Category Archives: Endometriosis Education


Endometriosis and Its Implications on Early Menopause: A Comprehensive Insight

Endometriosis, a chronic inflammatory condition, has been studied for its severe impact on women’s reproductive health in some aspects more than others. One area that has been relatively understudied is the connection between endometriosis and early menopause. This article will delve into the intricate relationship between endometriosis and early menopause, exploring the latest research studies, the associated risk factors, and the potential implications for women’s health.

I. Understanding Endometriosis

Endometriosis is an often painful condition in which tissue similar to the one lining the inside of the uterus — the endometrium — grows outside the uterus, typically on the ovaries, Fallopian tubes, and the tissue lining the pelvis. In some cases, it can spread beyond the pelvic area. Endo mostly affects women during their childbearing years and may also lead to fertility problems.

Read more: What causes endometriosis?

II. The Enigma of Early Menopause

Early menopause, also known as premature menopause or early natural menopause (ENM), is defined as the cessation of menstrual periods before the age of 45. This condition can have a profound impact on a woman’s life, affecting her fertility, cardiovascular health, cognitive function, and overall mortality rate.  The main driver is premature ovarian failure (POF) or insufficiency (POI).  Without proper levels of estrogen and progesterone, among other hormones, and highly coordinated hormonal fluctuations, menses cease.  Menses can also cease due to direct damage to the uterine endometrial lining, but that is far less common.  In this latter situation, in contrast to ovarian insufficiency, there are no symptoms of hot flashes or mood swings and the like.  

Read more: Endometriosis And Menopause: Everything You Need To Know

III. The Intersection of Endometriosis and Early Menopause

The potential implications of endometriosis on early menopause have not been extensively researched. There is a need for more comprehensive studies to understand the intricate associations and mechanisms linking these two conditions.

IV. Recent Studies on Endometriosis and Early Menopause

Recent investigations have shed light on the possible association between endometriosis and early menopause. These studies suggest that women with endometriosis may be at a higher risk of experiencing early menopause, even after adjusting for various demographic, behavioral, and reproductive factors.

V. Key Findings From the Studies

The studies indicate a statistically significant association between endometriosis and early menopause. Women with endometriosis, particularly those who never used oral contraceptives and are nulliparous, may have a heightened risk of experiencing a shortened reproductive lifespan. 

Studies focusing on premature ovarian failure (POF) or insufficiency (POI) suggest that this, in and of itself, is highly heterogeneous and related to mutations in more than 75 genes.  Some of these mutations overlap with those associated with endometriosis, particularly in the range of inflammatory autoimmune disorders.  

VI. Factors Influencing the Association

Multiple shared clinical factors may influence the association between endometriosis and early menopause, including body mass index (BMI), cigarette smoking, oral contraceptive use, parity, and history of infertility attributed to ovulatory disorder.

Given the genetic overlap of autoimmune and other disorders that influence POI and POF, it is quite probable that this is the root cause of the association between endometriosis and early menopause.  However, this remains to be scientifically validated. 

In those patients with advanced endo, where ovaries are partially removed or badly, as in the case of large endometriomas, there may be a direct anatomic cause for POI and POF.   

VII. Implications of the Findings

The findings of these studies have important implications for women’s health. They suggest that women with endometriosis may need to consider the potential risk of early menopause in their reproductive planning. Additionally, healthcare providers may need to consider these findings when developing individualized treatment plans for women with endometriosis.  A full evaluation should include screening for autoimmune disorders and possible genetic analysis for associated conditions.   

VIII. Limitations and Future Research

While these findings are significant, they are also limited by certain factors, including the reliance on self-reported data and the lack of racial and ethnic diversity in the study populations. Future research should aim to address these limitations and further explore the clinical and genetic or molecular association between endometriosis and early menopause.

IX. Coping With Endometriosis and Early Menopause

Living with endometriosis and dealing with early menopause can be challenging. However, understanding the connection between these conditions and seeking timely medical advice can help women manage their symptoms and maintain their quality of life. The first step is evaluation and management by providers who have specific and focused expertise in managing endometriosis. 

Read more: Navigating HRT for Menopause in Women with Endometriosis

X. Conclusion

The association between endometriosis and early menopause is a significant area of women’s health that mandates further exploration. While recent studies suggest a potential link, more comprehensive research is needed to fully understand the implications of this association. In the meantime, it is crucial for women with endometriosis to be aware of the potential risk of early menopause and to seek expert consultation with endometriosis specialists. 



Postmenopausal Malignant Transformation of Endometriosis

Endometriosis is a pain and infertility producing condition which predominantly affects premenopausal women.  Estimates suggest that up to 10% of women worldwide suffer from the condition during their reproductive years. While the incidence of postmenopausal endometriosis is considerably lower, studies have suggested that this may still be in the neighborhood of 2.5%.  So it is a misconception that endo is exclusively a disease of younger women. 

Further, although endometriosis is a benign disorder, there lies a risk of malignant transformation, at all ages. This article delves into the potential for malignant transformation of postmenopausal endometriosis.

Understanding Endometriosis and Menopause

Postmenopausal endometriosis refers to the occurrence or continuation of endometriosis symptoms after menopause, which typically occurs around age 50. This is defined as the cessation of menstrual cycles for twelve consecutive months. After this point, the ovaries produce minimal estrogen, a hormone which is generally considered essential for endo growth. So, without this hormone, or lowered levels, most cases of endometriosis naturally diminish. Yet, for some postmenopausal women, endometriosis can persist or even manifest anew. 

The cause or causes of endometriosis in younger women are controversial and incompletely defined.  Through uncertain but likely multifactorial mechanisms, endometriosis is characterized by the presence and growth of ectopic endometrial-like tissue outside the uterus. While one might assume that a hypoestrogenic state associated with menopause would alleviate endometriosis, this isn’t always the case. 

In postmenopausal women, the causes of endometriosis are less clear. Some contributing factors include:

  • Residual Disease: Endometriosis that began before menopause may continue after menopause due to residual disease and growth stimulated by factors other than estrogen or high sensitivity to low estrogen levels.
  • Exogenous Estrogen: Hormone replacement therapy (HRT) can potentially stimulate the growth of endometrial cells. This may be particularly relevant for postmenopausal women who take estrogen-only HRT, which can reactivate endometrial implants or even initiate new growths. 
  • Endogenous Estrogen Conversion: Adipose (fat) tissue can produce estrogen by converting it from other hormones. Postmenopausal women with higher amounts of adipose tissue might produce enough estrogen to promote the growth of endo. Fat can also store xeno-estrogens from certain toxins and then slowly release them into circulation.  The tissue microenvironment around endometriosis lesions also contributes to local estrogen production. 

Read more: Endometriosis And Menopause: Everything You Need To Know

Malignant Transformation: A Rare but Possible Event

While endometriosis is overwhelmingly benign, studies have indicated that women with endometriosis have an increased risk of developing certain types of ovarian cancers, specifically clear cell and endometrioid carcinomas.

Some factors that might increase the risk include:

  • Duration of Endometriosis: Prolonged presence of endometriosis lesions might increase the risk of malignant transformation. In general, cancer risk increases with age and  it is well known that chronic inflammation contributes to formation of cancer.  Endo is inflammatory in nature. Thus, if endo is still growing after menopause this means more time in an inflammatory state, hypothetically contributing to the risk. 
  • HRT Use: As mentioned, exogenous estrogen can stimulate endometriosis growth, potentially increasing the risk of malignant changes in existing lesions. This is not proven but may be a contributory factor which is very complicated due to individual variations in receptor activity and levels of estrogen.
  • Genetic Factors: Some genetic mutations might predispose women to both deeply invasive endometriosis and ovarian cancer, and there is overlap.  Epigenetic factors regulate which genes turn on an off during life and are influenced by environmental factors.  There is also a potential cumulative effect in the number of active mutated genes over the years. Some of the key genetic factors include:
  • PTEN: PTEN is a tumor suppressor gene. Its mutations have been identified in both endometriosis and endometrioid and clear cell ovarian cancers. Loss of PTEN function can lead to uncontrolled cell growth and might play a role in the malignant transformation of endometriosis.
  • ARID1A: ARID1A mutations are frequently seen in endometriosis-associated ovarian cancers. This gene is involved in chromatin remodeling, and its mutation can lead to disruptions in DNA repair and subsequent malignant transformation.
  • KRAS and BRAF: Mutations in these genes are known to play roles in the pathogenesis of various cancers. They’ve been identified in benign endometriotic lesions and might contribute to the early stages of malignant transformation.
  • Inherited Genetic Mutations: Women with inherited mutations in BRCA1 and BRCA2 genes, known for their association with breast and ovarian cancers, might also have an increased risk of developing endometriosis and its subsequent malignant transformation.

Read more: Understanding the Connection between Endometriosis and Cancer


Postmenopausal endometriosis, although less common than its premenopausal counterpart, cannot be overlooked. The absolute risk of malignant transformation, albeit very low, emphasizes the importance of regular monitoring and endo specialist consultations for postmenopausal women with endometriosis or its symptoms.  When postmenopausal endometriosis is suspected or diagnosed, especially if it is invasive and there are unusual symptoms or pelvic masses, a consultation with a gynecologic oncologist is also prudent.  


Bulun SE. Endometriosis. N Engl J Med. 2009;360(3):268-279. 

Pearce CL, Templeman C, Rossing MA, et al. Association between endometriosis and risk of histological subtypes of ovarian cancer: a pooled analysis of case-control studies. Lancet Oncol. 2012;13(4):385-394. 

Luca Giannella, Chiara Marconi, Jacopo Di Giuseppe, et al. Malignant Transformation of Postmenopausal Endometriosis: A Systematic Review of the Literature. Cancers (Basel) 2021 Aug 10;13(16):4026.

Luca Giannella, Chiara Marconi, Jacopo Di Giuseppe, et al.  The association between endometriosis and gynecological cancers and breast cancer: a review of epidemiological data. Gynecol Oncol. 2011;123(1):157-163. 

Sato N, Tsunoda H, Nishida M, et al. Loss of heterozygosity on 10q23.3 and mutation of the tumor suppressor gene PTEN in benign endometrial cyst of the ovary: possible sequence progression from benign endometrial cyst to endometrioid carcinoma and clear cell carcinoma of the ovary. Cancer Res. 2000;60(24):7052-7056. 

Wiegand KC, Shah SP, Al-Agha OM, et al. ARID1A mutations in endometriosis-associated ovarian carcinomas. N Engl J Med. 2010;363(16):1532-1543. 

Dinulescu DM, Ince TA, Quade BJ, Shafer SA, Crowley D, Jacks T. Role of K-ras and Pten in the development of mouse models of endometriosis and endometrioid ovarian cancer. Nat Med. 2005;11(1):63-70. 

Saha R, Pettersson H, Svedberg P, et al. Endometriosis and the risk of ovarian and endometrial adenocarcinomas: a meta-analysis. BMJ Open. 2020;10(4):e034760.


Can Endometriosis Become Malignant After Menopause?

Endometriosis, a condition commonly affecting women of reproductive age, doesn’t just vanish in menopause. In fact, an estimated 2-4% of postmenopausal women suffer from symptomatic endometriosis. Although endometriosis is generally benign, there lies a risk of malignant transformation. This article delves into the malignant transformation of postmenopausal endometriosis, presenting a comprehensive analysis of the topic.

Understanding Endometriosis and Menopause

Endometriosis is a complex clinical syndrome characterized by the presence of ectopic endometrial-like tissue. This pathological condition primarily affects women of reproductive age, often causing infertility and chronic pelvic pain leading to severe functional limitations.

While one might assume that the cessation of menstruation and the hypoestrogenic state associated with menopause would alleviate endometriosis, this isn’t always the case. Postmenopausal endometriosis can affect up to 4% of women. Recurrences or malignant transformations, although rare, are possible events.

Read more: Endometriosis And Menopause: Everything You Need To Know

Malignant Transformation: A Rare but Possible Event

While endometriosis is a benign condition, it carries a risk of malignant transformation. Approximately 1% of ovarian endometriosis can turn into cancer. However, a prospective study found a standardized incidence ratio of malignant transformation of 8.95, indicating that malignant transformation, while rare, is a serious concern.

In the case of postmenopausal endometriosis, malignant transformation is even rarer. There are no definitive percentages about its prevalence, with data derived from studies, including case reports and case series. This scarcity of data highlights the need for further research into this topic.

Read more: Understanding the Connection between Endometriosis and Cancer

Recurring Clinical Conditions

In the malignant transformation of postmenopausal endometriosis, some clinical conditions tend to recur:

  • History of endometriosis
  • Definitive gynecological surgery before menopause
  • Estrogen-only hormone replacement therapy (HRT) for a relatively long time

These conditions, however, have shown a significant decrease in recent years. This decrease could be due to changes in the attitudes and management of gynecologists, influenced by up-to-date scientific evidence about the use of major surgery in gynecological pathologies.

The Role of Hormone Replacement Therapy (HRT)

HRT plays a significant role in postmenopausal endometriosis. Among the women who used HRT, estrogen-only therapy was taken by approximately 75% of women. The duration of treatment had a median of 11 years, with the course of treatment exceeding five years in most women.

Current recommendations on HRT include continuous combination formulations or Tibolone for women with previous endometriosis. However, these recommendations are based on limited data, emphasizing the need for more extensive studies on this topic.

