Most women grow up thinking period pain is normal. What’s not normal is pain so bad that it keeps you home from work or school. Endometriosis affects more than 11% of American women between the ages of 15-44. While it is common, it is not often talked about. Frank Tu, MD, Director of Gynecological Pain and Minimally Invasive Surgery, helps us understand the signs, symptoms and treatment for endometriosis.

What is endometriosis?

Endometriosis is when cells from the glandular fluid secreting parts of a woman’s uterus start growing in areas outside the uterus. A hormonally mediated condition, it is heavily dependent on menstrual blood leaking backwards out of a woman’s tubes – which happens to 90% of women.

What are the symptoms? How do you diagnose endometriosis?

The common symptoms are infertility, painful periods and heavier menses. Less commonly known symptoms are pain with sex, bowel movements or urination. More rare, but pertinent symptoms of endometriosis include blood in the stool and occasionally an ovarian mass. Diagnosis is currently only by laparoscopic same day surgery but can also be treated at the same time by removing the disease implants.

Can you treat endometriosis? If so, how?

Initial treatment is to reduce pain for those with pain – nonsteroidal anti-inflammatory drugs (NSAIDs), but also nerve medications. To reduce growth, the recommendation is to suppress the menstrual cycle with oral contraceptives.

How can one manage pain that comes with endometriosis?

Same recommendation as above. Also, try to treat painful periods with as many non-opioid options as possible to get relief. It’s critical to also treat associated muscle spasms with physical therapy, protect impaired sleep and have a good balanced diet.

What are the causes of endometriosis? Are there risk factors in developing it?

A complex set of causes include vulnerabilities that come from exaggerated hormonal pathways promoting growth of these “foreign” uterine cells inside the pelvis and genetic changes promoting invasion of tissue into the normal peritoneal barrier cells. Also, the pain itself reflects changes in how sensitive a woman is to irritating stimuli both in the local nerves and even the central nervous system. Painful periods from an early age is one risk factor; a rarer factor is abnormal uterine anatomy (like having two uterine bodies).

Do you have any advice for someone who has endometriosis?

You may hear a lot about being at risk for multiple other health issues if you have endometriosis. If you are generally healthy, don’t worry too much about future risk of conditions such as autoimmune disorders, other pain issues or ovarian cancer. There are no guidelines for doing screening for such problems unless you are having symptoms. My advice is to work with a doctor who is comfortable finding the right choice of medications, diet and surgery if needed. If you have a lot of endometriosis growing in the pelvis, find a surgery team comfortable with doing the more difficult cases.