Endometriosis is a common gynecological condition that can affect women during their reproductive years. Painful periods are one of its best-known symptoms, but the condition can also cause pain during intercourse, bowel movements or urination and may affect fertility.
Because these symptoms are sometimes ignored or considered a normal part of menstruation, diagnosis can be delayed.
In this article, Dr. Madhu Juneja, Director of the OBGYN and IVF Department at Momstory Hospital, Pune, explains what endometriosis is, its symptoms, how it is diagnosed, available treatment options and its possible impact on fertility.
What Is Endometriosis?
The inner lining of the uterus is called the endometrium. During each menstrual cycle, this lining develops and is eventually shed as menstrual bleeding if pregnancy does not occur.
In endometriosis, tissue similar to the lining of the uterus grows outside the uterus. It can involve areas such as the ovaries, fallopian tubes and other structures within the pelvis.
Unlike the uterine lining that leaves the body during menstruation, endometriosis-related tissue outside the uterus can cause inflammation and other changes over time.
This may eventually contribute to pain, ovarian endometriomas or “chocolate cysts,” adhesions and fertility-related problems.
What Are the Symptoms of Endometriosis?
Pain is one of the most common symptoms of endometriosis. However, endometriosis pain is not limited to menstrual cramps.
Women may experience:
- Severe or worsening pain during periods
- Pain during or after sexual intercourse
- Pain during bowel movements
- Pain while urinating
- Chronic or recurring pelvic pain
- Difficulty conceiving
The type and severity of symptoms can vary considerably from one woman to another.
Why Is Endometriosis Sometimes Diagnosed Late?
One of the challenges with endometriosis is that women may continue living with symptoms for years before seeking medical attention.
Severe period pain may be dismissed as a normal part of menstruation. Similarly, women may hesitate to discuss symptoms such as pain during intercourse or pain during bowel movements.
Recognising these symptoms and consulting a gynecologist earlier can help initiate appropriate evaluation and management.
How Is Endometriosis Diagnosed?
The evaluation usually begins with a detailed discussion of symptoms and medical history. Depending on the findings, your gynecologist may recommend one or more investigations.
Pelvic Examination
A gynecologist may perform a pelvic examination to check for tenderness or other findings that could suggest endometriosis.
Transvaginal Ultrasound
A transvaginal ultrasound (TVS) can help identify certain manifestations of endometriosis, particularly ovarian endometriomas or chocolate cysts.
However, an ultrasound may not identify every form of endometriosis.
MRI
An MRI scan may be recommended in selected cases to provide more detailed information about the location and extent of the disease, particularly when deeper endometriosis is suspected.
Laparoscopy
In some cases, laparoscopy can be used to directly examine the pelvis. Depending on the clinical situation, it may serve both diagnostic and therapeutic purposes because endometriosis lesions can sometimes be treated during the procedure.
What Is an Endometrioma or Chocolate Cyst?
When endometriosis affects an ovary, it can lead to the formation of an ovarian endometrioma, commonly known as a chocolate cyst.
These cysts contain old blood and may be identified during an ultrasound or other imaging examination.
Their management depends on factors such as the woman’s symptoms, cyst characteristics, age and fertility plans.
Can Endometriosis Affect Fertility?
Yes. Endometriosis can be associated with difficulty conceiving in some women.
The condition may affect the reproductive system in different ways, including involvement of the ovaries, fallopian tubes and surrounding pelvic structures.
For women who are planning a pregnancy, the treatment approach needs to take fertility goals into consideration.
Depending on the individual’s condition and fertility evaluation, treatment may involve medical or surgical management, while some women may require fertility treatments such as IUI or IVF.
Having endometriosis, however, does not automatically mean that a woman will be unable to conceive.
How Is Endometriosis Treated?
There is no single treatment approach suitable for every woman. Management depends on factors such as:
- Severity and type of symptoms
- Extent and location of the disease
- Age
- Presence of ovarian endometriomas
- Fertility plans
- Previous treatments
Treatment may broadly include medication, hormonal therapy, fertility treatment or surgery.
Pain-Relief Medication
Pain-relieving medicines, including certain NSAIDs, may be recommended to manage endometriosis-related pain when appropriate.
Hormonal Treatment
Hormonal therapies may be used to suppress the activity of endometriosis and control symptoms. Depending on the patient’s condition, options may include:
- Progestin-based treatment
- GnRH analogues
- Other hormonal therapies recommended by the gynecologist
The appropriate medication and duration of treatment should be decided individually.
Fertility Treatment
For women trying to conceive, treatment needs to be planned differently because some hormonal treatments used for symptom control prevent pregnancy while they are being taken.
Depending on fertility factors, options such as IUI or IVF may be considered.
Surgery for Endometriosis
Surgery may be recommended in selected patients, particularly when there is extensive or deep endometriosis, significant pain, involvement of other pelvic structures or other clinical indications.
Laparoscopic surgery may be used to identify and remove endometriosis lesions when appropriate.
What Is Deep Endometriosis?
Deep endometriosis occurs when endometriosis lesions extend more deeply into tissues and may involve structures surrounding the reproductive organs.
It may be associated with symptoms such as:
- Significant pelvic pain
- Deep pain during sexual intercourse
- Pain or pressure involving the bowel
- Pain during bowel movements
Some cases of deep endometriosis may require surgical treatment depending on the location, severity of symptoms and the woman’s reproductive plans.
When Should You See a Gynecologist?
Period pain should not automatically be ignored, particularly when it is severe or interferes with everyday life.
Consider speaking with a gynecologist if you experience:
- Severe or progressively worsening period pain
- Persistent pelvic pain
- Pain during intercourse
- Pain during urination or bowel movements
- Difficulty conceiving
- Symptoms that regularly interfere with work, sleep or daily activities
Early evaluation can help identify the cause of your symptoms and determine an appropriate treatment plan.
Endometriosis and Fertility: Why Early Evaluation Matters
Endometriosis is a condition that can behave differently in different women. Some may have significant symptoms, while others may first discover the condition during an infertility evaluation.
If you have persistent painful periods, painful intercourse or difficulty conceiving, do not hesitate to discuss these concerns with your doctor.
An individualized approach based on symptoms, disease extent and future pregnancy plans can help determine the most appropriate management.
Conclusion
Endometriosis is more than just painful periods. It can cause pelvic pain, pain during intercourse, discomfort during bowel movements or urination and, in some women, fertility problems.
Evaluation may involve a pelvic examination, transvaginal ultrasound, MRI or laparoscopy, depending on the individual case. Treatment can range from pain relief and hormonal therapy to fertility treatment or surgery.
If your period pain is severe or you have symptoms suggestive of endometriosis, seeking timely gynecological evaluation rather than normalising the pain is important.