Read more: Navigating HRT for Menopause in Women with Endometriosis

Cancer Lesion Characteristics and Treatment

The malignant transformation of endometriosis can present with varying characteristics and may require different treatment approaches. Approximately 70% of cases had histology of endometrioid adenocarcinoma or clear cell carcinoma. The most frequent localization of the lesions was at the level of the pelvis, ovary, and vagina.

Most women underwent surgical treatment, with procedures including excision of the mass, hysterectomy with bilateral salpingo-oophorectomy, and surgical debulking. Adjuvant medical treatment was performed in about 60% of cases.

Read more: How to tell the difference between endometriosis and ovarian cancer.

Patient Outcomes and Follow-up

The outcomes for patients with malignant transformation of postmenopausal endometriosis are generally favorable. The survival rate is approximately 80% in 12 months, with a recurrence rate of 9.8% and a death rate of 11.5%.

The duration of follow-up had a median of 12 months. However, follow-up data is still too incomplete to provide adequate information on the prognosis, highlighting the need for further research in this area.


The malignant transformation of postmenopausal endometriosis presents a clinical challenge that requires further exploration. As gynecologists’ attitudes and management strategies evolve, it’s crucial to continue research into this area, to provide accurate and individualized evaluation and information for patients.

While endometriosis is generally a benign condition, the risk of malignant transformation, particularly in postmenopausal women, should not be overlooked. Comprehensive understanding and timely management of this condition are crucial to improving patient outcomes.



The Hidden Connection Between Endometriosis and Systemic Lupus Erythematosus

Based on possible shared characteristics and pathogenesis the interconnectedness of various ailments becomes a focal point of research. Such is the relationship between endometriosis and lupus, two seemingly unrelated conditions that share intriguing parallels. This article aims to shed light on the increased risk of being diagnosed with endometriosis in patients suffering from Systemic Lupus Erythematosus or SLE.  The purpose of unraveling connections is that this may lead to treatment discoveries. 

Understanding Endometriosis

Endometriosis is a multifaceted disease that primarily affects women in their reproductive years. It is characterized by the abnormal growth of endometrial-like tissue outside the uterus, leading to chronic pelvic pain, and potential infertility.

The pathophysiology of endometriosis involves a systemic inflammatory response, influenced by female sex hormones that may subtly affect the maintenance of immunity or the development of autoimmune diseases.

Getting to Know Systemic Lupus Erythematosus (SLE)

SLE is a chronic, autoimmune disease that can affect various parts of the body, including the skin, joints, kidneys, heart, and lungs. It involves the immune system attacking the body’s own tissues, leading to inflammation and damage. Women, especially of childbearing age, are more frequently diagnosed with SLE than men. Other factors such as ethnicity, age of onset, and socioeconomic class significantly influence SLE incidence, with notable geographic differences observed. 

Endometriosis and SLE: The Intriguing Association

Epidemiological studies suggest a solid link between endometriosis and female-dominant autoimmune diseases. However, not all studies support a significant association between endometriosis and SLE. The potential for spurious associations due to small study sizes and suboptimal control selection is high.

Unraveling the Connection: A Comprehensive Study

Given these inconsistencies, and accepting that the findings may not be applicable to all geo-ethnic populations, a large nationwide retrospective cohort study was conducted to assess the risk of endometriosis in women diagnosed with SLE. The study analyzed data from the Taiwan Longitudinal Health Insurance Research Database 2000 (n = 958,349) over a 13-year follow-up period (2000–2013).

Study Design and Population

The study adopted a retrospective cohort design with primary data sourced from the Taiwan National Health Insurance Research Database (NHIRD). The study cohort included women diagnosed with SLE between 1997 and 2013, and the index date was defined as the first diagnosis of SLE.

Assessed Outcome

The primary outcome was defined as the diagnosis of endometriosis. Given the lack of non-invasive diagnostic tools for endometriosis, the disease’s diagnosis was derived from clinical evidence or surgical intervention. Every effort was made to optimize parameters of non-surgical diagnosis of endo but surgical validation was lacking in a large number of subjects, representing a significant study weakness. 

Results and Implications

The study, within stated limitations,  found a statistically significant association between SLE and endometriosis, after controlling for age.

Read more: Unraveling the Connection Between Endometriosis and Autoimmune Diseases.

Conclusion: A Call for Further Research

The risk of endometriosis was found to be significantly higher in SLE patients compared to the general population in this study. This adds substantially to the overall body of evidence supporting an association.  However, more research is needed to fully understand this association and to determine if it can be generalized across different geo-ethnic populations.  Clearly, more basic science research is also critically needed to support epidemiologic associations. 



Can endometriosis cause miscarriage? Understanding Endometriosis and Its Impact on Miscarriage

Endometriosis is a prevalent health condition, affecting approximately 10% of women worldwide. It is often associated with chronic pain and infertility, but its potential connection to miscarriage is not as widely recognized. This article aims to shed light on the link between endometriosis and miscarriage, drawing on recent scientific research and expert insights.

What is Endometriosis?

Endometriosis is a chronic condition where tissue similar to the lining of the uterus, known as endometrium, grows outside the uterus. This tissue can grow on the ovaries, fallopian tubes, or the lining of the pelvic cavity. Just as the inner lining of the uterus thickens, breaks down, and bleeds with each menstrual cycle, so too does the endometrial-like tissue outside the uterus. However, this displaced tissue has no way to exit the body, leading to various problems.

Read More: What causes endometriosis?

Pathogenesis of Endometriosis

Endometriosis develops in stages, with severity ranging from minimal to severe. The American Society for Reproductive Medicine groups endometriosis into four stages: minimal (Stage I), mild (Stage II), moderate (Stage III), and severe (Stage IV). The stages reflect the extent, location, and depth of endometrial-like tissue growth, as well as the presence and severity of adhesions and the presence and size of ovarian endometriomas.

Symptoms of Endometriosis

While some women with endometriosis may have no symptoms, others may experience:

  • Painful periods
  • Pain during intercourse
  • Pain with bowel movements or urination
  • Excessive bleeding
  • Infertility
  • Other signs and symptoms such as fatigue, diarrhea, constipation, bloating, or nausea

Read more: 20 Signs and Symptoms of Endometriosis

Endometriosis and Pregnancy Complications

Endometriosis has long been associated with infertility, with studies indicating that up to 50% of women with infertility have the condition. However, less is known about its impact on women who do conceive. Emerging research suggests that endometriosis may increase the risk of several pregnancy complications, including preterm birth, cesarean delivery, and miscarriage.

Read More: How Does Endometriosis Cause Infertility? 

Endometriosis and Miscarriage: Understanding the Connection

Recent research has begun to explore the potential link between endometriosis and miscarriage. Miscarriage, also known as spontaneous abortion, is defined as the loss of a pregnancy before 20 weeks of gestation. It is estimated that about 10-20% of known pregnancies end in miscarriage. The actual number is likely higher, as many miscarriages happen so early in pregnancy that a woman might not even know she’s pregnant.

The Role of Inflammation

One theory proposes that the inflammation associated with endometriosis could interfere with the early stages of pregnancy. Endometriosis is characterized by chronic pelvic inflammation, which could potentially disrupt the implantation of the embryo or the development of the placenta.

The Impact of Surgical Treatment

Another factor to consider is the potential impact of surgical treatment for endometriosis. There have only been a few clinical trials and they do not indicate that surgical excision reduces the risk of miscarriage.  However, there are two very large databases from Sweden and Scotland that suggest a benefit to removing known endometriosis to lower pregnancy loss risk.  More research is required. 

Hormonal Factors

Endometriosis can alter the hormonal environment of the uterus, which could potentially impact early pregnancy. More research is needed to fully understand how these hormonal changes might contribute to miscarriage risk.

Research Insights: Endometriosis and Miscarriage Risk

Several studies have investigated the link between endometriosis and miscarriage. A meta-analysis published in 2020 in the journal BioMed Research International found that women with endometriosis had a significantly higher risk of miscarriage compared to women without the condition. This risk was particularly pronounced in women who conceived naturally, rather than those with tubal infertility who conceived through assisted reproductive technology (ART).

Coping with Endometriosis and Miscarriage

The potential link between endometriosis and miscarriage can come as distressing news. However, it’s important to remember that many women with endometriosis have successful pregnancies.  So, counseling and intervention really depend on the individual situation. With repeat losses, there are many potential reasons but it appears that endo can be one of them.  

Read more: Find an Endometriosis Specialist for Diagnosis, Treatment, & Surgery.


Endometriosis is a complex condition that can impact various aspects of a woman’s health, including her fertility and pregnancy outcomes. While research suggests a potential link between endometriosis and miscarriage, many women with the condition have successful pregnancies. If you have endometriosis or suspect you have endo, and having difficulty conceiving or experiencing pregnancy losses,  it’s crucial to seek consultation with an endometriosis specialist.   



Genetics and Epigenetics of Endometriosis: Unraveling the Complex Web of Hereditary Implications

Endometriosis, a medical condition afflicting numerous women worldwide, continues to puzzle medical researchers due to its complex nature and the myriad of genetic and environmental factors contributing to its development. This article aims to dissect the convoluted genetic aspect of endometriosis, providing a comprehensive understanding of its hereditary implications.

1. Introduction to Endometriosis

Endometriosis is a condition characterized by the growth of endometrium-like tissue outside the uterus. This disease exhibits significant diversity in its manifestation, with the tissue appearing in various forms and locations. It has a significant impact on the quality of life of the affected individual, often causing pain, infertility, and other related complications.

2. The Genetic Puzzle of Endometriosis

2.1 Hereditary Factors in Endometriosis

Endometriosis has been confirmed as a hereditary disease, with the risk of developing the condition significantly higher in first-degree relatives of affected women. Twin studies further corroborate this, showing a similar prevalence and age of onset in twins. Despite this, the exact genetic mechanisms contributing to endometriosis remain elusive and likely presents with an inheritance pattern that is multifactorial. 

2.2 Genetic and Epigenetic Incidents in Endometriosis

Genetic and epigenetic incidents, both inherited and acquired, significantly contribute to the development of endometriosis. These incidents, which can cause changes in gene expression, are often triggered by environmental factors such as oxidative stress and inflammation. Familial clustering of endometriosis has been shown in an array of studies with similar findings. First-degree relatives are 5 to 7 times more likely to have surgically confirmed disease. 

Familial endometriosis may be more severe than sporadic cases. This also supports the multifactorial inheritance of endometriosis and a genetic propensity as it may spread more severely to offspring or siblings. These women with familial inheritance may also have earlier age of onset and symptoms. 

3. Theories on the Pathogenesis of Endometriosis

3.1 The Implantation Theory

The implantation theory, popularized by Sampson in 1927, suggests that endometriosis is caused by the implantation of endometrial cells in locations outside the uterus. This theory, while reasonable, fails to explain certain observations, such as the occurrence of endometriosis in men and women without endometrium.

3.2 The Metaplasia Theory

The metaplasia theory postulates that endometriosis is a result of metaplastic changes, a process where one type of cell changes into another type due to environmental stress. This theory, while accounting for some observations, is limited by the varying definitions of “metaplasia” and the disregard for genetic or epigenetic changes.

3.3 The Genetic/Epigenetic Theory

The genetic/epigenetic theory proposes that endometriosis results from a series of genetic and epigenetic incidents, both hereditary and acquired. This theory is compatible with all known observations of endometriosis, providing a comprehensive understanding of the disease’s pathogenesis.

4. The Genetic/Epigenetic Theory: A Closer Look

4.1 Genetic and Epigenetic Incidents: The Triggers of Endometriosis

According to the genetic/epigenetic theory, endometriosis is triggered by a series of genetic and epigenetic incidents. These incidents can be hereditary, transmitted at birth, or acquired later in life due to environmental factors such as oxidative stress and inflammation.

4.2 The Role of Redundancy in the Development of Endometriosis

Redundancy, where a task can be accomplished by multiple pathways, plays a significant role in the development of endometriosis. This redundancy can mask the effects of minor genetic and epigenetic changes, causing them to become visible only when a higher capacity is needed.

4.3 The Genetic/Epigenetic Theory and Endometriosis Lesions

Endometriosis lesions are clonal, meaning they originate from a single cell that has undergone genetic or epigenetic changes. The genetic/epigenetic theory proposes that these lesions can remain dormant for extended periods, similar to uterine myomas, and may only be reactivated by certain triggers such as trauma.

5. Clinical Implications of the Genetic/Epigenetic Theory

5.1 Understanding the Nature of Endometriosis Lesions

According to the genetic/epigenetic theory, most subtle or microscopic lesions are normal endometrium-like cells that would likely resolve without intervention. In contrast, typical, cystic, and deep lesions are benign tumors that do not recur after complete excision but may progress slowly or remain dormant for an extended period.

5.2 The Role of Hereditary Factors in Endometriosis

The genetic/epigenetic theory suggests that genetic and epigenetic defects inherited at birth may play a significant role in the development of endometriosis. These hereditary factors may not only contribute to the disease’s onset but also to associated conditions such as subfertility and pregnancy complications.

5.3 Variability in Endometriosis Lesions

The genetic/epigenetic theory explains that endometriosis lesions can vary significantly in their reaction to hormones and other environmental factors. This variability is due to the specific set of genetic and epigenetic changes present in each lesion.

