Endometriosis is a lifelong, painful condition that affects 6.5 million women in the US alone, causes a loss of over six hours of productivity a week, and profoundly impacts a person’s professional and emotional life.
Nonetheless, surveys have shown that around 90% of people with endometriosis are disbelieved or dismissed by loved ones and healthcare professionals alike.
Thanks to advances in research, we now know that this condition and the symptoms that come with it are real and debilitating. But we also know that painkillers, hormonal therapies, and surgeries are no longer the only treatment options available to patients with endometriosis.
In this guide by Neuragenex, we’ll look at what endometriosis is and how Neurofunctional Pain Management programs may treat its symptoms without invasive procedures or medications. Let’s get started.
To understand what endometriosis is and how it develops, it is firstly important to offer an overview of the female reproductive system.
In particular, the uterus – the pear-shaped organ in a woman’s pelvis, also called the womb – is the organ responsible for functions such as menstruation, gestation, and labor. The uterus is lined with endometrial tissue, which is called the endometrium.
The endometrium grows and thickens during the luteal phase of the menstrual cycle to prepare the uterus for a fertilized egg. If you become pregnant, the endometrium will support fetal growth by supplying oxygen and nutrients and will protect the embryo from microbial invasions during pregnancy.
However, if you are not pregnant, the body sheds the endometrium during your menstruation (period). New endometrium is created during each menstrual cycle.
Endometriosis develops when endometrial tissue begins to grow in areas outside of the uterus.
The abnormal growths of endometrial tissue – known as endometrial implants – may affect several organs and tissues around the uterus, including:
In severe cases, endometrial tissue can also be found in the diaphragm and chest.
The build-up of abnormal endometrial tissue outside of the uterus can lead to a cascade of complications, including inflammation, scarring, and cysts. The tissue may also bind organs in the pelvis together, causing adhesions and preventing the organs from functioning as they should.
The endometrial tissue that grows outside of the uterus behaves in the same way as the tissue inside the uterus. This means that it responds to the hormonal changes that occur during the menstrual cycle and other events such as menopause.
So, during your cycle’s luteal phase, the endometrial implants will also grow, swell, and thicken. However, unlike the lining within the uterus, abnormal tissue that grows on other organs cannot easily leave your body during menstruation.
Over time, the accumulation of endometrial implants will expand and cause severe problems such as:
Endometriosis is generally classified into stages to describe the extent and location of the abnormal growth of endometrial tissue.
However, it is important to notice that the correlation between how far the endometrial tissue has spread and the severity of symptoms isn’t often straightforward. For example, some women may experience excruciating pain and severe symptoms even if they have a mild form of endometriosis or are in the early stages of the condition. Conversely, some patients have a severe form of endometriosis and only experience very mild discomfort.
Below, we’ll look at the stages of endometriosis in more detail.
Stage 1 endometriosis is characterized by minimal lesions and small wounds. During this stage, endometrial implants may affect your ovaries and cause inflammation in and around the pelvic cavity.
As the abnormal endometrial growths continue to build up, you may experience stage 2 endometriosis. In this phase, the endometrial implants are still shallow and mostly affect the ovaries and pelvic lining.
Moderate endometriosis causes more and deeper implants, which are usually localized within the ovaries and pelvic linings but may extend to other organs. During this stage, you may also have small adhesions between organs, ovarian cysts, and lesions.
Stage 4 endometriosis is the more severe form of this condition. It involves many deep implants that have spread through the ovaries, pelvic lining, fallopian tubes, and bowels. You may also have large cysts on one or both of your ovaries, as well as severe adhesions between organs.
As we have seen above, the symptoms of endometriosis are not always correlated to the stage of the condition you are in. So, you may have stage 4 endometriosis and experience very little discomfort – and vice-versa.
Nonetheless, only around 20% of women with endometriosis are asymptomatic, and they often discover their condition when they deal with unexplained infertility. In the remaining 80% of cases, patients deal with chronic pain, painful periods, excessive bleeding, pain during intercourse, difficult bowel movements, digestive issues, and infertility.
