Endometriosis is a condition in which tissue that should only grow in the uterus implants and grows elsewhere. It can cause significant pain in some cases and is often a factor in female infertility.

Various forms of pain relief and fertility treatment can help address endometriosis symptoms and related health complications. Here’s what to know about the condition’s causes, symptoms, and treatment options.

What is endometriosis?

The endometrium is the tissue that typically lines the lining of the uterus. Endometriosis occurs when this type of tissue grows outside of the uterus, most commonly in the ovaries, fallopian tubes, and lining of the pelvic cavity. It may also grow in the intestines, rectum, bladder, vagina, cervix, or vulva. In extremely rare cases, it may be found outside of the pelvic area.

Just like endometrial tissue that grows normally in the uterine lining, the abnormal tissue that characterizes endometriosis thickens and bleeds during each menstrual cycle. However, whereas normal endometrial tissue is shed with the cycle, the abnormal tissue cannot leave the body. This can lead to inflammation and scarring of the surrounding tissue, as well as adhesions that bind the pelvic organs to one another.

In cases of endometriosis where tissue grows in the ovaries, the condition may lead to the development of cysts in the ovaries.

There is a spectrum of severity of endometriosis cases, defined by the amount of excess tissue and resulting cysts, scar tissue, or adhesions. The level of pain, which varies by individual, does not always correlate to the stage or severity of the condition. Pain typically peaks during a menstrual period.

Causes and risk factors of endometriosis

The specific causes of endometriosis have not been identified, but the medical community believes that the following factors may contribute to its development:

• Retrograde or reverse menstruation, in which endometrial tissue flows backwards through the fallopian tubes and into the abdomen during a menstrual cycle

• Transformation of the cells that line the inside of the abdomen into endometrial-like tissue as the result of hormone or immune factors

• Transformation of embryonic cells into endometrial-like tissue during puberty as the result of hormone factors

• Attachment of endometrial cells to an incision during surgical procedures such as a hysterectomy or c-section

• Transport of endometrial cells to other parts of the body via blood vessels or lymphatic fluid

• Issues with the immune system that keep the body from destroying abnormal endometrial tissue

In addition, the following risk factors are often linked to endometriosis:

• Getting your first menstrual cycle at an early age

• Going through menopause at an older age

• Having an abnormally short menstrual cycle (e.g., less than 21 days)

• Abnormally heavy menstrual periods lasting beyond seven days

• Higher levels of estrogen

• Other health conditions that prevent the flow of menstrual blood during a menstrual period

There is also evidence that endometriosis may have a genetic component. You may have a higher risk of developing it if you have a mother, sister, or aunt with the condition.

Symptoms of endometriosis

Common symptoms of endometriosis include:

• Pain, especially severe menstrual cramps in the abdomen or lower back

• Painful sex

• Abnormally heavy menstrual periods

• Painful urination or bowel movements during menstrual periods

• Gastrointestinal issues including diarrhea, constipation, and nausea

• Infertility

Endometriosis can look very different from one individual to another, with varying experiences of symptoms. In some cases, the condition may not be accompanied by any noticeable symptoms.

How endometriosis affects female fertility

Endometriosis is a leading cause of female infertility, as abnormal growth of endometrial tissue can block the fallopian tubes, preventing the fertilization of an egg. It accounts for 24-50% of all female infertility cases, and one-third to one-half of individuals with the condition experience difficulty conceiving.

In mild or moderate cases of endometriosis, surgery to remove adhesions, cysts, and scar tissue is all that is needed to restore fertility. In other cases, additional procedures or fertility treatment may be required.

Diagnosing endometriosis

Getting an accurate diagnosis is critical to effectively treating the condition. However, the diagnosis process can be lengthy, with multiple steps, as symptoms frequently overlap with those of ovarian cysts, pelvic inflammatory disease, and irritable bowel syndrome (IBS).

An evaluation for endometriosis begins with a conversation about your health history. Several tests may be used during the diagnostic process, including the following.

• A pelvic exam

• A transvaginal or abdominal ultrasound, which provides images of your reproductive organs to help your doctor identify cysts potentially related to endometriosis

• A laparoscopy, a procedure that inserts a small camera through the abdomen with the goal of directly identifying endometrial tissue outside of the uterus. This is the only procedure that can definitively confirm a diagnosis of endometriosis.

Treating endometriosis

Severe pain from endometriosis can affect daily activities, and there are a variety of pain relief options, including both medications and surgery. Your doctor will likely try non-surgical interventions as a starting point and recommend procedures if the condition does not respond to initial treatment.

The following treatments may be used to treat discomfort caused by endometriosis or related health issues:

• Over-the-counter pain medication such as ibuprofen

• Supplemental hormones including the male hormone androgen, which can regulate hormonal production or minimize fluctuation to prevent abnormal tissue growth

• Hormonal birth control including pills, patches, and vaginal rings, which prevent abnormal tissue growth by decreasing fertility

• Gonadotropin-releasing hormone (GnRH) agonists, which block the production of estrogen to prevent menstruation

If symptoms do not improve after the treatments above, your doctor may recommend surgery. In addition to its usage during the diagnosis process, a laparoscopy can remove abnormal endometrial-like tissue. 

A hysterectomy, which removes the uterus and cervix, is typically reserved for severe cases. The procedure permanently affects your fertility, and you will not be able to become pregnant after the procedure. It’s important to consult your doctor about your options as well as your reproductive goals before moving forward.

Fertility treatment

In vitro fertilization (IVF) — a process in which eggs and sperm are fertilized and then placed into the uterus with the potential outcome of a pregnancy — can help individuals experiencing endometriosis-related infertility conceive.

In cases where fallopian tubes are blocked or severe scar tissue is present, your doctor may recommend proceeding directly to IVF before trying to conceive naturally.

A partner in your care

Since 2016, Alto has supported more than 50,000 fertility journeys. We understand that fertility treatment is a significant investment — physically, emotionally, and financially — and we see ourselves as a partner in your health.

We offer free, same-day delivery seven days a week and temperature controlled packaging to ensure that your fertility medications always arrive in the right condition. And our fertility-trained pharmacists are available until 9 pm PST (12 midnight EST) on weeknights to offer any support you need.

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This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.