6. Prevention and Treatment of Endometriosis: A Genetic/Epigenetic Perspective

6.1 Prevention of Genetic/Epigenetic Incidents

Preventing the genetic/epigenetic incidents that trigger endometriosis can be a complex task. However, reducing repetitive stress may be useful in this regard.

6.2 Treatment of Endometriosis

The genetic/epigenetic theory suggests that the treatment of endometriosis should focus on the complete excision of the lesions to prevent recurrence. However, it also proposes that less radical surgery may be sufficient in some cases where the surrounding fibrosis and outer cell layers are composed of normal cells with reversible changes.

7. Conclusion

While the genetic/epigenetic theory provides a comprehensive understanding of the pathogenesis of endometriosis, it remains a theory until disproven by new observations. Further research is needed to fully elucidate the genetic and epigenetic mechanisms contributing to endometriosis, paving the way for more effective prevention and treatment strategies. Despite the complexity and challenges, the pursuit of knowledge in this field continues, offering hope for a future where endometriosis can be effectively managed and potentially prevented.


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Unraveling the Connection Between Endometriosis and Autoimmune Diseases

Endometriosis causes pain, multiple bowel symptoms and infertility, among many other debilitating symptoms, in about 10% of women, mostly in the reproductive age range. Developing research has shown that there is a link to various autoimmune conditions. 

Understanding Endometriosis

Endometriosis is a chronic gynecological disorder characterized by the presence of endometrial-like tissue growing outside the uterus. This means the cells look like those which line the inner part of the uterus but differ markedly in multiple ways at the molecular level.  The more we find out the less it is clear what the origins are.  However, they are likely partly genetic and partly based on other multiple influences of the environment on your body and genes. 

Read more: What causes endometriosis?

The Immune System’s Role

Research suggests that abnormalities in the immune system may play a key role in the development of endometriosis. These abnormalities could prevent the immune system from effectively clearing ectopic endometrial cells, regardless of how they get there, allowing them to implant and grow outside the uterus. This hypothesis suggests that endometriosis might be, at least in part, an immunity-associated disorder.

Furthermore, endometriosis is often associated with a chronic inflammatory response, triggered by the presence of ectopic endometrial-like cells. This inflammation, coupled with the immune system’s inability to effectively remove ectopic cells, could partly explain the chronic pain often associated with endometriosis.

Autoimmune diseases occur when the immune system mistakenly attacks the body’s own cells, viewing them as foreign invaders. The link between endometriosis and autoimmune diseases is still being explored, but multiple studies suggest that women with endometriosis may have a higher risk for certain autoimmune diseases.  It is not clear if endo carries a risk of developing autoimmune diseases or if the reverse is true or if they simply share common molecular mechanisms which results in both potentially occurring in any given individual.  At this point it is important to stress that an “association” does not mean “cause”. 

This review aims to delve into the current state of research on the association between endometriosis and autoimmune diseases. It presents key findings from population-based studies, discusses the potential implications, and highlights areas for future research.

Systemic Lupus Erythematosus (SLE) and Endometriosis

Systemic Lupus Erythematosus (SLE) is an autoimmune disease characterized by inflammation and damage to various body tissues, including the skin, joints, kidneys, and heart. Some studies have suggested a positive association between endometriosis and SLE.

One study suggested a seven-fold increase in the odds of having SLE among women with endometriosis. However, the study relied on self-reported diagnoses, which may introduce bias. A more recent cohort study found a more modest but still significant elevation in SLE risk among women with endometriosis.

Read more: The Hidden Connection Between Endometriosis and Systemic Lupus Erythematosus

Sjögren’s Syndrome (SS) and Endometriosis

Sjögren’s Syndrome (SS) is an autoimmune disorder characterized by dry eyes and mouth, often accompanied by other systemic symptoms. Several studies have investigated the potential link between SS and endometriosis.

A meta-analysis of three case-control studies found a 76% higher odds of SS in women with endometriosis. However, these studies had small sample sizes and wide confidence intervals, indicating a need for further research. Confidence intervals describe the range of results around a measurement which indicate how accurate the conclusion might be.  The tighter it is among measurements the better. 

Rheumatoid Arthritis (RA) and Endometriosis

Rheumatoid Arthritis (RA) is a chronic inflammatory disorder affecting many joints, including those in the hands and feet. Some studies have suggested a link between endometriosis and an increased risk of developing RA.

One meta-analysis, for example, found a 50% increased risk of RA among women with endometriosis. Again, the studies included in the analysis had limitations, including small sample sizes and wide confidence intervals.

Autoimmune Thyroid Disorders (ATD) and Endometriosis

Autoimmune thyroid disorders (ATDs), including Graves’ disease and Hashimoto’s thyroiditis, occur when the immune system attacks the thyroid gland, leading to either overactivity (hyperthyroidism) or underactivity (hypothyroidism) of the gland.

A meta-analysis of three case-control studies suggested a non-significant increase in the odds of ATD in women with endometriosis. However, the studies had high heterogeneity and low-quality scores, suggesting that further research is needed.

Coeliac Disease (CLD) and Endometriosis

Coeliac disease (CLD) is an autoimmune disorder where ingestion of gluten leads to damage in the small intestine. Some studies have suggested a possible link between endometriosis and CLD.

A meta-analysis of two case-control studies found a four-fold increase in the odds of CLD among women with endometriosis. Again, these studies had small sample sizes and wide confidence intervals, indicating a need for further research.

Multiple Sclerosis (MS) and Endometriosis

Multiple Sclerosis (MS) is a chronic disease that attacks the central nervous system. Current research on the association between MS and endometriosis is limited and inconclusive, with some studies suggesting a possible link while others finding no significant association.

Inflammatory Bowel Disease (IBD) and Endometriosis

Inflammatory bowel disease (IBD), including Crohn’s disease and ulcerative colitis, is characterized by chronic inflammation of the gastrointestinal tract. Some studies indicate a possible association between IBD and endometriosis.

One study found a 50% increase in the risk of IBD among women with endometriosis. However, the study had a small sample size and the confidence interval was wide, indicating a need for further research.

Read more: Is Endometriosis Genetic? Understanding the Genetic Links in Endometriosis.

The Bigger Picture

While the evidence for an association between endometriosis and certain autoimmune diseases is compelling, it’s important to emphasize that correlation or association does not imply causation. Further research is needed to determine whether endometriosis actually increases the risk of developing autoimmune diseases or vice versa, or whether the two share common risk factors or underlying mechanisms.

The potential link between endometriosis and autoimmune diseases highlights the importance of a comprehensive approach to women’s health. For women with endometriosis, being aware of the potential increased risk of autoimmune diseases can inform their healthcare decisions and monitoring.

The Path Ahead

The intersection of endometriosis and autoimmune diseases is a complex and evolving field of research. Better understanding the relationship between these conditions could help improve diagnosis, treatment, and ultimately, the quality of life for patients with endometriosis.

By continuing to explore this connection, we are gaining new insights into the pathophysiology of endometriosis and autoimmune diseases, potentially leading to novel treatments and preventive strategies. 



Navigating HRT for Menopause in Women with Endometriosis

Endometriosis, a chronic condition, is often associated with the fertile years of a woman’s life. But what happens when these women reach menopause? Can the symptoms of endometriosis persist, or even worsen, during this transition? This article aims to shed light on these questions and provide guidance for women with a history of endometriosis approaching menopause.

Understanding Endometriosis: A Quick Overview

Endometriosis is a medical condition characterized by the growth of endometrial-like tissue (the tissue that lines the uterus) outside the uterus. This condition, affecting approximately at least 10% of women in their reproductive years, can lead to debilitating pain, infertility, and other complications. However, the diagnosis of endometriosis often gets delayed due to the non-specific nature of its symptoms and the lack of reliable diagnostic tools.

The exact cause of endometriosis remains unclear, but estrogen dependence, progesterone resistance, inflammation, environmental factors and genetic predisposition are some of the known contributing factors. The primary treatment and support options for endometriosis include hormonal therapy, pain management, pelvic floor physical therapy and excisional surgery.

Read more: What causes endometriosis?

Endometriosis and Menopause: The Connection

Menopause, the cessation of menstruation, is a natural phase in a woman’s life. It is commonly believed that endometriosis, an estrogen-dependent condition, resolves after menopause due to the decline in estrogen levels. However, this belief is being challenged as more cases of postmenopausal endometriosis are reported.

The persistence or recurrence of endometriosis after menopause can be attributed to multiple factors. One factor may be persistent higher levels of estrogen in some women.  One common estrogen source is Hormone Replacement Therapy (HRT) to manage menopausal symptoms. HRT, which usually includes estrogen, may reactivate endometriosis in some cases. However, it is a complex interplay of estrogen, progesterone or progestins if they are included, receptor sensitivity and number and other molecular signaling factors, including the presence or absence of genomic alterations.  It’s also important to keep in mind that endometriosis cells and their surrounding support cells can locally produce estrogen.  Estrogen can also be generated by the interconversion of other hormones in your fat cells.  So, taking hormonal replacement is not the only potential source of estrogen after menopause.  

Postmenopausal Endometriosis: Case Studies and Observations

Numerous case reports and series have documented the recurrence of endometriosis or malignant transformation of endometriotic foci in postmenopausal women. In these reports, the majority of women had undergone surgical menopause (ovaries were removed) due to severe premenopausal endometriosis.

Read more: What would happen to the signs and symptoms of endometriosis after menopause?

Recurrence of Endometriosis

In several case studies, postmenopausal women reported symptoms similar to those experienced during their premenopausal years. These symptoms included abnormal bleeding if the uterus was still intact and pain, often in the genitourinary system. Notably, all women who experienced recurrence were on some form of Hormone Replacement Therapy (HRT), particularly unopposed estrogen therapy.

Malignant Transformation of Endometriotic Foci

Case studies have also reported instances of malignant transformation of endometriotic foci in postmenopausal women on HRT. These cases highlight the potential risk of exogenous estrogen in stimulating malignant transformation in women with a history of endometriosis.  It’s critical to point out that this is rare and that is why these are case reports rather than large studies.  When these steps towards malignant transformation  have been found they are usually associated with genetic alterations like PTEN, TP53 and ARID1A.  These alterations are more often found in deep infiltrating and endometrioma types of endometriosis, which are less common than the superficial variant. 

Read more: Understanding the Connection between Endometriosis and Cancer

Should HRT be Given to Women with Previous Endometriosis?

The decision to prescribe HRT to women with a history of endometriosis is complex and should be individualized on a holistic basis, looking at the risk and benefit overall. This includes risk and benefit for other symptoms and conditions like hot flashes, osteoporosis, heart disease, skin and vaginal changes, and more.  While HRT is the most effective treatment for these menopausal symptoms, it may increase the risk of recurrence or, more rarely,  malignant transformation of the endometriosis. 

Several observational studies and clinical trials have sought to assess the risks of HRT in women with a history of endometriosis. Although these studies suggested a small association between HRT and endometriosis recurrence, the differences between treatment and control groups were not statistically significant.  This means that for the vast majority, it is likely safe to take hormone replacement therapy, especially when considering the far more common benefits of such therapy.  

Whether or not the uterus has been removed or not is another  factor.  HRT for those with an intact uterus usually includes estrogen and a progestational agent, most often a synthetic progestin.  This is to protect against developing uterine endometrial cancer.  If the uterus is surgically absent, then only estrogen is usually administered.  There is a big reason for this.  The large Women’s Health Initiative (WHI) study performed over twenty years ago revealed that the risk of breast cancer mainly increases with hormone therapy that contains a progestin (synthetic progestational agent).  Estrogen alone does not increase this risk.  This is because progestins act as growth factors (mitogens) in breast tissue.  While natural progesterone was not evaluated in the WHI study, we know that it is not a mitogen from other studies.  So, if your uterus has not been removed, from a breast risk perspective, it may be reasonable to inquire about natural progesterone rather than a synthetic progestin as part of hormonal replacement therapy.  

It is also important to recognize that ectopic endometriosis cells are not as sensitive to progestational hormones as is eutopic endometrium, located in the uterine lining.   So, the real benefit of adding progestin or progesterone may not be as significant as it is in theory.  This requires more study, looking at the very complex molecular interplay of these hormones with their receptors located on and in endometriosis cells.  

Should HRT be Given Immediately Following Surgical Menopause?

Another question that arises is whether HRT should be initiated immediately after surgical menopause. Delaying the start of HRT could potentially allow any residual endometriotic tissue to regress before introducing exogenous estrogen. However, current research is inconclusive, with studies showing mixed results.

Read more: Integrative Therapies for Endometriosis

What Menopausal Treatments are Most Appropriate for Women with Previous Endometriosis?

If a woman with a history of endometriosis decides to opt for HRT, choosing the most suitable preparation is crucial. Current research suggests that combined HRT, which includes both estrogen and progestin (or progesterone), may be a safer option for women with residual endometriosis.  Keep in mind the caveat about breast tissue and synthetic vs natural progesterone. However, more research is needed to confirm these findings.

Read more: Postmenopausal Malignant Transformation of Endometriosis

Conclusions and Guidance

Navigating the transition to menopause can be challenging for women with a history of endometriosis. While HRT can be effective in managing menopausal symptoms, it may also increase the risk of endometriosis recurrence or malignant transformation.

Women with a history of endometriosis should have a thorough discussion with their healthcare providers about the overall potential risks and benefits of HRT.  It is also important to explore the risk and benefit of synthetic vs natural progestational agents. Not all practitioners are well versed in this innuendo.  

