Endometriosis Symptoms, Root Causes, & Treatments

Endometriosis is a complex inflammatory condition affecting approximately 70 percent of women with chronic pelvic pain, and at least 10 to 15 percent of reproductive-age women globally. It often causes severe pelvic pain that interferes with daily life, not just during your period but also before menstruation, during ovulation, and with sex. Other common endometriosis symptoms include excruciating pain during urination and bowel movements, digestive issues such as diarrhea and constipation, irregular or heavy periods, and infertility. 

The actual percentage of women affected by this debilitating disease is likely even higher than we know, as endometriosis can only be definitively diagnosed via a surgical procedure known as a laparoscopy. For this reason, it can take a decade or longer to be diagnosed with endometriosis — and approximately six out of 10 women never receive a definitive diagnosis. 

While this may seem discouraging if you’re experiencing endometriosis symptoms and haven’t yet received a diagnosis, all hope is not lost! By learning to advocate for yourself this Endometriosis Awareness Month, you can significantly reduce the severity of your symptoms and improve your quality of life. 

What is endometriosis?

As a chronic inflammatory condition, endometriosis occurs when cells resembling endometrial tissue grow outside of the uterus in areas they don’t belong (such as the ovaries, fallopian tubes, bladder, bowels, and other nearby organs). These misplaced cells can also exist in more remote locations, such as the lungs and diaphragm, leading to the growth of endometriosis lesions in those areas. It’s known as extrapelvic endometriosis when endometrial cells grow outside of the pelvic region. 

While we don’t currently know the exact cause of endometriosis, a combination of factors likely comes into play. This is why a multifaceted approach is often necessary to reduce inflammation in the body, regulate the immune system, balance hormones, improve fertility, and alleviate endometriosis symptoms. 

Several of the factors that may contribute to the development of endometriosis lesions include: 

• Genetics. 
• Differences in the anatomy of the uterus. 
• Immune dysfunction + inflammation.
• Retrograde menstruation (or reverse menstruation).
• Estrogen excess conditions or conditions with unopposed estrogen. Endocrine-disrupting chemicals (EDCs) will worsen estrogen excess symptoms as EDCs mimick estrogen in the body. Likewise, impaired estrogen metabolism will block removal of estrogen and lead to excess estrogen metabolites. 
• Infection with disease-causing bacteria such as Borrelia burgdorferi (B. burgdorferi). 

Because endometrial tissue responds to the hormonal changes that occur throughout the menstrual cycle, endometriosis symptoms typically worsen during your period (and sometimes during ovulation). So, even though the endometrial tissue is located outside of the uterus, it still becomes inflamed and irritated during menstruation — affecting nearby organs and causing symptoms such as severe pelvic pain, painful bowel movements, and painful urination. 

Endometriosis pain isn’t “normal” period pain

Unlike normal menstrual cramps — a mild pain or cramping that occurs when your period starts — endometriosis causes severe pain throughout the menstrual cycle. You might experience endometriosis pain before, during, and after your period; during ovulation; and persistently throughout the month. 

Endometriosis pain is so excruciating that it’s often described as stabbing, throbbing, shooting, or burning. The pain can even extend to the legs, lower back, and chest.

Interstitial cystitis vs adenomyosis vs endometriosis: what’s the difference?

As if endometriosis wasn’t painful enough on its own, it commonly coexists with other painful conditions like interstitial cystitis (IC) and adenomyosis. When interstitial cystitis and endometriosis coexist, it’s known as the “evil twins syndrome”. 

While endometriosis, adenomyosis, and interstitial cystitis may occur independently, differentiating between them can be challenging. This is because all three conditions are influenced by hormone fluctuations, particularly increased estrogen levels and lower progesterone levels. They also share overlapping symptoms, such as severe pelvic pain and bladder discomfort. 

