pelvic exam. Your doctor may also perform an imaging test such as an ultrasound or MRI to detect abnormal tissue. 

If there is evidence of abnormal activity, your doctor will need to make a definitive diagnosis using a minor surgical procedure known as a laparoscopy, which includes biopsies of endometrial tissue. This combination of procedure and testing can help doctors to understand which stage a woman may be in by identifying the location, size, amount, and the extent of the growth. 

The Stages of Endometriosis

Endometriosis has been classified by the American Society for Reproductive Medicine into four stages based on the location and amount of tissue affected: minimal, mild, moderate, and severe. Stages aren't usually based on pain experienced, risk of infertility, or other symptoms. Instead, the stages are established based on the spread of the endometrial tissue, extent of the pelvic adhesions, and potential blockage of the fallopian tubes.



Treatments for Endometriosis

While there is no cure for endometriosis, there are treatment options that can help to relieve a patient's symptoms.  

Hormonal Treatments

Hormonal birth control is usually the first step in treatment. This is an excellent place to begin if you are not trying to get pregnant and are not experiencing extreme pain. Hormonal birth control can come in many forms, from the pill to a hormonal intrauterine device (IUD) but will only relieve symptoms as long as it is taken.

Surgical Treatments

For patients with severe symptoms or infertility issues, surgery is recommended. Using the minimal-incision laparoscopic method, doctors will remove the excess endometrial tissue from the body, preserving the reproductive organs and creating an increased chance for ongoing fertility. 



If you're struggling with pelvic pain, you're not alone. Explore the personal journey of pelvic pain and learn the questions that you should ask your doctor at your next appointment in our free eBook.

Female pelvic health and reconstruction


Metro OBGYN's care team includes two leading experts in female pelvic medicine and reconstructive surgery, Dr. Kevin A. Hallman and Dr. Ron Mjanger.

Dr. Hallman and Dr. Mjanger are experienced providers specializing in women’s health. They are:

  • Board-certified Fellows in the American College of Obstetricians and Gynecologists (FACOG)
  • Board-certified inaugural Fellows in the subspecialty of Female Pelvic Medicine and Reconstructive Surgery (FPMRS)

Our specialists have extensive experience treating all conditions related to the pelvis and reproductive tract. 



Don’t let this debilitating condition create roadblocks and disruptions in your life. Schedule an appointment at one of our three Metro OBGYN locations to learn more about endometriosis.