woman holds a model of the female reproductive system

Endometriosis 101: Symptoms, Causes, and Treatments

Endometriosis is currently incurable, but symptoms can be managed with a thorough treatment plan. For couples TTC, learn about its causes and implications.

Endometriosis is a female-related fertility disease in which tissues similar to the uterine lining are found in other body parts. The endometrial-like tissue usually appears on other reproductive organs inside the pelvis or in the abdominal cavity.

This chronic illness can be painful and debilitating and may be accompanied by several symptoms that vary in intensity between individuals. Some of the health effects of endometriosis can hinder couples who are TTC (trying to conceive). Most notably, the condition is implicated in up to 50% of women with infertility [1].

Disclaimer: The information provided in this post is not intended as medical advice.

What Are the Symptoms of Endometriosis?

In endometriosis, the endometrial-like tissue grows outside the uterus, spreading to the ovaries, bowels, and elsewhere in the pelvic cavity. In rare instances, this tissue may grow beyond the pelvic region, affecting the abdomen and chest regions [7].

Because it is similar to the tissue that usually lines the uterus, endometrial-like tissue also responds to the natural hormonal changes of the menstrual cycle. Organs and structures affected by endometriosis become inflamed and painful as the endometrial-like tissue grows, thickens, and breaks down. Because there is no way for the body to naturally drain endometrial-like tissues in areas outside of the uterus, they become trapped in the body over time. In addition, scar tissue and cysts may form [5].

As such, endometriosis can present with a range of symptoms, and pain may be present to varying degrees. It is also possible to feel little to no pain or experience no other signs [6].

Note that the intensity of the pain does not indicate how severe the disease is. Some women may feel extreme pain with mild endometriosis, while others with more advanced stages may feel slight discomfort [6].

Some of the common symptoms of endometriosis are [5]: 

  • Pain in the lower abdomen or back (pelvic pain) — it usually occurs for a short while during period, but some women experience it constantly throughout their menstrual cycle
  • Painful periods
  • Cramps about 1-2 weeks before menstruation
  • Pain during or after sexual intercourse
  • Pain while using the toilet
  • Difficulty in getting pregnant

How Is Endometriosis Diagnosed?

Your healthcare provider will assess your condition based on your medical history and the symptoms you experience. This diagnosis may be performed with a pelvic examination that incorporates ultrasound, MRI (magnetic resonance imaging), or CT (computerised tomography) scans [8]. 

However, the only way your doctor can be sure whether you have endometriosis or not is to conduct a laparoscopy. This is a small surgical procedure where a thin tube with a camera attached at the end is inserted into the stomach through a small incision to look for endometrial-like tissue. If such tissue is found, it will be biopsied and identified under the microscope [8].


What Causes Endometriosis? [2]

asian woman sits up in bed with pain in lower abdomen

The exact cause of endometriosis is still undetermined. That said, scientists have identified several factors that may contribute to its development.

The current hypotheses on what causes endometriosis include the following:

  • Retrograde menstruation: During your period, menstrual blood containing endometrial-like cells flows back into the pelvis via the fallopian tubes. This causes some cells to land outside the uterus, where they may grow into endometrial-like tissues. Even though retrograde menstruation is relatively common, it can pose a health issue when accompanied by symptoms of endometriosis [11].
  • Cellular metaplasia: This occurs when cells of a particular type are replaced by another. In the case of endometriosis, cells outside the uterus are transformed into endometrial-like cells.
  • Menstrual stem cells: This type of cell can trigger endometriosis. The growth of endometrial-like tissues then spreads to other parts of the body via the bloodstream and lymphatic vessels.
  • A weakened immune system: Research shows that a poor immune system is unable to clear away the endometrial-like tissues that accumulate outside the uterus [12].
  • Genetics: A family history of endometriosis increases your risk of this disease. According to the University of Oxford, new research involving 11,000 women found a “specific common variant in the NPSR1 gene” was linked to endometriosis stages 3 and 4 [13].
  • Environmental toxins: Exposure to certain toxins in your surroundings, like endocrine disruptor chemicals, is associated with an enhanced risk of endometriosis [14].