It’s also important to remember that each woman’s experience with endometriosis and menopause is unique. Therefore, individualized care that takes into account the symptoms, medical history, and personal preferences is crucial.  

Ultimately, more high-quality research is needed to better understand the molecular relationship between endometriosis and menopause, and to guide the management of menopausal symptoms in women with a history of endometriosis.



What causes endometriosis?

…Actionable insights and cause-based treatments on the horizon

Most of what you read online and in books or articles says something like “The cause of endometriosis is unknown, but we have a number of theories, some of which are more likely than others.” But what does this practically mean for you as an individual?   As someone who is looking for answers for pain relief or infertility solutions or a diagnosis or why your endo recurred, you probably want practical answers not abstract theories. Actionable answers seem remarkably elusive.  To add to your frustration, you may also find yourself stumbling upon a storm of “controversies” regarding the best treatment options, further muddying the water in your personal quest for answers.   

As a backgrounder for the problem, endometriosis is a chronic and often painful condition that affects at least 10% of women (XX) of reproductive age and significantly, but not entirely, fueled by sex hormones, mainly estrogen.  It is exceedingly rare in men (XY), but has been reported with high doses of prolonged estrogen therapy for prostate cancer and similar conditions.  Thus it may have increasing implications for trans women who might be prescribed prolonged estrogen therapy. 

This article is an introductory overview of the most current research on the etiology, pathobiology, and potential therapeutic strategies for this extremely complex and prevalent condition.  In other words, it attempts to connect what we know with some practical insights for you to base decisions on, including factoring in what may be coming as options down the road. This may or may not alter your decision-making in the here and now.  

At the end of this article, we will introduce some practical tips and strategies for getting you to where you want to go. But you have to understand the basis for these first, or it won’t make sense.   

What is Endometriosis?

Endometriosis is a medical condition characterized by the growth of endometrial-like tissue, similar to the internal lining of the uterus, outside the uterus. You see this a lot in print, but what does it mean exactly?  It means that the cells look quite similar under the microscope, but molecularly they are very different.  

Gene expression: Endometriotic cells often express genes associated with survival, inflammation, angiogenesis (blood vessel formation to have access to nutrients), and invasion more highly than typical endometrial cells. Major examples include genes coding for COX-2, VEGF, MMPs, and various cytokines, which are often upregulated. These all encode for aggressive epigenetics (something you will read about below): Epigenetic differences, including DNA methylation and histone modification differences, have been observed between endometriotic and endometrial cells. These changes can alter gene expression without changing the DNA sequence itself.

Hormonal responses: Endometriotic cells often show altered responses to hormones, including estrogen and progesterone. For example, they often contain higher levels of aromatase, an enzyme that produces estrogen and may be less responsive to progesterone due to changes in progesterone receptor expression.

Immune response: Endometriotic lesions often contain immune cells, such as macrophages and T cells, and produce pro-inflammatory cytokines. This is indicative of an ongoing inflammatory response, which may contribute to the symptoms of endometriosis and the survival of endometriotic cells outside the uterus.

The presence of these aberrant endometrial-like tissues in ectopic or unusual locations often results in chronic pelvic pain, intestinal symptoms like bloating, fertility problems, and a host of other symptoms that can significantly impact the quality of life. 

The Prevalence and Impact of Endometriosis

Beyond affecting at least 10% of XX women and potentially an increasing number of XY trans-women, the condition is detected in up to 50% of women seeking treatment for fertility issues. Moreover, epidemiological studies suggest that women with endometriosis may be at a higher risk of developing other health conditions including, but not limited to, asthma, rheumatoid arthritis, intestinal dysbiosis, other immune dysfunction, cardiovascular disease and even cancers like ovarian, breast and melanoma. So, while endo cannot explain all symptoms, at the root, these symptoms and signs may still be very related and due to a common root cause. Too often, the diagnosis is extremely delayed, up to a decade, because medical evaluation and testing do not explore these connections.  In other words, for example, intestinal complaints are looked at in isolation, and connections to painful periods, pain during sex, or infertility are overlooked.  

Symptoms and Diagnosis of Endometriosis

While debate concerning possible causes of endometriosis may continue for some time and the etiologies may overlap or differ between individuals, the first step is to get a correct diagnosis. That leads to the best personalized and informed treatment plan. 

The symptoms of endometriosis can vary greatly based on where it is located in your body, the inflammation it is causing and all of the related conditions. But, the most common symptoms include bloating, chronic pelvic pain (both cyclical and non-cyclical), painful periods, painful intercourse, and pain during bowel movements and urination. In addition to physical discomfort, endometriosis is often associated with fatigue and depression, further compounding the impact of the condition.

Diagnosing endometriosis is challenging due to the overlap of its symptoms with more common conditions. This can result in up to a decade of visiting emergency rooms and various specialists, who look at the symptoms through their specialty’s diagnostic lens with somewhat of a tunnel-vision result.  So, a gastro will focus on the gut, a general gynecologist will focus on the uterus and ovaries, a neurologist will focus on nerves, a urologist will focus on the bladder, and so on, all looking for common diagnoses within their specialties. These more common diagnoses are usually not endometriosis.  Further, there are no specific blood tests yet and imaging is not very accurate. However, inflammatory markers and other tests can help an endo specialist hone in on the diagnosis.  Similarly, imaging via ultrasound or MRI may be helpful in finding obvious signs of endometriomas (ovarian cysts filled with old blood and endometriosis tissue)  or deep infiltrating type of endometriosis.  This simply helps preparation for surgery in the event of findings like disease near the sciatic nerve or growing into the bladder or rectum. However, if negative, the surgeon and/or team must expect and be ready to handle the unexpected.  

Today, a definitive diagnosis of endometriosis can only be achieved by biopsy, usually during a diagnostic minimally invasive surgery.  Ideally, the surgeon who is operating should be capable of removing any endo that is found by excising it, at that time and not at a subsequent surgery.  This is where the diagnosis overlaps with an effective known treatment, excision surgery. The skill base for this is usually beyond most general gynecologists unless they have devoted extra time and training to acquire more advanced surgical skills.  If at all possible, this diagnosis and possibly therapeutic surgery should be done correctly the first time in order to minimize misdiagnosis, complications and repeat surgeries. 

Based on some of what you are about to read, diagnostics will likely soon be enhanced and accurate blood tests will become available for diagnosis and monitoring.  These tests will be based on proteomics and miRNA signatures, which means that endometriosis is associated with various measurable proteins and ribonucleic acids (RNA) of a specific kind, circulating in the blood.    A lot of research has already been done on this but it is a matter of finding a combination of these that is accurate.  

Unraveling the Cause or Causes of Endometriosis

It is highly unlikely that there will be a discovery of “THE’ unifying cause of endometriosis any time soon, if ever. However, this is still possible on a gene level and is a focus of ongoing research. But when you are looking for actionable, practical answers, this uncertainty should be framed a little better.  Far more likely than not, the causes (plural) of endometriosis are polygenic (multiple gene aberrations), multifactorial, and most likely differ between individuals. In general, this certainly affects choosing the best treatment plan for any disease, and the same situation exists in other diseases we treat.  There is no single cause of cancer, blood pressure problems, different types of diabetes, and so on.  Yet, treatment options are increasing because we are now searching for causative factors and targeted therapies at a molecular, genetic, epigenetic and genomic level.  That is a mouthful, but these subcellular molecular factors control everything in your body, normal and abnormal. More on this below. 


One of the most widely accepted theories for the origin of endometriosis is the very old concept of retrograde menstruation. It has been both overly glorified and vilified and certainly misunderstood often. This theory suggests that endometrial tissue fragments and cells escape from the uterus during menstruation, being forced backward through the Fallopian tubes, and implant in the pelvic cavity, directly forming endometriosis lesions.  But since retrograde menstruation is very common (at least 70-90% of all women based on laparoscopy observational studies), why do most or all women with a uterus not have endo?  Also, from a molecular point of view, eutopic endometrium and ectopic endometriosis cells differ in many respects. The answer to these disconnects is that perhaps this theory is indeed totally wrong and outdated.  Or perhaps there are factors in most women that are able to bio-molecularly or immunologically repel the growth of spilled endometrial cells, while some can’t. Or perhaps, since we know somatic stem cells exist in the endometrium, only a fraction of a certain type of stem cell may grow and differentiate if dropped into the peritoneal cavity and not all endometrial cells.  So, before completely retiring this theory, more sophisticated studies are required with today’s scientific tools. We have come a long way since the limited science that was available more than 100 years ago, when this was initially proposed.   

One thing is for certain, in order for endo to grow and cause problems it has to get there somehow and take root first.  Other than retrograde menstruation, how else might that happen? 

Other theories as to how endo originates include: 

1/ coelomic metaplasia: this theory suggests that peritoneal mesothelium (lining) could transform into endometrial-like tissue (also proposed about 100 years ago) 

2/ endometrial somatic stem/progenitor cells may play a role in the formation of endometriosis lesions, getting to the peritoneum either by retrograde menstruation (a variation of the original theory) or via lymph or tiny vascular transport channels 

3/ benign metastasis, meaning that endometrial cells are transported by the lymphatic system beyond the uterus 

4/ bone marrow pluripotent stem cells (i.e. can turn into any cell imaginable), which we know circulate in the blood, can reach the pelvis or other areas directly, implant due to a favorable local growth environment and grow.  

There are others, and variations of the above have also been proposed. 

The truth, as almost always, is likely in between all of these theories and likely differs between individuals to some extent. Today, we have molecular evidence that supports most of the above in varying degrees and tends to overlap.  

Endometriosis Growth and Progression 

Finding out how endometriosis develops will eventually lead to prevention strategies, which may be highly individualized.  But for now, the more actionable question is, once the initial cells are there, what causes them to grow and regrow, and at different rates?  It is the growth that gets you into trouble with symptoms by triggering inflammation, fibrosis and pain.   Keep in mind that there are three general types of endo: 1/ superficial 2/ deep infiltrating and 3/ endometrioma.  These can overlap, or not. So, there will never be a one-size-fits-all solution in all likelihood. 

However, what happens with progression, when it happens and why is happens is where the rubber meets the road. In answering these questions, insights and actionable strategies can be developed.  The following are avenues or pathways by which endometriosis cells can be fueled to grow.  Therefore, they present actionable intervention possibilities, now and into the future as we identify more targets.  

So, the following is where we are going with all this, what is medically/surgically actionable now and what you can do proactively today that may influence your personal situation.  The latter is in the realm of lifestyle and diet, but grounded in science.  There is a lot of woo-woo “alternative” stuff out there but also quite a bit that is evidence-informed and that can be helpful.  

Genetics and Genomics

From epidemiologic, twin, single gene, and genome-wide association studies (GWAS) there is little doubt that your risk for developing endo is largely grounded in multiple genes (polygenic) and their polymorphisms (alterations of various magnitudes).  Further, genes can interact with each other, either amplifying or attenuating disease.  But inheriting less desirable gene polymorphisms or mutations is not the be-all end-all because how these genes are activated or suppressed is dependent upon other multifactorial influences (e.g. your environment, including nutrition, toxins and lifestyle choices).  In other words, you may inherit good cards or bad cards, but how they play out can be influenced.  These influences are based on genomics and epigenetics and related sciences like proteomics,  metabolomics, nutrigenomics, and so on, introduced below.  

Read more: Is Endometriosis Genetic? Understanding the Genetic Links in Endometriosis.


Epigenetics studies how genes are controlled or expressed without changing the inherited DNA sequence.  “Epi-” means on top of the genes.  These are modifications that attach to the DNA, like methyl groups (from diet and supplement sources), which can suppress or help activate genes. Environmental factors such as diet, hormones, stress, drugs, chemical toxin exposure alter methylation.  Directly related to endo, alterations in DNA methylation patterns in endometriotic lesions have been described.  The epigenome harbors other ways that this gene to environment interplay occurs.  This includes histone modification, which is regulatory mechanism that controls unraveling of DNA so it can be read or transcribed.  This is also subject to lifestyle and dietary influence today, and is a major potential therapeutic target for the future. 

Hormonal imbalances

Endometriosis is often described as a “steroid-dependent” disorder, reflecting the significant role of steroid hormones, mainly estrogen, in its pathogenesis. 

This is a VERY complex influence and defies logic in some cases.  It is not as simple as therapeutically adding or taking away estrogen or progesterone.  Rather, it depends on tissue levels of estrogen and progesterone as well as the number and sensitivity of estrogen and progesterone receptors. The hormones and their receptors work like a lock (receptor) and key (hormone).  And that is just the beginning, because there are different components of receptors and additional molecular pathway influences, before and after estrogen binds to its receptor. 

For example, there is more estrogen on board when someone is significantly overweight, because there is production from the ovaries AND estrogen from fat cell interconversion AND from environmental xenoestrogen endocrine disruptors that are stored in fat. So that would mean the people who are overweight are more likely to have endo, right?  Wrong.  Endo, is more common in women with a healthy BMI. Problematic deep infiltrating endo and endometrioma types, is more prevalent in those who are very thin (BMI less than 18.5).  Why?  This is unknown, but various homeostatic mechanisms like estrogen receptor upregulation can hypothetically lead to higher estrogen sensitivity. Also, hormonal signals are not the only molecular  influence on endo.