These symptoms are often due to the endometrial implants outside of the uterus, which grow, thicken, and bleed during the menstrual cycle each month, but are unable to leave the body during menstruation. This leads to inflammation and irritation of the surrounding tissue.
Tissue scarring and thickening (fibrosis), as well as adhesions between organs, can contribute to discomfort and pain.
Below, we’ll look at the symptoms of endometriosis in more detail.
In the case of painful periods caused by a recognized pelvic condition such as endometriosis, this symptom is referred to as secondary dysmenorrhea.
Endometriosis causes painful periods because the endometrial implants respond to hormonal changes, and grow and bleed during the menstrual cycle. Dysmenorrhea manifests itself with several symptoms, including:
One of the reasons behind this symptom is that the inflammation of the endometrial growths is aggravated by the thrusting during penetration. However, in severe cases of endometriosis, the pain may also be due to the fact the endometrial implants bind the front wall of the rectum to the back wall of the vagina. These adhesions inhibit the mobility and expansion of the vagina during sex.
Some women with endometriosis only experience pain during deep penetration, or only have mild discomfort during sex. Others experience sharp and stabbing pain that may last for hours or days after sex.
The painful sensations may be more or less intense depending on the stage of your menstrual cycle.
Endometriosis can cause irregular and painful bowel movements. While the connection between these two conditions isn’t clear, the pain is often due to lesions and endometrial growth that occurs in the large bowel, bladder, rectum, or intestines.
The high levels of sustained inflammation, coupled with the thickening of the endometrial growth during the menstrual cycle, make passing stools painful. The painful sensations are often described as stabbing or sharp, and they are often accompanied by other gastrointestinal symptoms, such as constipation and bloating.
Endometriosis can change the frequency and nature of your menstruation. You may experience excessive bleeding or light bleeding (spotting) between periods.
Some changes in your periods that you may experience due to endometriosis include:
The reason for these changes in the menstrual cycle is that people with endometriosis have more blood and endometrial tissue to shed each month.
While a lot of the connection between endometriosis and infertility is yet to be understood, the correlation between these two conditions is undeniable.
According to a 2010 study published in the Journal of Assisted Reproduction and Genetics, 25-50% of infertile women have endometriosis, and 30-50% of women with endometriosis are infertile.
There may be several reasons why you have problems conceiving if you have endometriosis:
Women with endometriosis can still get pregnant and carry a baby to term successfully, sometimes with the help of fertility treatments such as in-vitro fertilization (IVF). Additionally, in the case of mild or moderate endometriosis, infertility may only be temporary.
Depending on where the endometrial growths are located, people with endometriosis may experience several gastrointestinal problems and digestive issues, a condition known as “endo-belly”.
This is due to several factors. Firstly, women with endometriosis are more prone to gastrointestinal bacterial overgrowth, which can cause changes in the digestive process. Additionally, the high levels of inflammations and the cysts caused by trapped blood in the ovaries may lead to bloating.
Endo-belly symptoms include the following:
Another symptom of endometriosis is fatigue. Endometriosis-related fatigue becomes more evident during the menstrual cycle when the body attempts to eliminate abnormal or diseased tissue. During menstruation, the immune system attempts to combat endometriosis by releasing inflammatory toxins known as cytokines. These chemicals cause high levels of inflammation, which can lead to fatigue.
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Endometriosis is considered to be an idiopathic disease. This means that the reasons why endometrial implants and scar tissue grow outside of the uterus are unknown.
However, since the discovery of endometriosis in the 1860s, several theories have attempted to look into the causes and risk factors of this condition. Currently, some of the most valid hypotheses include retrograde menstruation, the transformation of peritoneal and embryonic cells, and endometrial cell transport. Immune system disorders and surgical scar implantation may also be contributing factors.
Let’s look at these theories in more detail below.
Retrograde or reverse menstruation may be one of the most likely causes of endometriosis. Retrograde menstruation is prevalent in 90% of menstruating women and occurs when endometrial tissue goes from the uterus back into the fallopian tubes and the abdomen instead of leaving the body during menstruation.