      How Common Is Endometriosis, and What Are the Risk Factors?

      According to the World Health Organization (WHO), around 10% of women of reproductive age worldwide are affected by endometriosis. This makes it a relatively common female health issue [2].

      A 2021 systematic review and meta-analysis covering 17 studies of 127,476 women was conducted to measure the prevalence of endometriosis. According to its findings, the incidence rates in the following countries are [3]:

      • Asia (36%)
      • Africa (26%)
      • Americas (19%)
      • Europe (17%)

      That said, this particular study has some limitations to it. As such, more inclusive research is necessary to better understand the disease.

      The risk factors for endometriosis vary, ranging from hormonal imbalances to genetic predispositions [4]. Common risk factors include:

      • Never given birth
      • Menstruation at an early age
      • Menopause at an older age
      • A shorter menstrual cycle 
      • Heavy menstrual periods lasting for more than a week
      • Higher-than-normal levels of oestrogen
      • Low body mass index (BMI)
      • A family history of endometriosis among female members
      • Health issues that stop blood from flowing out of the body during menstruation
      • Reproductive disorders 

      How Does Endometriosis Impact Fertility? [4, 9]

      Roughly 30-50% of women with endometriosis have trouble getting pregnant, making the condition one of the leading causes of infertility [1]. 

      Endometriosis can impair fertility when it affects the reproductive organs. For instance, endometrial-like tissue may stop eggs from being released from the ovary or hinder sperm from moving up the fallopian tubes. A fertilised egg may also be thwarted from moving down the tubes toward the uterus. Undergoing surgery to remove the endometrial-like tissues from the reproductive organs may correct these issues.

      However, there are other ways endometriosis may make it difficult for you to conceive. For instance, the disease can alter the body’s hormonal chemistry. This condition can also trigger an unwanted immune response causing the body to attack the embryo. In addition, endometriosis can cause pain during or after sexual intercourse. This may dampen the desire for sex, posing a further obstacle to getting pregnant.

      If you or your partner is struggling with discomfort during penetrative sex, consider an at-home insemination kit like the twoplus Fertility Applicator Extra. It’s a single-use device for couples trying to conceive (TTC) without penetrative sex. You optimise your chances of fertilisation by directly depositing sperm to the right spot (read: as close to the cervix as possible).

      What’s more, when you purchase the twoplus Applicator Extra, its nifty Soft Tip maximises comfort during insertion while reducing immediate sperm leakage out of the vaginal tract. In other words, you can bid farewell to raising your legs in the air after self-insemination.

      Shop The twoplus Fertility Applicator Extra


      That said, if you have a health condition that hinders ovulation or makes it dangerous for you to get pregnant, the Applicator Extra may not be suitable for you. In such cases, do consult your primary doctor for medical advice.

      While endometriosis negatively affects your chances of conceiving, it’s still possible to get pregnant and carry a baby to term in mild to moderate cases of endometriosis (i.e., stages 1 to 3). That said, healthcare experts advise prioritising family planning as early as possible because endometriosis may worsen as you age.

      How To Manage Endometriosis

      Caucasian woman looks out of the window thoughtfully with a cup in her hands

      Can Endometriosis Be Treated? [7, 10]

      At the moment, there is no cure for endometriosis. Generally, treatment is centred around managing symptoms. 

      Accordingly, endometriosis treatment plans are drawn up based on factors such as:

      • How advanced the condition is
      • Plans for future pregnancies
      • The patient’s age
      • How severe the pain is 

      Common treatment options include:

      • Pain relief: Medications are given to help manage painful symptoms. Depending on the severity of your pain, your doctor may prescribe non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or other more potent drugs if necessary. But if you’re TTC, do let your doctor know as certain medications like NSAIDs may affect your fertility health.
      • Hormonal therapy: This treatment typically involves birth-control pills, patches, and intrauterine devices (IUDs). The goal is to reduce oestrogen levels to help stop the growth of endometrial-like tissues in unwanted areas. However, take note that these are not recommended options for people who are TTC.