As another example, after menopause, estrogen levels drop and endometriosis does tend to regress, but not in everyone. That is partly because endometriosis lesions can produce their own estrogen and there are likely other molecular growth factors in play.  There are also more ERβ receptors on endometriosis cells, and this causes higher prostaglandin production (which contributes to pain at any point in life).

In general, lowering “estrogen-dominance” to some degree suppresses endometriosis, but ideally not using synthetic progestins to “balance” hormones.   Progesterone (natural) and progestins (synthetic) do downregulate and limit the mitogenic (growth) influence of estrogen but progestins can be a mitogenic in some tissues (e.g. breast). Also, overall progesterone or progestins exert less of an effect on endometriosis than on eutopic endometrial tissue inside the uterus.  Likewise, dropping estrogen levels radically via GnRH agents for a relatively short period of time does not achieve the desired result and causes side effects and harm.  The risk vs benefit is particularly precarious here. Potentially, chronic gentle suppression might be more effective, and at least safer.  This can be achieved by using progesterone.  Synthetic progestins like norethindrone acetate can be used but with the caveats above. Alternatively, you can also help by consuming seaweed, regular exercising and other lifestyle choices, like active xenoestrogen toxin avoidance.

Read more: What would happen to the signs and symptoms of endometriosis after menopause?

Read more: Endometriosis And Menopause: Everything You Need To Know


Endometriosis may be partially a product of inflammation and is also characterized by generating an inflammatory response itself.  So it can snowball and contribute to the development and persistence of symptoms. Immune cells, such as macrophages, NK and T cells, are found in abundance in endometriosis lesions, and their interactions with endometriosis cells can promote the formation and growth of these lesions. Additionally, the peritoneal fluid of women with endometriosis often exhibits an altered composition, with increased levels of pro-inflammatory cytokines and growth factors.  

Inflammation can be from various sources, including infection which may be clinical (in other words you feel sick) or chronic subclinical.  For example it is well established that chronic endometritis (infection inside the uterine lining) is present in endometriosis patients more often than those without endo. This is an association and the cause-effect is not well worked out, but more recently various bacteria have been implicated.  At least in animal models, antibiotic treatment targeting those bacteria have produced regression of endometriosis lesions. Bacteria from the uterus or cervix can easily travel, either directly through the Fallopian tubes or via the bloodstream, to cause inflammation in the peritoneal cavity.  This inflammatory response is postulated to lead to progression of endo. 

Leaky gut, which may be related to an unhealthy low microbiome diversity, can lead to bacterial fragments, called lipopolysaccharides (LPS), seeding the peritoneal cavity as well.  This in turn causes inflammation and the same potential effect on endo growth.   

But inflammation can be due to a myriad of other non-infectious factors including stress, autoimmune disorders, obesity, systemic diseases like diabetes or pre-diabetes, mast cell activation, toxin exposure and so on.  

Most of these inflammatory conditions are actionable. Failing that, general anti-inflammatory strategies may also be beneficial, both pharmacologic and integrative.   


Dysbiosis of the gut has a direct negative effect on the gut-endocrine axis and can impact endometriosis growth.  There are three significant ways this happens. 

Estrobolome: This term refers to the fraction of gut microbiota capable of metabolizing estrogens. In healthy individuals, the estrobolome helps maintain a balance of estrogen levels by contributing to the enterohepatic circulation of estrogens, thereby affecting the overall circulating and excreted amounts of these hormones. Dysbiosis, however, can disrupt the functioning of the estrobolome, leading to alterations in the metabolism of estrogens. In the context of endometriosis, this dysbiosis may lead to excess circulating estrogen, which stimulates the growth and survival of endometrial cells outside the uterus, contributing to endometriosis. 

Gut-Endocrine Axis: The gut microbiota also influences the gut-endocrine axis, which refers to the complex interplay between the gut microbiota, gut cells, and endocrine organs. Dysbiosis can result in changes in gut permeability (also known as “leaky gut” introduced above), leading to increased inflammation and immune dysregulation. This can, in turn, disrupt normal hormone regulation, potentially exacerbating conditions like endometriosis.

Gut-Brain Axis: Dysbiosis can also influence the gut-brain axis, a bi-directional communication system that links the central nervous system with the enteric nervous system. Changes in the gut microbiota can affect this axis and lead to altered pain perception and increased stress responses, both of which can affect the experience and progression of endometriosis.

Read more: Endo-Fighting Microbiome Optimization: Research-based Tips

Cancer molecular shared growth drivers

It’s important to note that a very small fraction of women with endometriosis might develop an endo-associated cancer (<1%), and gene mutations probably drive that.  Having said that there is overlap of these genes with more aggressive variants of endo, like deep infiltrating and endometrioma.  Meaning, they may not lead to cancer but may still fuel a more aggressive form of endometriosis.  This has led some researchers to propose that endometriosis is a pre-cancerous condition in a small percentage of those with endo.  The most studied gene in this regard is ARID1A, but the following have also been associated: KRAS, PTEN, HOXA10, VEGF, ESR1 and ESR2, and FN1.  Since there is a lot of research on these in the cancer world, there may be targeted therapies for more aggressive variants of endometriosis arising from this research.

Read more: How to tell the difference between endometriosis and ovarian cancer.

Current Treatment Strategies for Endometriosis

Current effective treatment for most patients is built upon a personalized evaluation, correct diagnosis, and expert excision surgery to reduce the amount of inflammation and triggering of pain and other symptoms.  This is followed by some degree of medical suppression in many patients, usually on a hormonal basis.  Personalized guidance is key, which does not go overboard by either over or under-treating. 

Excisional surgery is today’s cornerstone because it yields an accurate diagnosis and removes the visible disease if at all possible.  But this should not be indiscriminate and should be done by an expert if the index of suspicion for endo justifies the surgical risks.  It seems prudent to reserve consideration of medical suppressive treatments for use after an accurate diagnosis is made vs. use of potentially very dangerous hormonal therapies based on a suspicion of endo only.   

Before and after surgery there are quite a few optimization strategies, including pelvic floor physical therapy (PFPT) and a pain management plan which take into account what the pain triggers are.   These can differ between people. Both of these supportive therapies are complex but integral to treatment in the vast majority of cases. This helps you get ready for surgery and go through surgery more smoothly and then transition to a life without endo.  

In addition, evaluation of the related conditions covered in this article, like dysbiosis and possible small bacterial overgrowth (SIBO) and leaky gut is mandatory.  The symptoms can easily cross over from these conditions and endo so it helps to sort out other related causes of pain and bloating. Finally, evaluation should also consider mast cell activation, chronic inflammatory response syndrom (CIRS), autoimmune hypothyroidism, fibromyalgia, irritable bowel syndrome (IBS) or disorders of gut-brain interactions, interstitial cystitis (IS).  There are also conditions not directly related to endo but often associated, like Lyme disease and mold.  The latter two can accentuate inflammatory response and water logged buildings often have black mold.  The CDC is also warning that tick-borne disease like Lyme and Babesiosis is on the rise.    

Also, as you are now aware from reading this article, there are many other steps you can take to influence and limit the course of endo recurrence and progression.  None of this is magic and none of it is a quick fix but when guided by an expert it is also generally pro-health, not dangerous and not expensive by and large.  Again, best results are obtained with expert guidance. 

Emerging Therapeutic Approaches

Although we have some options today, there is a pressing need for novel, effective therapies for endometriosis beyond surgery and variations of hormonal therapy. For instance, immunotherapies that target specific cytokines or immune cells involved in endometriosis are currently under investigation. Other promising areas of research include therapies targeting the altered metabolic environment of endometriosis lesions and neuromodulatory treatments aimed at disrupting pain pathways associated with the condition. This article is not intended to cover these future options in depth, but based on all of the potential causes and influencing factors it becomes easier to see what is coming sooner than later.   

Some recent example animal studies and concepts which should get to human trials include: Targeted anti inflammatory therapy,  antibiotic therapy targeting specific bacteria like Fusobacterium, antibody (AMY109) that binds IL-8, small interfering RNA for VEGF (siVEGF), epigenetic and histone modification targeting endo-related gene transcription including estogen and progesterone receptors, epigenetic modification of T-cell immune response in endo, ARID1A and related “cancer gene” targeting, and more. So, while we do not have these available in clinical practice yet, the research wheels are turning.  Certainly that can be accelerated with more funding, but it is ongoing. 

Holistic Proactive Principles

While we await mainstream targeted molecular therapies you should know that the same molecular pathway targets are also influenced by natural integrative approaches.  They may not be laser targeted on a specific pathway but that can actually be a good thing.  Abnormal cells like endo know how to work around blockades from therapy and the treatment can stop working. We know that from other diseases where molecular therapies are already quite common.   Mother nature has actually considered that problem, so to speak, and a lot of nutrients can have a synergistic favorable effect on multiple molecular pathways at the same time.  

Further, your microbiome, estrobolome, inflammation, oxidation, nutrition, stress, lack of exercise, and so much more, impacts your body on the basis of epigenetics that was introduced above and, more specifically, a significant part is related to nutrigenomic epigenetics. 

It’s critical to note that this does not mean loading up on the weirdest supplements you never heard of that cost an arm and a leg.  The 80/20 rule, which says that you get 80% of your result from 20% of an action, suggests that you can get pretty far with a personalized anti-oxidant anti-inflammatory diet and that is most often embodied by a whole food plan-based diet.  Combine this with an exercise plan and stress management and you are 80% of the way there. 

Read more: Integrative Therapies for Endometriosis


Endometriosis is a complex, multifaceted, polygenic and multifactorial disorder, and much remains to be understood about its causes and progression. As our understanding of endometriosis deepens, so too does our ability to develop accurate diagnostics and targeted, effective therapies. But for now, in expert hands and with your own proactive commitment to nutritional and lifestyle options, outcomes can be good to great. There is no disease or condition where everyone gets the benefit of a great outcome, but certainly in the case of endo it can be optimized by seeking out an endometriosis expert.

Read more: Breaking the Cycle: Understanding Endometrioma Recurrence After Surgery.

Read more: The Endometriosis Roller Coaster: Understanding Recurrence and How to Prevent It


  1. Endometriosis: Etiology, pathobiology, and therapeutic prospects
  2. The Main Theories on the Pathogenesis of Endometriosis
  3. Nutrition in the prevention and treatment of endometriosis: A review
  4. Cancer-Associated Mutations in Endometriosis without Cancerf

Is Endometriosis Genetic? Understanding the Genetic Links in Endometriosis.

Endometriosis is a significant cause of discomfort and can greatly reduce the quality of life.  Although the disease’s origin remains somewhat elusive, research indicates a potential familial pattern. This article delves into the possible genetic basis of endometriosis, exploring its genetic and genomic aspects and their implications for improved diagnosis and treatment.

The Enigma of Endometriosis

Endometriosis is a condition where tissue similar to the endometrium – the internal lining of the uterus – grows outside the uterus. This can occur on the ovaries, fallopian tubes,the tissue lining the pelvis, and beyond. In some cases it grows superficially, in others it can invade deeply into other tissues or affect the ovaries. Despite extensive research, the exact cause of endometriosis and the reason for these variants remains an enigma. However, an interesting pattern has emerged over time – the disease appears to cluster in families, suggesting a potential genetic link.

Is Endometriosis Genetic?

Familial  predisposition suggests that endometriosis could be inherited in a polygenic or multifactorial manner. Polygenic or multifactorial inheritance refers to a condition that is affected by multiple genes (polygenic) and influenced by environmental factors (multifactorial).  Since everyone is different, this may also help explain why some people get one variant of the disease and others do not.  

Several factors make it difficult to understand the genetic link in endometriosis. The foremost is the diagnostic method. Endometriosis can only be definitively diagnosed through invasive procedures like laparoscopy or laparotomy. This can often lead to under-reporting of the disease with many people walking around undiagnosed for years. Another factor is the disease’s heterogeneous nature mentioned above, as it can manifest in different variants and locations within the body, suggesting potentially diverse disease processes.  Once these genetic links, which likely overlap, are unraveled and mapped then we will be able to diagnose endometriosis through blood tests rather than surgery.  Each genetic link eventually leads to molecular signals which can be used for diagnosis, treatment and follow-up monitoring.  

Familial Clustering and Evidence

Epidemiologic research has shown a familial clustering of endometriosis, meaning it appears more frequently within families. However, it does not seem to follow a simple Mendelian inheritance pattern. This observation supports multiple genetic factors contributing to the disease, consistent with polygenic/multifactorial inheritance and environmental impact.  

Genetic Mapping and Endometriosis

Gene mapping is a technique used to investigate potential gene mutations or polymorphisms associated with diseases like endometriosis. This method involves looking at the genome for excess sharing of informative polymorphic microsatellite markers in affected siblings. Studies using this method have highlighted areas in chromosomes 10 and 20 that may be linked to endometriosis. Despite the identification of these risk loci, the exact mechanism by which these genes influence the development of endometriosis is not yet fully understood.  So this association means someone may be at higher risk but does not guarantee that endometriosis will actually develop in any given individual. 

Genome-Wide Association Studies

Genome-Wide Association Studies (GWAS) represent a very promising method used to identify differences in the genetic makeup of individuals that could be responsible for variations in disease susceptibility. Basically, they compare the genomes of people with a certain disease (like endometriosis) to healthy individuals to look for genetic differences.