When the blood containing endometrial tissue flows back into the pelvic cavity, it may stick to the pelvic walls and organs, thus triggering endometriosis. These endometrial implants will then continue to spread and thicken with each menstrual cycle.
Another potential cause of endometriosis is described by what’s known as “induction theory”. According to this theory, unknown substances released by the endometrium in the uterus cause other cells in the body to transform into endometrial cells and grow outside of the uterus.
The most commonly affected cells in this process are the peritoneum mesenchymal stem cells, which are stem cells located in the inner side of the abdomen and stomach.
Often, endometriosis begins during puberty. One of the theories that attempt to explain why this happens is the embryonic cell transformation hypothesis.
As a woman’s body prepares for menarche (the first menstrual cycle), the levels of estrogen in the body gradually increase. This usually happens during puberty.
The higher levels of estrogen may transform the embryonic cells in a woman’s body into endometrial-like cells that implant outside of the uterus. Embryonic cells are the cells responsible for the earliest stages of the human body’s development.
Endometriosis may also be caused by direct transplantation of the endometrial cells into organs and tissues (i.e.: the walls of the abdomen) that are located outside of the uterus.
This may happen during surgical procedures that involve the pelvic areas, such as a cesarean delivery (C-section) or hysterectomy (a surgical procedure used to remove parts of the uterus).
During these procedures, cells belonging to the endometrium in the uterus may contaminate organs or attach to the surgical incision.
In some cases, endometrial cells located within the uterus may be transported to other areas of the body via blood vessels or the lymphatic system. This happens similarly to how cancer cells are spread throughout the body.
Studies conducted in 2022 attempt to define the role of the immune system in the development of endometriosis. Research has shown that certain disorders of the immune system may inhibit its ability to recognize, combat, and destroy endometrial cells that travel outside of the uterus.
Endometriosis may occur at any point during the reproductive age and affect any woman, but it is more likely to develop at some point after the first menstrual cycle (menarche).
Symptoms may develop over time and not become noticeable for several years. Often, in asymptomatic patients, a diagnosis of endometriosis is only achieved when investigating unexplained infertility.
While the idiopathic nature of endometriosis makes it hard to diagnose and treat, some risk factors may make you more prone to developing this disease during your lifetime. Let’s look at the risk factors in detail below.
If you have never given birth, you may be at greater risk of developing endometriosis.
This is because pregnancy temporarily stops the menstrual cycle and lowers the levels of estrogen in the body. In turn, this reduces the growth of endometrial cells inside and outside of the uterus.
If you already have endometriosis, pregnancy may temporarily reduce the intensity of your symptoms.
However, you can still develop endometriosis after carrying a baby to term. This is often due to the transfer of endometrial cells to organs outside of the uterus during a C-section.
Postpartum endometriosis may also occur in women who had long labor because the longer period of time between the rupture of the fetal membrane and delivery makes contamination and infections more likely.
Some aspects of your menstrual history may make endometriosis more likely. These include:
Having an early menarche and late menopause will increase your exposure to retrograde menstruation, while heavy or long periods may indicate an abundance of endometrial tissue. Both these factors may make endometriosis more likely.
While the onset of endometriosis usually occurs during puberty, women in their 20s, 30s, and 40s are more likely to be diagnosed with this condition. This may also be because women in this age range may attempt to become pregnant and discover infertility problems.
The prevalence of endometriosis in certain demographics may have a genetic factor, but no direct correlation has been established yet.
Generally, you may be at greater risk of developing this condition if one or more of your first-degree relatives (i.e.: mother, aunts, or sisters) have endometriosis. Having a family history of infertility may also be a risk factor for endometriosis.
If your body produces excessively high levels of estrogen or you are exposed to this hormone throughout your lifetime, you may be at risk of endometriosis. This is because estrogen is responsible for supporting the growth and thickening of the endometrium during the menstrual cycle, which can make the build-up of endometrial tissue in and outside of the uterus more likely.