Here’s how endometriosis, adenomyosis, and interstitial cystitis differ: 

• Endometriosis occurs when lesions that resemble endometrial tissue are found outside of the uterus (womb). This tissue can exist in the ovaries, fallopian tubes, uterosacral ligaments, vagina, bladder, bowels, rectum, lungs, diaphragm, and (rarely) the brain.   
• Adenomyosis occurs when endometrial tissue grows into the myometrium, the smooth muscular wall of the uterus. Endometriosis lesions can grow anywhere in the body, while adenomyosis affects the uterus specifically.     
• Interstitial cystitis, or painful bladder syndrome, occurs when there is inflammation or irritation of the bladder wall. You’re about four times more likely to develop interstitial cystitis if you have endometriosis. 

If you suspect you have endometriosis or another painful condition such as adenomyosis or interstitial cystitis, naturopathic functional medicine can help. Specialized lab testing can uncover the root causes of your symptoms and help us develop a treatment plan that reduces pain and improves your quality of life. 

Endometriosis vs irritable bowel syndrome

Endometriosis can also be misdiagnosed as irritable bowel syndrome (IBS), especially when bowel symptoms such as belly pain, diarrhea, and constipation are present. The difference, however, is that endometriosis symptoms tend to worsen during menstruation and ovulation. 

On the other hand, endometriosis can often cause adhesions around the intestines or the sacral ligaments, which can trigger IBS-like symptoms, such as pain on defecation, or increased pelvic pain with constipation. 

Endometriosis treatment and prevention

Although there’s no known prevention or cure for endometriosis, there are many treatments that can help manage the disease and reduce the severity of symptoms. Some treatments can even address the root cause of endometriosis symptoms — whether it’s estrogen excess, immune dysregulation, or chronic inflammation — and provide long-term symptom relief. 

For example, identifying and treating estrogen excess — a hormone imbalance in the body — can help reduce lesion growth and relieve endometriosis pain. Treating underlying infections and reducing inflammation in the body can also be helpful, which is where naturopathic functional medicine comes in! 

Potential endometriosis treatment options

If you have endometriosis, the right treatment approach for you will depend on several different factors. A combined approach that includes conventional treatments and lifestyle interventions is best in most situations. 

Several treatment approaches for endometriosis include:

• Surgery to physically remove endometriosis lesions and increase the efficacy of other treatments. Recurrence after surgery is possible, but laparoscopic excision surgery seems to provide longer-lasting relief compared to laparoscopic ablation. 
• Hormonal birth control to reduce lesion growth and relieve endometriosis pain by blocking the production of estrogen and progesterone. Examples include combined or progestin-only contraceptive pills and the Mirena intrauterine device (IUD). Keep in mind, however, that hormonal birth control is not a permanent solution for endometriosis symptoms, especially if you wish to become pregnant. 
• Natural progesterone to buffer the effects of estrogen. Note: natural progesterone is not the same and does not act like synthetic progestin. 
• Other drugs that reduce inflammation, modulate the immune system (e.g., low-dose naltrexone), and relieve endometriosis pain. 
• Dietary and lifestyle interventions that support healthy estrogen metabolism, reduce inflammation and oxidative stress in the body, and address intestinal permeability and dysbiosis. 

As a naturopathic functional medicine doctor, I take a holistic approach to managing endometriosis symptoms. Treatments may include conventional therapies as well as bioidentical hormones, nutrient supplements, botanicals, dietary changes, and lifestyle interventions. Things like improving sleep quality, increasing physical activity, avoiding foods containing gluten, A1 dairy, and eggs, and supplementing with turmeric, zinc, and resveratrol can all be helpful (Briden, 2021, p. 247). 

Why is a holistic endometriosis treatment plan necessary?

Conventional treatments, like surgery and contraceptive pills, only provide temporary symptom relief for endometriosis. This is because these treatments take more of a “band-aid” approach to endometriosis symptom relief rather than addressing the underlying root cause of the disease. 

While there’s nothing wrong with “band-aid” approaches if they relieve painful endometriosis symptoms and improve quality of life, the problem is that symptoms often return in the future. Common endometriosis treatments such as contraceptive pills also tend to cause side effects like depression, headaches, blood clots, and osteoporosis.