GWAS scans the genome of individuals for small variations, called single nucleotide polymorphisms (SNPs), that occur more frequently in people with a particular disease than in people without the disease. Each study can look at hundreds or thousands of SNPs at the same time. Then statistical methods can help identify which SNPs are associated with the disease.

First, genetic markers identified through GWAS could potentially be used to develop a genetic test for endometriosis. This could enable earlier and more accurate diagnosis of the disease, which is often difficult to diagnose due to its nonspecific symptoms and the need for invasive procedures to confirm diagnosis.

Second, as an example of treatment potential,  if a GWAS identifies a SNP in a gene involved in inflammation that is associated with endometriosis, researchers could develop a drug that targets this gene to reduce inflammation and treat endometriosis.  There are many other potential molecular pathways that influence endo development and progression that can and will be targeted.  

Genomics of Endometriosis

While genetics refers to the inheritance of a trait, genomics focuses on how genes are expressed, meaning how they are turned into structural proteins and signals and so forth. Genomics studies have identified significant alterations in gene expression in endometriosis, providing major insights into underlying biology. Genomic studies will likely lead to new noninvasive diagnostic strategies and possible new therapies. 

So, deeper understanding of endometriosis genomics can provide insights into the biological pathways and processes involved in the disease.  This can, in turn, inform diagnosis, treatment, and monitoring strategies.


When we better understand the genomics of endometriosis, we will be able to develop non-invasive non-surgical diagnostic tests. For example, if certain genetic variants are found to be associated with endometriosis, a simple blood test could be developed to look for these variants.

In addition to these genetic tests, understanding the molecular signaling pathways involved in endometriosis could potentially lead to the development of biomarker-based tests. Biomarkers are substances, such as proteins, that are indicative of certain biological conditions, like inflammation or fibrosis formation. If certain molecules are found to be elevated or decreased in women with endometriosis, these could be used as biomarkers for the disease.

Read more: The Different Tests Used to Diagnose Endometriosis 


Current treatments for endometriosis are basically limited to hormonal-based therapy, pain management, and surgery. However, these approaches do not work for everyone and can have significant short and long-term side effects. Short of a complete excision surgery, which is the cornerstone of today’s therapy, these are not curative therapies. Despite world-class excision surgery microscopic invisible post-surgical residual remains a concern and we need better options to eliminate anything that might be left in order to minimize or eliminate risk of recurrence.   

By understanding the genes and molecular pathways involved in endometriosis, we can identify new targets for biological drug development. For example, if a certain gene is found to be overactive in endometriosis, an agent could be developed to inhibit this gene. Similarly, some protein-based molecular pathways can be selectively inhibited. This is reality today in many diseases and there is no reason that endometriosis should not be amenable to similar options. 

Read more: Why You Need an OB-GYN Who Specializes in Endometriosis


Lastly, understanding the genomics of endometriosis could also improve disease monitoring. For example, if certain genetic variants or molecular signals are associated with disease progression, these could potentially be used to monitor disease progression or response to treatment. This could lead to more personalized treatment strategies and improve patient outcomes.  To the point of microscopic residual after excision surgery, if none is likely present and no signals point to that, then no additional therapy would be required.  On the other hand, if there is molecular evidence to support possible micro-residual then treatment might be initiated right away, or at least at the time of first molecular evidence of recurrence or progression. 

The caveat here is that the translation of genomic and molecular research into clinical practice is a complex process that requires extensive further research and validation. It’s also worth noting that endometriosis is a complex disease likely influenced by a combination of genetic, environmental, and hormonal factors, and understanding these will be crucial for developing better diagnostic and treatment strategies. 

Read more: Debunking the Myths About Endometriosis & Exploring the Facts

Concluding Thoughts

The notion of endometriosis being genetic is supported by a growing body of research, highlighting the disease’s intricate and multifaceted nature. While our understanding of the genetics and genomics of endometriosis is still evolving, it holds the promise of improved diagnosis and treatment methods in the future. By continuing to explore the genetic foundations of this disease, we move closer to empowering those affected by endometriosis with knowledge and more effective treatment options.

In the end, unlocking the genetic and genomic secrets of endometriosis will pave the way for a future where this enigmatic condition is better understood, diagnosed, and treated.  While a lot of the above is in research or upcoming, some is available now.  Seek out an endometriosis expert who can discuss these with you and individualize a treatment plan.


Diana Maria Chiorean et al. New Insights into Genetics of Endometriosis—A Comprehensive Literature Review: Diagnostics (Basel). 2023 Jul; 13(13): 2265.


How Does Endometriosis Cause Infertility? 

Endometriosis, a complex and often misunderstood condition, can significantly impact a woman’s fertility. Understanding the intricacies of this condition, its causes, and its effects on fertility can be vital in paving the way for effective treatment strategies.

An Introduction to Endometriosis

Endometriosis is a benign, estrogen-dependent disorder primarily affecting approximately one in ten cisgender women in their reproductive years. It may also have an impact on transgender men, where the condition may be present in a higher percentage. While it has been reported in cisgender men, it is exceedingly rare. Thus the fertility impact discussed here is that which specifically affects the uterus, Fallopian tubes and ovaries.  

Endometriosis is characterized by the abnormal presence of endometrial-like tissue outside the uterus. This abnormally growing tissue is often found in the pelvic region, such as on the ovaries, fallopian tubes, and the outer surface of the uterus. Still, in some cases, it can extend beyond the pelvic area.

While endometriosis affects approximately 10-15% of cisgender women in their reproductive years, the condition is more prevalent in those struggling with infertility, affecting up to 25%-50% of this demographic. The exact cause of endometriosis remains a subject of research and debate, and its impact on fertility is multi-faceted and complex.

Understanding The Pathogenesis of Endometriosis

While the precise cause of endometriosis is still under debate, several theories have emerged over the years, trying to explain the pathogenesis of this condition.

Retrograde Menstruation

The oldest theory is retrograde menstruation, which suggests that during menstruation, some of the endometrial tissue flows backward, through the fallopian tubes, into the pelvic cavity instead of leaving the body. These endometrial cells then attach to the peritoneal surfaces, proliferate, and form endometriosis implants.

Coelomic Metaplasia and Metastatic Spread

Other theories suggest that cells in the peritoneum can transform into endometrial cells, a process known as coelomic metaplasia. Alternatively, endometrial tissue may spread through the bloodstream or lymphatic system to other parts of the body, a process known as metastatic spread. Both these theories could explain how endometriosis implants can be found in areas outside the pelvic region.

Altered Immunity

Another theory proposes that women with endometriosis have a compromised immune system, which fails to eliminate the endometrial cells that have migrated to the peritoneal cavity. This immune dysfunction may also contribute to the progression of the disease, as the immune system’s reactions may inadvertently promote the growth and proliferation of endometrial implants.

Stem Cells and Genetics

Recent research also suggests that stem cells and genetic factors may play a role in the development of endometriosis. Bone marrow-derived stem cells may differentiate into endometriosis cells, contributing to the formation of ectopic endometrial-like tissue.

Additionally, genetic predisposition may play a significant role in the development of endometriosis. People with a first-degree relative affected by the disease have a seven times higher risk of developing endometriosis.

Learn More: Current Knowledge on Endometriosis Etiology: A Systematic Review

How Does Endometriosis Cause Infertility?

Endometriosis can affect fertility through various mechanisms:

Effect on Gametes and Embryo

Endometriosis can impact the production and quality of oocytes (eggs), as well as sperm function and embryo health. The presence of endometriomas (cysts caused by endometriosis) and the inflammatory environment they create can negatively affect both oocyte production and ovulation.

Effect on Fallopian Tubes and Embryo Transport

Endometriosis can disrupt the fallopian tubes’ normal functioning and impact the embryo’s transport. The inflammation caused by endometriosis can impair tubal motility and cause abnormal uterine contractions, which can hinder the transportation of gametes (eggs and sperm) and embryos.

Effect on the Endometrium

Endometriosis can also impact the uterine lining or endometrium, which can lead to implantation failure. Research suggests that endometriosis can alter the gene expression in the endometrium, affecting its receptivity to implantation.

Read More: Learn More About the Connections Between Endometriosis and Infertility

Current Treatment Options for Endometriosis-Associated Infertility

The treatment of endometriosis-associated infertility is multi-faceted and can include expectant management, medical treatment, surgical treatment, and assisted reproductive technologies.

Expectant Management

While endometriosis significantly lowers fertility rates, some women with mild to moderate endometriosis can still conceive without any medical or surgical intervention. However, this approach may be more suitable for younger women with mild endometriosis and no other fertility issues.

Surgical Treatment

Surgery can be both diagnostic and therapeutic in the context of endometriosis. The goal of surgical treatment is to remove or reduce endometriosis implants and restore normal pelvic anatomy and reduce the inflammatory impact. This could potentially improve fertility, particularly in women with severe endometriosis.

Assisted Reproductive Technology

In vitro fertilization (IVF) is currently the most effective treatment for endometriosis-associated infertility. IVF can be particularly beneficial for women with severe endometriosis or those for whom other treatments have failed.

Medical Treatment

Medical treatment for endometriosis primarily targets reducing the severity of the disease and relieving symptoms. Hormonal medications such as combined oral contraceptives, progestins, danazol, and gonadotropin-releasing hormone agonists or antagonists (GnRH analogs) are commonly used. However, these medications have not shown any significant benefit in treating endometriosis-associated infertility.

Read More: Natural, Medical & Surgical Treatment of Endometriosis Infertility

Looking Towards The Future: Potential Treatments

As our understanding of endometriosis deepens, new potential treatment options are emerging, such as therapies targeting the abnormal gene expression and inflammation caused by endometriosis. Furthermore, stem cell therapies and genetic interventions hold promise for treating endometriosis-associated infertility in the future. As research continues, the hope is that these advancements will lead to more effective strategies for managing this complex condition and improving fertility outcomes in those with endometriosis.

Read More: How Do Endo Fertility Issues Impact the Mental Health of a Person?

Reference: Macer ML, Taylor HS, Obstet Gynecol Clin North Am. 2012 Dec;39(4):535-49.


Interstitial Cystitis and Endometriosis: Unraveling the “Evil Twins” Syndrome of Chronic Pelvic Pain


Chronic pelvic pain (CPP) is a health condition that burdens millions of women worldwide. The complexity of diagnosing and treating CPP is often overwhelming due to the multitude of potential underlying causes and associated conditions. Two such conditions, often called the “Evil Twins” syndrome, are Interstitial Cystitis (IC) and Endometriosis, both commonly found in patients suffering from CPP. This article will explore these conditions’ prevalence, diagnosis, and treatment in patients with CPP.

Understanding Chronic Pelvic Pain

Chronic Pelvic Pain (CPP) is a prevalent health condition affecting an estimated 9 million women in the United States alone. It accounts for up to 40% of laparoscopies and 10% to 12% of all hysterectomies, indicating its significant impact on women’s health. The annual expenditure on diagnosing and treating CPP is nearly $3 billion.

The “Evil Twins”: Interstitial Cystitis and Endometriosis

Two conditions frequently associated with CPP are Interstitial Cystitis (IC) and Endometriosis. These conditions can present similar symptoms and coexist in patients, making the diagnosis and management of CPP even more challenging.

Interstitial Cystitis (IC)

Interstitial Cystitis, or bladder-originated pelvic pain, is a significant disorder related to CPP. The etiology of IC is multifactorial and progressive, involving bladder epithelial dysfunction, mast cell activation, and bladder sensory nerve upregulation. The exact prevalence of IC in the United States varies, with estimates ranging from 10 to 510 per 100,000 normal population. However, current research suggests that IC might be more prevalent than previously estimated.


Endometriosis is another common condition among women with CPP, affecting more than half of the patients diagnosed with CPP. Symptoms include pain during sexual intercourse (dyspareunia), cyclical perimenstrual lower abdominal pelvic pain, symptom flares after sexual intimacy, and irritative voiding in case of urinary tract involvement. A definitive diagnosis of endometriosis requires visual confirmation of the lesion during laparoscopy and histologic confirmation of the presence of both ectopic endometrial glands and stroma.

The Overlap Between Interstitial Cystitis and Endometriosis

Research has demonstrated a high rate of overlap between IC and endometriosis in patients with CPP. This overlap poses challenges in diagnosis and treatment, as the presence of one condition does not preclude the existence of the other. Therefore, it is crucial to consider both conditions in the evaluation of patients with CPP.

Diagnosis of Interstitial Cystitis

The diagnosis of IC and endometriosis involves various tests and procedures, including the Potassium Sensitivity Test (PST), cystoscopy with hydrodistention, and laparoscopy.


Laparoscopy for direct visualization of endometriosis lesions and taking a biopsy is the gold standard for endometriosis diagnosis.

Read more: The Different Tests Used to Diagnose Endometriosis 

Potassium Sensitivity Test (PST)

The PST is a diagnostic test developed to detect abnormal permeability of the bladder epithelium, a key factor in the pathophysiology of IC. Previous studies have validated the use of the PST in diagnosing IC, particularly at the early stages of the disease.

Cystoscopy with Hydrodistention

Cystoscopy with hydrodistention is a diagnostic procedure often used to confirm the presence of IC. The bladder is filled with sterile water under passive hydrostatic pressure, then slowly drained. The presence of submucosal petechial hemorrhages, or glomerulations, confirms the diagnosis of IC.


