Some discomfort during menstruation is normal, but if you have severe cramps every month, you may be suffering from more than just typical period pain. Endometriosis is a painful condition that affects more than 11 percent of women in the United States aged between 15 and 44. Various treatments can help to manage and control endometriosis, so there is no need to suffer in silence with heavy, painful periods.

What Is Endometriosis?

The endometrium is a soft lining that grows inside the uterus every month as part of the normal menstrual cycle. It provides an environment in which a fertilized egg can implant itself and begin to grow into a baby. For people who have endometriosis, this lining starts to grow outside the uterus.

These terms might help you understand endometriosis:

  • Endometrium: Uterus lining that supports a growing embryo during pregnancy.
  • Uterus (womb): The organ in which an embryo grows during pregnancy.
  • Ovaries: Organs that release eggs each month as part of the menstrual cycle.
  • Fallopian tubes: Tubes that connect the ovaries to the uterus.

Stages and Types of Endometriosis

Endometriosis can affect many parts of the body. Most often, endometrium tissue grows on the ovaries, fallopian tubes or the outside of the uterus. Growth can also occur on the vagina, cervix, vulva, bladder, or bowel.

Doctors classify endometriosis into four different stages: minimal, mild, moderate and severe. Higher stages of endometriosis are defined by larger growths that penetrate more deeply into organs. However, the stage doesn’t determine the severity of symptoms. Even if you have Stage 1 (minimal) endometriosis, you may have severe pain that requires treatment.

Symptoms and Causes

Here are the most common symptoms of endometriosis:

  • Painful periods
  • Pain during or after sex
  • Long-lasting back pain
  • Bleeding between periods
  • Digestive problems, such as diarrhea, constipation, and bloating

Doctors and researchers aren’t sure exactly what causes endometriosis. Because it runs in families, genes may be one possible cause. Researchers also think that hormonal imbalances or problems with the immune system may encourage endometrial tissue to grow outside the uterus.

Prevention and Risks

Research suggests that high levels of estrogen in the body encourage the growth of the endometrium, which could increase the possibility of endometriosis. Therefore, reducing the amount of estrogen in your body could help to lower your risk of developing this condition. Here are some ways to keep estrogen production at a safe level:

  • Hormonal birth control: Using a low-estrogen pill, patch, or ring could help to keep estrogen levels low and stable.
  • Diet and exercise: Having a high body fat percentage can increase estrogen production. Exercise regularly and eat a calorie-controlled diet to keep your weight within a healthy range for your height.
  • Reducing alcohol consumption: Alcohol increases estrogen levels, so it’s a good idea to stick to no more than one drink per day.
  • Reducing caffeine consumption: Caffeine increases estrogen levels, so switching to decaf coffee and tea may help to lower your risk.

According to Mark Trolice, MD at Fertility Care: The IVF Center in Orlando, FL, "Factors that increase the risk of endometriosis are not having children, prolonged exposure to estrogen (either from starting periods early in life or having a late menopause), shorter menstrual cycles, heavy periods, genital tract congenital abnormalities, being taller than 68 inches, being thin, and eating a diet high in trans unsaturated fat."

Diagnosis and Tests

One of the first tests doctors use to check for signs of endometriosis is a pelvic exam. During this test, the doctor places their fingers inside the vagina and presses on the lower abdomen to feel for cysts and large areas of endometrium. Small growths are hard to feel during a pelvic exam, so this test may not diagnose the condition in all cases.

Doctors can also use an ultrasound or MRI scan to take pictures of the inside of your pelvis. These images can show growths on the uterus or nearby organs.

Another option for diagnosing endometriosis is a laparoscopy, which in this instance involves a surgeon taking a small sample of tissue from the uterus to confirm that you have the condition.

Potential Complications

According to Carolyn Alexander, MD of the Southern California Reproductive Center in Los Angeles, complications of endometriosis include:

  • Possible increased risk of clear cell ovarian cancer
  • Risk of scar tissue formation in the pelvis that can lead to abdominal or pelvic pain
  • Distorted pelvic anatomy
  • Embryo Implantation issues
  • Compromised egg and embryo quality
  • Altered fallopian tubal peristalsis (impacting the ability of the egg and sperm to meet to fertilize) 

"Endometriosis can affect fertility as a consequence of the above," Dr. Alexander said. "[The] environment around the egg can be altered, ovulation can be distorted, fallopian tube issues, embryo implantation in the uterus, but these issues may also not [affect] some women."