Endometriosis is more likely to occur in women with a slight, smaller frame, or low Body Mass Index (BMI). However, the connection between low BMI and endometriosis is unclear.
What’s more, in a new study, nearly 40% of the participants with endometriosis were overweight or obese, making a high BMI also a risk factor for endometriosis.
Some medical conditions prevent the menstrual blood as expected, or flowing back into the fallopian tubes and ovaries, thus making endometriosis more likely.
Some of these medical conditions include abnormalities or obstructions in the uterus, vagina, or cervix.
Some disorders of the reproductive tract can increase the risk of endometriosis.
Although endometriosis affects up to 11% of all women of reproductive age, most people experience a delay of nearly seven years in obtaining an accurate diagnosis.
However, over the past years, diagnostic protocols have improved to shorten this delay and ensure that women with endometriosis access adequate treatment as soon as possible.
Some of the tools used to determine a diagnosis of endometriosis include the following:
Sometimes, the symptoms of endometriosis may alleviate or disappear on their own, usually during health such as pregnancy or menopause. However, in most cases, the endometrial growths outside of the uterus will continue to grow with each menstrual cycle, causing the symptoms of this condition to aggravate over time.
If the symptoms become debilitating or life-limiting, a healthcare provider may recommend one or more lines of treatments to ease the pain and improve your quality of life.
However, given the consequences of some treatment options, women in their reproductive age must discuss their fertility goals before choosing a treatment plan for endometriosis.
Below, we’ll look at the treatment options that are most commonly recommended.
As seen above, endometrial implants – and endometriosis as a whole – are hormone-dependent. In turn, some hormonal therapies that aim to suppress certain hormones in the body may help slow down the progression of endometrial implants and ease the symptoms of this condition.
Some of the hormonal therapies often recommended for endometriosis include the following:
When opting for these lines of treatment, you’ll have to take into account your plans of conceiving, as most hormone suppressants will stop you from getting pregnant. You should also note that the symptoms of endometriosis may come back as soon as you stop taking the medication, and the drugs seen above may come with significant side effects.
Another option to manage the symptoms of endometriosis is over-the-counter pain medications and non-steroidal anti-inflammatory drugs (NSAIDs). While these medications may help you temporarily cope with the flare-ups of endometriosis, it is important to understand that they cannot be considered a sustainable long-term solution.
Indeed, taking NSAIDs over long periods can expose you to significant side effects, including stomach ulcers, increased risk of heart attack and stroke, and dependency. What’s more, painkillers may not work as efficiently for all patients with endometriosis.
If you are dealing with life-limiting endometriosis pain, your doctor may suggest undergoing surgery. Surgical procedures are often seen as the last resort because they are invasive and come with significant complications and risks. What’s more, in 20% of cases, surgery is ineffective and patients require further treatment.
Two of the most common surgical interventions for endometriosis are laparoscopy and hysterectomy:
Although there is no permanent cure for endometriosis, it is important not to let this condition go unaddressed. Without adequate treatment, endometrial implants outside of the uterus will continue to grow with every menstrual cycle. This may lead to severe complications, such as the following:
The World Health Organization estimates that around 10% of women of reproductive age worldwide have endometriosis – a percentage that accounts for 190 million people globally. The condition is present in nearly 40% of infertile women and reaches peak prevalence in women aged 15 to 44.
While, at a glance, these statistics show how common endometriosis is, it is believed that the number of women with endometriosis is much higher. This is because this condition is often underdiagnosed or misdiagnosed.
What’s more, the prevalence of endometriosis may depend on race and ethnicity.
A 2019 study shows that, compared to White women, Black women are less likely to obtain an accurate diagnosis for endometriosis, while Asian women are more likely to receive a diagnosis. Research on the prevalence of this disease among other ethnic groups – including American Indian patients – is still limited. What’s more, on average, women wait between 8 and 12 years from the start of symptoms to be diagnosed with endometriosis.
As seen above, hormone suppressants are the first line of treatment for endometriosis. Although these may be efficient temporary solutions, they are not suitable for women looking to conceive. Additionally, birth control pills and other hormonal therapies come with severe side effects, such as mood swings, weight gain and loss, nausea, headaches, skin problems, and decreased sex drive.