During cystoscopy under anesthesia, your provider may remove a sample of tissue (biopsy) from the bladder and the urethra for examination under a microscope. This is to check for bladder cancer and other rare causes of bladder pain.

Urine cytology

Your provider collects a urine sample and examines the cells to help rule out cancer.


This article highlights the complex interplay between IC and endometriosis in the context of CPP. It underscores the need for careful evaluation and simultaneous consideration of these conditions in patients with CPP. A multidisciplinary approach, including the use of PST and concurrent cystoscopy and laparoscopy, is crucial for accurate diagnosis and effective treatment of concurrent interstitial cystitis and endometriosis.


Endo-Fighting Microbiome Optimization: Research-based Tips

Endometriosis is partly caused by, and causes, inflammation. The origin or genesis of this
inflammation is probably multifactorial but recent research suggests that the microbiome, the
community of microorganisms living in or on the human body, plays an important role through
inflammatory pathways. Dysbiosis, which means an imbalance or impairment of the microbiota,
is observed in endometriosis, and is thought to both contribute to and result from endo.

Studies have focused on the gut, peritoneal fluid, and female reproductive tract microbiota to
identify specific microbiome signatures associated with endometriosis. The gut microbiome, in
particular, has been extensively studied. Changes in bacterial composition, such as increased
levels of Proteobacteria and decreased levels of Lactobacilli, have been observed in the gut of
endometriosis patients. Other body sites, including the peritoneal fluid and female reproductive
tract, also show altered microbiota in endometriosis.

The dysbiosis observed in endometriosis is believed to contribute to the disease through
various mechanisms. One theory suggests that bacterial contamination, particularly with
Escherichia coli, in the menstrual blood may lead to inflammation and immune activation in the
peritoneal cavity, contributing to endometriosis development. Dysbiosis can also affect
estrogen metabolism, through dysfunction of the so called “estrobolome”. This can lead to
increased levels of circulating estrogen and a hyper-estrogenic state, which promotes
endometriosis. Additionally, dysbiosis-induced epigenetic changes and immune modulation
may play a role in direct endometriosis pathogenesis.

Research on the microbiome in endometriosis is still in its early stages, but it holds promise for
potential diagnostic and therapeutic approaches. Microbiome testing could potentially be used
as a non-invasive tool for detecting endometriosis, complementing current imaging modalities.
The technology for doing this is already here and you can get it ordered. However, the meaning
of the results is still not well understood in any given individual. So, it’s complicated.

Beyond testing, manipulating the microbiome through interventions like probiotics, antibiotics,
or dietary modifications may offer new treatment options for endometriosis. To the extent that
you can diversify your microbiome and get it to a healthier state, this is something that can be
done with little risk or cost today. Options available to you are covered below, most of which
are focused on the bacterial part of your microbiome.

Future studies will explore the role of different types of microorganisms, beyond bacteria, such
as viruses and fungi, and utilize advanced analytical methods like shotgun metagenomics and
metabolomics to gain a more comprehensive understanding of the microbiome in
endometriosis. Newer technologies like this are significantly accelerating gains in knowledge.

Meanwhile, emerging understanding of the bidirectional relationship between endometriosis
and the microbiome has implications for potential treatment strategies available today.


Antibiotics could be used to target specific bacteria associated with dysbiosis in
endometriosis, especially if you are diagnosed with small intestinal bacterial overgrowth (SIBO).
Animal studies have shown that treatment with antibiotics can reduce the size of endometriotic
lesions and associated inflammation. In humans, we know that chronic endometritis (infection
of the uterine cavity) seems to play a role in development of endo. However, this requires
expert guidance. It’s critical to exercise caution with antibiotic use to avoid disrupting healthy
commensal (good bacteria) microbiota and contributing to antimicrobial resistance. You don’t
want to grow a bug that might be resistant to multiple antibiotics down the line.


Probiotics are live bacteria that can have beneficial effects on your microbiome
health and diversity when consumed. Studies in animal models have demonstrated that certain
probiotic strains, such as Lactobacillus gasseri, can suppress the development and growth of
endometriotic lesions. Probiotics may modulate the immune response and restore a healthier
microbiota composition, potentially mitigating the inflammatory processes associated with
endometriosis. However, again, this requires expert guidance because, for example, it could
lead to ineffectiveness against or exacerbation of SIBO. This is partly because there are at least
three different general types of SIBO, based on what type of gas is produced by the


Prebiotics are basically food substances that selectively promote the growth of
beneficial bacteria in the gut. By providing a favorable environment for beneficial bacteria,
prebiotics can help restore a healthy microbiota balance. An example of a prebiotic shown to
be beneficial in SIBO treatment is partially hydrolyzed guar gum (PHGG). Further research is
needed to investigate the potential roles of prebiotics in endometriosis treatment, but it could
be a gamechanger for simple treatment of various intestinal disorders, leaky gut and so on.

Dietary modifications:

Diet can hugely influence the composition and activity of the
microbiome. Consuming a diet rich in fiber and plant-based foods, which are known to support
a diverse and healthy microbiota, may have beneficial effects on endometriosis. Low FODMAPs
diets, which restrict fermentable carbs, can help. Omega-3 polyunsaturated fatty acids (PUFAs),
found in fatty fish, flaxseeds, and chia seeds, have shown anti-inflammatory properties and
have been associated with a lower incidence of endometriosis. Incorporating these dietary
changes, among many others, may help modulate the microbiome and reduce inflammation.


The microbiome has profound effects on the immune system, and
targeting the immune response could be a potential avenue for endometriosis treatment.
Modulating the immune system through therapies such as immune-suppressing medications or
immune-modulating agents may help regulate the inflammatory processes associated with
endometriosis. The idea here is to keep it as natural as possible, but sometimes prescription
medications may turn out to be necessary.

Please keep in mind that these treatment implications are based on current research, primarily
in the lab and animal models, and further studies are needed to validate their effectiveness and
safety in humans. Additionally, personalized approaches considering an individual’s specific
microbiota composition and disease characteristics may be necessary for optimal treatment
outcomes. It is exciting research in development and will be part of upcoming revolutionary
advances which take us far beyond hormonal manipulation for endo management. Since these
approaches are exploring the root cause of endo, treatments will likely be therapeutic as
opposed to simply something that reduces symptoms, which is the case with today’s hormonal

The best part is that with proper expert guidance, much of the above can be used today
because, in most cases, the risk and cost are relatively low.


Uzuner, C., Mak, J., El-Assaad, F., & Condous, G. (2023). The bidirectional relationship between
endometriosis and microbiome. Frontiers in Endocrinology, 14, 1110824. doi:

Moreno, I., Franasiak, J. M., & Endometrial Microbiome Consortium. (2020). Endometrial
microbiota—new player in town. Fertility and Sterility, 113(2), 303-304. doi:


Understanding Fatigue and Endometriosis: A Practical No-Nonsense Guide

Fatigue is a common symptom these days, but for those living with endometriosis, it can be
particularly challenging. While it’s not one of the primary symptoms of endometriosis, fatigue is
often reported by women who have endo. What’s the relationship? What are some potential
causes and what can you do to regain some lasting energy, without hocus pocus “cures”, more
coffee, or energy drinks?

If you’re not sure if you have endometriosis, please remember that not all symptoms are
directly related to or caused by endo. While many can be related, something else can be
wrong. For example, you can have anemia from various causes, adrenal or thyroid disease and
many other conditions, some of which can be serious. Chronic fatigue is a very challenging
condition to treat but before treatment you first must get to the root cause or causes. This
requires either a mainstream internal medicine or family medicine doctor that is going to
carefully explore every angle with you. Most will just get basis tests and not spend much time
with you, because their time is limited by today’s healthcare mess. Alternatively, seek out an
integrative and/or functional medicine physician who is trained to approach all disease by
tracing it down to the root cause. This is critical and not just a matter of getting a few blood
tests. If you’re “lucky” something obvious might pop up on basic testing. But most of the time
it’s not that straightforward. Do it right!

If you already know you have endo and are experiencing fatigue along with other symptoms of
endometriosis, make sure your endo specialist is aware of this. They can help evaluate how root
causes may be in play that are directly related to endo or adenomyosis, provide an accurate
diagnosis or diagnoses, and develop a personalized treatment plan. Everyone is not the same.

Understanding Fatigue and Endometriosis:

The Impact of Chronic Pain:

Endometriosis, in most, is characterized by chronic pelvic pain, which can significantly impact
quality of life. Living with constant pain can be exhausting both physically and mentally, leading
to fatigue. Additionally, the stress and emotional burden associated with chronic pain can
further contribute to fatigue.

Hormonal Imbalances:

Hormonal imbalances play a role in the development and progression of endometriosis.
Estrogen, in particular, is thought to promote the growth of endometrial tissue outside the

uterus. Fluctuations in estrogen levels throughout the menstrual cycle can result in fatigue and
tiredness. Furthermore, if you are in a hormone balancing program of some kind, excess
progesterone can definitely cause fatigue. “Balancing hormones” requires an expert hand
because it is like conducting a symphony orchestra, as opposed to throwing in a few hormones
to see what happens. Beyond that, it is not just a matter of balancing estrogen and
progesterone. For example, people with endometriosis are six times more likely to have an
underactive thyroid. So, again, it’s a symphony orchestra, not a small band that needs
conducting for best results.

Sleep Disturbances:

Endometriosis often leads to sleep disturbances due to pain, discomfort, and hormonal
imbalances. Insufficient or poor-quality sleep can easily leave one feeling fatigued during the
day. It is essential to prioritize sleep hygiene and seek strategies to improve sleep, such as
creating a relaxing bedtime routine and ensuring a comfortable sleep environment.


Endometriosis and adenomyosis can lead to heavy or prolonged menstrual and inter-menstrual
bleeding, which can result in iron deficiency anemia. Iron is vital for carrying oxygen to the
body’s tissues, and when its levels are low, fatigue and weakness can occur. Bringing iron levels
up may mean taking iron supplements for a while or it can as simple as adjusting your diet to
include iron-rich foods, like leafy veggies.

Inflammation and Immune Dysfunction:

Endometriosis is associated with chronic inflammation and immune system dysfunction. The
inflammatory response and immune activation can definitely contribute to fatigue. Strategies
that reduce inflammation, such as a healthy diet rich in anti-inflammatory foods, regular
exercise, and stress management techniques, may help alleviate fatigue symptoms.

Management Strategies for Fatigue:

Pain Management:

Effective pain management is essential for reducing fatigue associated with endometriosis. Your
doctor may recommend over-the-counter pain relievers, such as nonsteroidal anti-
inflammatory drugs (NSAIDs), to help alleviate pain and inflammation. Hormonal treatments,
such as birth control pills or hormonal intrauterine devices (IUDs), can also be prescribed to
regulate hormone levels and reduce pain. Of course, narcotics are an option but that can lead
to feeling loopy and fatigued, defeating the purpose. Gabapentin and similar drugs can help
with central sensitization and might be used just for transition while you reduce pelvic floor
inflammation triggers using multi-modality therapies. Pelvic floor physical therapy is critical.
Integrative modalities like acupuncture and acupressure can help as well. Endo excision surgery
is always part of the conversation and requires an expert to minimize the risk of multiple repeat

Lifestyle Modifications:

a. Regular Exercise: Engaging in regular exercise can improve energy levels and reduce fatigue.
It might be counter-intuitive to go out and exercise if you are already feeling beat, it works.
Even low-impact activities like walking, swimming, or practicing yoga can have a positive
impact. Start with light exercises and gradually increase intensity based on your comfort level.
Consult with a trainer or a physical therapist to determine the best exercise plan for you.

b. Balanced Diet: A well-balanced anti-inflammatory antioxidant diet plays a crucial role in
managing fatigue and supporting overall health. Incorporate a variety of fruits, vegetables,
whole grains (whole food plant-based diet), and lean proteins into your meals. These provide
essential nutrients which work together, including iron and other vitamins, which can help
combat anemia-related fatigue. Limiting processed foods, sugary snacks, and caffeine can also
promote more stable energy levels throughout the day. Given that endo is inflammatory and
the damage that is caused is based on reactive oxygen species oxidation, it is critical to keep
inflammation low and anti-oxidation high. Your body is a very complex laboratory which also
works like a symphony orchestra when tuned properly. It needs the right fuel, and an expert
nutritional “conductor” can help select and tune up the right plan for you.

c. Adequate Hydration: Drinking enough water throughout the day is important for maintaining
optimal energy levels. Dehydration can exacerbate fatigue, so aim to consume at least eight
glasses of water daily. Carry a refillable water bottle with you as a reminder to stay hydrated.
This is not directly related to endo but is a forgotten baseline critical need to maintain a slightly
alkaline, antioxidant and anti-inflammatory status.

Stress Management:

a. Mindfulness and Relaxation Techniques: Practicing mindfulness meditation, deep breathing
exercises, or progressive muscle relaxation can help reduce stress and improve energy levels.
Find a quiet and comfortable space and allocate a few minutes each day for relaxation
exercises. There is a lot of choose from including various forms of yoga, Tai Chi, Qigong,
mindfulness, biofeedback techniques like Heart Math, meditation and so on. These days there
are various mobile apps and online resources available to guide you through some these
techniques. But it is important to select something that resonates with you. If you are not “into
it”, it won’t help.

b. Engage in Activities You Enjoy: Participating in activities that bring you joy, and relaxation can
help alleviate stress and combat fatigue. Whether it’s reading, listening to music, taking a warm
bath, or spending time in nature, make time for activities that help you unwind and recharge.
Do something that makes you laugh. This all has psycho-biological proof behind it.

c. Prioritize Self-Care: Self-care is essential in managing fatigue and overall well-being. Set aside
regular time for self-care activities such as taking a bubble bath, getting a massage, practicing
gentle yoga, or indulging in a hobby you love. Remember that self-care looks different for
everyone, so find activities that resonate with you and make them a priority.

