Endometriosis: Recognising and Understanding it

According to the World Health Organisation (WHO) endometriosis affects roughly 10% (190 million) of menstruators globally. Raising awareness to educate the public and healthcare providers is needed. 

What Is Endometriosis?

Endometriosis is a condition in which tissue similar to the tissue that forms the lining of your uterus grows outside of your uterine cavity. The lining of your uterus is called the endometrium.

Endometriosis most commonly involves your ovaries, fallopian tubes and the tissue lining your pelvis. It’s unusual for endometrial tissue to spread beyond your pelvic region, but it’s not impossible. Endometrial tissue growing outside of your uterus is known as an endometrial implant.

Read more: Young women on their first periods: ‘I wish I had known it was okay’ 

The hormonal changes of your menstrual cycle affect the misplaced endometrial tissue, causing the area to become inflamed and painful. This means the tissue will grow, thicken, and break down. Over time, the tissue that has broken down has nowhere to go and becomes trapped in your pelvis.

When endometriosis involves the ovaries, cysts called endometriomas may form. Surrounding tissue can become irritated, eventually developing scar tissue and adhesions — abnormal bands of fibrous tissue that can cause pelvic tissues and organs to stick to each other.

Endometriosis can cause severe pain especially during menstrual periods. Fertility problems also may develop. Fortunately, effective treatments are available.

Endometriosis symptoms

The symptoms of endometriosis vary. Some women experience mild symptoms, but others can have moderate to severe symptoms. Common signs and symptoms of endometriosis include:

  • Painful periods (dysmenorrhea). Pelvic pain and cramping may begin before and extend several days into a menstrual period. You may also have lower back and abdominal pain.
  • Pain with intercourse. There is often pain during or after sex is common with endometriosis.
  • Pain with bowel movements or urination. You’re most likely to experience these symptoms during a menstrual period.
  • Excessive bleeding. You may experience occasional heavy menstrual periods or bleeding between periods (intermenstrual bleeding).
  • Infertility. Sometimes, endometriosis is first diagnosed in those seeking treatment for infertility.
  • Other signs and symptoms. You may experience depression or anxiety, fatigue, diarrhea, constipation, abdominal bloating or nausea, especially during menstrual periods.

You may also have no symptoms. It’s important to see your doctor if you have signs and symptoms that may indicate endometriosis. Endometriosis can be a challenging condition to manage. An early diagnosis may result in better management of your symptoms.

READ MORE: “It’s Only Blood” Fights Stigma And Shame Around Menstruation


The causes of endometriosis are still unknown. 

“There is a theory that menstrual blood gets expelled into the abdominal cavity through Fallopian tubes and that tissue gives rise to endometriosis. We also know that endometriosis runs in families and it is more common for a woman to develop it if her mother or her  sister has it,” said Dr Natalia Novikova, gynaecologist and endoscopic surgeon. 


At present, there is no known way to prevent endometriosis. Awareness, followed by early diagnosis and management may slow or halt the natural progression of the condition and reduce the long-term burden of its symptoms.


Treating your pain requires an accurate diagnosis. Your doctor will perform one or more of the following tests: pelvic exam, ultrasound, magnetic resonance imaging and laparoscopy. These are all used to determine whether it’s just period pain or more serious. 

Endometriosis treatment

Treatment for endometriosis usually involves medication or surgery. The approach you and your doctor choose will depend on how severe your signs and symptoms are and whether you hope to become pregnant.

Treatment options include:

  • Pain medications
  • Hormone therapy
  • Hormonal contraceptives
  • Gonadotropin-releasing hormone (GnRH) agonists and antagonists
  • Danazol
  • Conservative surgery
  • Last-resort surgery (hysterectomy)
Endometriosis stages

Endometriosis has four stages. It can be any of the following:

Stage 1: Minimal

In minimal endometriosis, there are small lesions or wounds and shallow endometrial implants on your ovary. There may also be inflammation in or around your pelvic cavity.

Stage 2: Mild

Mild endometriosis involves light lesions and shallow implants on an ovary and the pelvic lining.

Stage 3: Moderate

Moderate endometriosis involves deep implants on your ovary and pelvic lining. There can also be more lesions.

Stage 4: Severe

The most severe stage of endometriosis involves deep implants on your pelvic lining and ovaries. There may also be lesions on your fallopian tubes and bowels.

The stages are determined based on the extent of endometriotic tissue. The severity of the endometriosis condition does not define the severity of symptoms. Women with severe endometriosis may have minimal or even no symptoms and vice versa. 


“Endometriosis may affect fertility. Women can still have children. Surgical removal of endometriosis or in vitro fertilization may be necessary to improve fertility, said Dr Novikova.

Featured image via Flickr