On the other hand, surgical interventions may be even more problematic. According to a 2014 study, 62% of people who undergo a hysterectomy for endometriosis still have pain after the procedure and require further treatment. 31% of these required a second surgery. Among those who had both their uterus and ovaries removed, 10% still had pain and 4% required a second surgery.
So, is there a more efficient treatment option that does not come with such severe side effects? If you are battling endometriosis, Neurofunctional Pain Management programs may be the solution you’ve been looking for. Learn more about these lines of treatment below.
When it comes down to finding a treatment for endometriosis that is both non-invasive and non-pharmaceutical, educating yourself about new approaches is critical. Among your options is Neuragenex’s Neurofunctional Pain Management®.
Neurofunctional Pain Management is a treatment program customized around the unique needs and goals of each patient. Each program leverages a combination of drug-free, non-surgical therapies and tools, such as electroanalgesia, nutritional hydration therapy, and lifestyle counseling to help patients magnify their lives.
Let’s look at this whole-person approach in more detail:
IV nutritional therapy, or intravenous therapy, involves administering vital nutrients directly to the bloodstream through an IV. This type of treatment bypasses the digestive system, allowing for maximum absorption and utilization of nutrients by the...
Lifestyle counseling is an approach to managing chronic pain that involves identifying, assessing, and modifying lifestyle factors contributing to an individual's pain. For example, lifestyle factors such as nutrition, physical activity, stress, sleep quality...
Endometriosis is certainly a chronic, life-limiting condition that can impact all aspects of your life, from your ability to be productive at work to your plans to conceive. However, dangerous surgical interventions and hormonal therapies are no longer the only options available to fight the pain you are experiencing.
With Neurofunctional Pain Management provided by Neuragenex, you can regain control over your body and magnify your quality of life without medications or invasive procedures.
We take great pride in the wealth of talent and expertise that our providers have as they improve the health outcomes of our patients, each and every day.
Dr. Victor Osisanya is Board Certified in Physical Medicine and Rehabilitation. He earned his undergraduate degree from the University of Michigan in Ann Arbor and his medical degree from Chicago Medical School. Upon completion of...
Ashley Locus is a Board-Certified Nurse Practitioner who began her career in healthcare as a registered nurse in 2013, working in a diverse array of healthcare settings including the emergency department, critical care, case management,...
Dipa is a double board-certified Nurse Practitioner in Family as well as Adult-Gerontology Acute Care. She graduated with her Bachelor’s in Nursing from Mercer University in Macon, GA and her Master’s in Nursing from Columbia...
Emma Henigman is a Board-Certified Family Nurse Practitioner. She received her Bachelor of Science in Nursing from Lakeview College of Nursing and then her Master of Science in Nursing at Olivet Nazarene University. Emma started...
Dr. Joanne Wu is an accomplished physician leader specializing in integrative and functional rehabilitation. In addition, as a certified holistic health coach, as well as an experienced registered yoga and fitness teacher, she is dedicated...
Over the last 18 years he has worked in family practice and as a civilian contractor for the Department of State spending almost 5 years split between Iraq and Afghanistan. During his medical missions overseas,...
Dr. Johnny Ross was born and raised in Waco, Texas. He graduated from Waco High school, McLennan Community College and Baylor University. He attended The University of Texas Health Science Center at Houston, and completed...
Originally from Jacksonville, FL, Dr. Williams enlisted in the United States Air Force after graduating from high school. After serving honorably in the military, he enrolled in college at the University of North Florida where...
John Ham is a board certified physician assistant with extensive experience working in rehabilitation services, musculoskeletal medicine, and pain management since 2004. He received his PA degree with a masters in medical science from Midwestern...
Dr. Mikuzis is also a certified life care planner (CLCP, LCP-C). He has studied extensively and trained with physicians including programs sponsored by The American Association of Orthopedic Medicine, The American Academy of Osteopathic Medicine,...
You can manage your endometriosis pain.