      Surgery To Improve Fertility

      If non-surgical treatments are ineffective, your healthcare provider may recommend surgery like laparoscopy to remove the endometrial-like tissues.

      Discuss with your doctor as treatment is highly individualised for each patient based on your unique symptoms and health condition.

      What Lifestyle Changes Help With Endometriosis? [9]

      If you’re dealing with endometriosis, you may find relief from your symptoms through these lifestyle changes:

      • Try warm baths, hot water bottles, and heating pads for temporary pain relief.
      • Eat a healthy and well-balanced diet rich in fruits and vegetables. New research in 2021 also suggests that a high consumption of foods rich in omega 3 fatty acids, like salmon and walnuts, has been associated with a reduced risk of endometriosis [15].
      • Avoid consumption of alcohol, caffeine, and trans fats.
      • Take part in regular exercise.
      • Practise healthy stress management techniques, like meditation and yoga.

      You Can Still TTC With Endometriosis

      Endometriosis is a progressive gynaecological issue that can interfere with your fertility levels, making it more difficult for you to get pregnant. The condition can also come with painful symptoms that negatively impact your quality of life. 

      However, this chronic disease can be managed with early diagnosis and a proper treatment plan. If you notice any signs or symptoms that may indicate endometriosis, see a doctor as soon as possible to correct or resolve some of the fertility challenges arising from endometriosis.

      Remember, successful pregnancy is still possible with mild to moderate endometriosis. 

      [1] American Society for Reproductive Medicine, Endometriosis: Does It Cause Infertility?, https://www.reproductivefacts.org/news-and-publications/patient-fact-sheets-and-booklets/documents/fact-sheets-and-info-booklets/endometriosis-does-it-cause-infertility/ 
      [2] World Health Organization, Endometriosis, https://www.who.int/news-room/fact-sheets/detail/endometriosis
      [3] Indian Journal of Medical Research, A Systematic Review On The Prevalence Of Endometriosis In Women, https://journals.lww.com/ijmr/Fulltext/2021/09000/A_systematic_review_on_the_prevalence_of.9.aspx
      [4] Mayo Clinic, Endometriosis, https://www.mayoclinic.org/diseases-conditions/endometriosis/symptoms-causes/syc-20354656
      [5] NHS, Endometriosis, https://www.nhs.uk/conditions/endometriosis/
      [6] Healthline, Endometriosis, https://www.healthline.com/health/endometriosis
      [7] Cleveland Clinic, Endometriosis, https://my.clevelandclinic.org/health/diseases/10857-endometriosis
      [8] John Hopkins Medicine, Endometriosis, https://www.hopkinsmedicine.org/health/conditions-and-diseases/endometriosis
      [9] WebMD, Endometriosis, https://www.webmd.com/women/endometriosis/endometriosis-causes-symptoms-treatment
      [10] MedicalNewsToday, What To Know About Endometriosis,
      [11] Verywell Health, An Overview of Retrograde Menstruation,
      [12] Journal of Expert Review of Clinical Immunology, Immune interactions in endometriosis, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3204940/
      [13] University of Oxford, Researchers identify genetic cause of endometriosis and potential drug target, https://www.ox.ac.uk/news/2021-08-26-researchers-identify-genetic-cause-endometriosis-and-potential-drug-target
      [14] Frontiers in Medicine, Environmental Risk Factors for Endometriosis: An Umbrella Review of a Meta-Analysis of 354 Observational Studies With Over 5 Million Populations, https://www.frontiersin.org/articles/10.3389/fmed.2021.680833/full
      [15] Geburtshilfe und Frauenheilkunde, Does Nutrition Affect Endometriosis?, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7870287/