Additionally, according to Dr. Trolice, "women with endometriosis have a higher risk for ovarian cancer and possibly cardiovascular disease."

Treatment, Procedures, and Medication

Endometriosis has several treatment options. The right treatment for you will depend on your symptoms and whether you are currently trying to get pregnant.

  • Extended-cycle hormonal birth control regulates your hormones and reduces the number of periods you have each year. You can take hormonal birth control in the form of pills, injections, or an intra-uterine device (IUD). These treatment options all prevent pregnancy in addition to treating endometriosis.
  • A type of medicine called gonadotropin-releasing hormone agonist is a suitable treatment option if you are trying to get pregnant. This medicine reduces the growth of endometriosis and could increase your chance of getting pregnant.
  • Surgery to remove endometriosis is an option when hormonal medicines don’t fully control it. You may need to take hormones after the surgery to prevent the growth coming back. "If the pain is persistent and debilitating, some women may need a laparoscopy," said Dr. Alexander. "This can have risks so it must be discussed in detail [with your doctor.]"
  • Pain medicines such as ibuprofen and naproxen don’t treat endometriosis, but they can reduce the pain it causes during your period.

Healthy Lifestyle Tips

"Medication and surgery are the standard of care to manage endometriosis," said Dr. Trolice. "There are no proven benefits of lifestyle modifications in the treatment of this disease. Studies have explored self-management with coping strategies."

Regular exercise could help to reduce symptoms of endometriosis. Women who regularly do intense forms of exercise, such as jogging or aerobics, usually have lighter periods and lower estrogen production than women who are less active. If your lifestyle is sedentary, try to fit in more activity gradually. Don’t jump into a serious exercise plan quickly, since you could risk injury. Instead, slowly increase the amount of time you spend jogging or playing sports. You might also want to consider getting professional advice from a personal trainer.

Eating a diet that is high in fruit and vegetables and low in fat could also help to reduce endometriosis symptoms. Some researchers think that dietary fat increase estrogen production, which could explain why a low-fat diet helps some women with this condition. Try to cut back on red meat and include more vegetables in your meals.

Some women use supplements to help manage endometriosis. The most common supplements used for this purpose are thiamine, magnesium, and omega-3 fatty acids. Talk to your doctor to find out whether these supplements might be suitable for you to use alongside your prescribed treatments.

What Type of Doctors to See

If you think you might have endometriosis, make an appointment with your gynecologist. A gynecologist can carry out a pelvic exam and prescribe hormonal birth control options, which may help to control endometriosis.

If you need surgery to diagnose or treat your endometriosis, you will need to see a surgeon. Usually, surgeons who specialize in gynecological surgery treat endometriosis. However, if your endometriosis affects your bowel, you may need to see a colorectal surgeon instead.


Many women with endometriosis don’t know they have this condition because they assume that painful periods are normal. If you have pain that affects your ability to live a normal life during your period, it is important not to suffer in silence. See a gynecologist to find out whether you have endometriosis and to explore your treatment options.

If you need help finding a doctor, try searching Caredash's database for one near you.

About the Expert Contributors:

Mark P. Trolice, MD, FACOG, FACS, FACE is the Director of Fertility CARE: THE IVF Center as well as Clinical Associate Professor in the Department of Obstetrics & Gynecology (OB/GYN) at the University of Florida in Gainesville and the University of Central Florida in Orlando. He is double Board Certified in REI and OB/GYN while maintaining annual recertification in these specialties.

Carolyn Alexander, MD, of the Southern California Reproductive Center in Los Angeles, is board-certified in both Obstetrics and Gynecology as well as Reproductive Endocrinology and Infertility. Dr. Alexander’s main clinical interests include the treatment of polycystic ovary syndrome, endometriosis, unexplained infertility and recurrent pregnancy loss. Additionally, she works closely with oncologists on the fertility preservation of patients who are about to undergo chemotherapy.