Support Networks:

a. Seek Emotional Support: Living with endometriosis is emotionally challenging. Connecting
with others who share similar experiences through support groups or online communities can
provide valuable emotional support, validation, and information. Sharing experiences, seeking
advice, and knowing you are not alone can help in managing fatigue and the overall impact of
endometriosis. Everyone is different and some of the solutions you hear about may not work
for you, but it is good to hear about them. The only prudent caveat might be that if something
sounds too good to be true in this setting, check it out through trusted credible sources and
your endo specialist.

b. Involve Loved Ones: Educate your loved ones about endometriosis and how it affects your
energy levels. Communicate your needs and limitations so that they can offer support and
understanding. Having a strong support system can make a significant difference in managing
fatigue and coping with the challenges of endometriosis.

c. Consider Counseling: If fatigue and the emotional impact of endometriosis are strongly
impacting your mental well-being, consider seeking professional counseling or therapy.
Everyone needs help at some point in their life. A mental health professional can provide
guidance, coping strategies, and a safe space to process your emotions.


By implementing these management strategies, you can better cope with fatigue and improve
your quality of life. Remember that everyone’s experience with endometriosis is unique, and it
may take time to find the strategies that work best for you. Seek support from an
endometriosis specialist and other practitioners noted above, make lifestyle modifications,
prioritize self-care, and build a strong support network. Ideally, seek out an endo specialist who
is not only a surgeon but is also either trained in integrative holistic care or has a team that
provides these valuable support and treatment options. With the right tools and resources, you
can more effectively manage fatigue and navigate the challenges of living with endometriosis.


Johnson NP, Hummelshoj L; World Endometriosis Society Montpellier Consortium. Consensus
on current management of endometriosis. Hum Reprod. 2013;28(6):1552-1568.

Nnoaham KE, Hummelshoj L, Kennedy SH, et al. World Endometriosis Research Foundation
Women’s Health Symptom Survey Consortium. World Endometriosis Research Foundation
global study of women’s health consortium. Fertil Steril. 2011;96(2):366-373.

Hadfield R, Mardon H, Barlow D, Kennedy S. Delay in the diagnosis of endometriosis: a survey of
women from the USA and the UK. Hum Reprod. 1996;11(4):878-880.

Vercellini P, Vigano’ P, Somigliana E, et al. Endometriosis: pathogenesis and treatment. Nat Rev
Endocrinol. 2014;10(5):261-275.

Ferrero S, Esposito F, Abbamonte LH, et al. Quality of life in women with endometriosis: a
narrative overview. Minerva Ginecol. 2019;71(6):464-478.

Mathias SD, Kuppermann M, Liberman RF, et al. Chronic pelvic pain: prevalence, health-related
quality of life, and economic correlates. Obstet Gynecol. 1996;87(3):321-327.

Hartwell D, Jones K, Hinshaw K, et al. Sleep disturbances and fatigue in women with
endometriosis. Am J Obstet Gynecol. 2019;221(6):638.e1-638.e14.

Vitale SG, La Rosa VL, Rapisarda AMC, et al. Impact of endometriosis on quality of life and
psychological well-being. J Psychosom Obstet Gynaecol. 2017;38(4):317-319.

Giudice LC. Clinical practice. Endometriosis. N Engl J Med. 2010;362(25):2389-2398.

La Rosa VL, De Franciscis P, Barra F, et al. Sleep quality in women with endometriosis: a
systematic review and meta-analysis. J Clin Med. 2020;9(6):1834.

Panir K, Schjenken JE, Robertson SA, et al. Immune interactions in endometriosis. Expert Rev
Clin Immunol. 2019;15(6):649-662.

Koga K, Takamura M, Fujii T, et al. Dysfunction of innate immune system in the development of
endometriosis. Reprod Med Biol. 2018;17(1):49-55.

Agarwal SK, Chapron C, Giudice LC, et al. Clinical diagnosis of endometriosis: a call to action. Am
J Obstet Gynecol. 2019;220(4):354.e1-354.e12.


Understanding and Managing Endo Belly: A Comprehensive Guide

Endo belly is a term used to describe the painful abdominal bloating experienced by individuals with endometriosis. It is characterized by severe distension and discomfort, often resembling the appearance of pregnancy. This article aims to provide a comprehensive guide to understanding and managing endo belly, including its causes, symptoms, and treatment options. We will delve into the underlying mechanisms of endo belly, explore various management strategies, and discuss the importance of seeking medical advice for an accurate diagnosis and personalized treatment plan.

What is Endo Belly?

Endo belly refers to the extreme bloating and distension of the abdomen in individuals with endometriosis. Unlike mild and temporary bloating associated with the menstrual cycle, endo belly is more severe and can cause significant physical and emotional distress. It is often accompanied by pain, tenderness, and a feeling of fullness. Many individuals with endo belly describe their abdomen as looking pregnant, which can profoundly impact their self-image and overall quality of life.

Read more: Endo Belly: A Guide to Understanding the Symptoms and Causes

The Causes of Endo Belly

The exact causes of endo belly are not fully understood, but there are several factors that contribute to its development. Endometriosis, a condition in which tissue similar to the lining of the uterus grows outside the uterus, plays a key role in the development of endo belly. The endometrial-like tissue can cause inflammation in the abdomen, leading to swelling, water retention, and bloating. Additionally, endometriosis can lead to the formation of ovarian cysts, which further contribute to abdominal distension. Gastrointestinal issues, such as constipation and gas, are also commonly associated with endometriosis and can contribute to the development of endo belly.

Symptoms of Endo Belly

The main symptom of endo belly is severe abdominal bloating, particularly during or before the menstrual period. The abdomen may feel tight, hard to the touch, and tender. Many individuals with endo belly report that their abdomen expands throughout the day, making it difficult to button their pants or wear fitted clothing. Other gastrointestinal symptoms, such as gas pain, nausea, constipation, and diarrhea, may accompany endo belly.

Diagnosis and When to Seek Medical Help

If you are experiencing severe and persistent abdominal distension or suspect that you may have endo belly, it is important to seek medical help for a proper diagnosis. Endo belly can mimic other health conditions, so consulting with a healthcare professional specializing in endometriosis or pelvic pain is crucial. The diagnostic process may involve:

  • A pelvic exam.
  • Imaging tests such as ultrasounds.
  • A thorough evaluation of your symptoms and medical history.

Early diagnosis and intervention can lead to more effective management and improved quality of life.

Managing Endo Belly: Strategies and Treatment Options

Various strategies and treatment options are available to manage endo belly and alleviate its symptoms. The choice of treatment depends on the severity of symptoms and individual needs. Here are some approaches that can help:

  • Pain Management

Nonsteroidal anti-inflammatory drugs (NSAIDs) can be used to manage pain and inflammation associated with endo belly. Over-the-counter NSAIDs, such as ibuprofen, can provide temporary relief. However, it is essential to consult with a healthcare professional before starting any medication.

  • Hormonal Therapy

Hormonal therapy is commonly used to manage endometriosis symptoms, including endo belly. Birth control pills, hormonal patches, and intrauterine devices (IUDs) can help regulate hormonal fluctuations and reduce the growth of endometriosis tissue. Gonadotropin-releasing hormone (GnRH) agonists or antagonists may also be prescribed to suppress the production of certain hormones and alleviate symptoms.

  • Dietary Changes

Making dietary changes can have a significant impact on managing endo belly. Avoiding trigger foods that can contribute to inflammation, such as caffeine, refined sugars, alcohol, and processed foods, may help reduce bloating and discomfort. Incorporating a diet rich in fruits, vegetables, lean proteins, and high-fiber options can promote gut health and reduce inflammation.

  • Heat Therapy

Applying heat to the abdomen can provide relief from pain and muscle tension associated with endo belly. A hot water bottle or heating pad can be used to soothe cramps and relax the abdominal muscles. Heat stimulates sensory receptors, blocking pain signals and providing instant pain relief.

  • Pelvic Floor Physiotherapy

Pelvic floor physiotherapy can be beneficial for individuals with endo belly. A pelvic floor physiotherapist can provide exercises and techniques to improve pelvic muscle strength and flexibility, alleviate pain, and promote proper alignment and breathing. Manual therapy techniques may also be used to release muscle tension and restore mobility.

  • Surgical Intervention

In severe cases of endometriosis, surgical intervention may be necessary to remove endometrial tissue and alleviate symptoms. Laparoscopic surgery is often the preferred approach, as it is minimally invasive and allows for precise removal of endometriotic lesions and scar tissue. However, surgery is not a cure for endometriosis, and a comprehensive treatment plan should include other management strategies to address symptoms and prevent recurrence.

Read more: Finding an Endometriosis Specialist: Your Guide to Effective Treatment.

Coping with Endo Belly: Self-Care and Emotional Support

Coping with endo belly involves not only managing physical symptoms but also addressing the emotional impact it can have on individuals. Here are some self-care strategies and emotional support options to consider:

  • Mindfulness and Meditation

Practicing mindfulness and meditation can help reduce stress and anxiety associated with endo belly. Deep breathing exercises and guided meditation can promote relaxation and provide a sense of calm.

  • Support Groups and Counseling

Joining a support group or seeking counseling can provide a safe space to share experiences, seek guidance, and receive emotional support from others who understand the challenges of living with endo belly. Professional counseling can also help individuals navigate the emotional aspects of their condition and develop coping mechanisms.

  • Body-Positive Practices

Embracing a body-positive mindset and practicing self-acceptance can help individuals with endo belly feel more confident and comfortable in their bodies. Wearing loose-fitting clothing, engaging in activities that promote body awareness and self-care, and reframing negative self-talk can contribute to a healthier body image.

Read more: Types of Endometriosis Pain & Natural, Medical & Surgical Treatment


Endo belly is a distressing symptom experienced by individuals with endometriosis. Understanding its causes, symptoms, and available management strategies is essential for effectively addressing this condition. Seeking medical help, implementing lifestyle changes, and exploring various treatment options can significantly improve the quality of life for individuals living with endo belly. Remember, each person’s experience with endo belly is unique, and finding a personalized approach to managing symptoms is key. With the right support, empowerment, and self-care, individuals with endo belly can navigate the challenges of this condition and live their lives to the fullest.

Additional Information: It is important to consult with a healthcare professional before implementing any treatment or management strategies mentioned in this article.


Finding an Endometriosis Specialist: Your Guide to Effective Treatment

Living with endometriosis can be an incredibly challenging experience. The chronic pelvic pain and other symptoms associated with this condition can profoundly impact a person’s daily life. If you suspect that you may have endometriosis, it is crucial to find an endometriosis specialist who can provide you with the proper diagnosis and treatment. This comprehensive guide will explore the significance of seeking a specialist, how to find the right doctor for you, and the key factors to consider during your search.

Understanding the Importance of an Endometriosis Specialist

Endometriosis is a complex condition requiring the expertise of a specialist with in-depth knowledge and experience in diagnosing and treating it effectively. While your family doctor or regular gynecologist may provide primary care, they may not possess the specialized skills required to manage endometriosis comprehensively. This is why seeking out an endometriosis specialist is essential. These specialists have a thorough understanding of the disease, including its symptoms, causes, and treatment options. They are equipped with the latest surgical techniques and have experience dealing with the complexities of endometriosis cases.

Read more: How are Endo Specialists Different than Typical Gynecologists?

Comprehensive Knowledge and Expertise

Endometriosis specialists possess a comprehensive understanding of the condition, including its underlying causes, symptoms, and potential complications. They stay updated with the latest research and advancements in the field, allowing them to offer the most current and effective treatment options. Their extensive knowledge ensures they can accurately diagnose endometriosis and develop personalized treatment plans tailored to each individual’s needs.

Surgical Skills and Techniques

Surgery is often a crucial component of endometriosis treatment, especially in cases where the condition has progressed or when conservative measures have proven ineffective. Endometriosis specialists are highly skilled in performing minimally invasive surgeries, such as laparoscopy, which allows for precise visualization and removal of endometriosis tissue. These specialists have mostly undergone additional training and certification in minimally invasive gynecologic surgery, ensuring they possess the necessary expertise to perform complex surgical procedures.

Read more: Red Flags About a Potential Endometriosis “Expert”

Complementary Approaches and Holistic Care

In addition to surgical interventions, endometriosis specialists also recognize the importance of a holistic approach to care. They understand that managing endometriosis involves more than just addressing physical symptoms. These specialists often work collaboratively with other healthcare professionals, including pelvic floor physical therapists, fertility specialists, counselors, pain specialists, massage therapists, and nutritionists. This multidisciplinary approach ensures that all aspects of a person’s well-being are addressed, promoting comprehensive and effective treatment.

Finding an Endometriosis Specialist

Now that we understand the significance of seeking out an endometriosis specialist, let’s explore some practical steps you can take to find the right doctor for you.

Find the best endometriosis specialists.

Step 1: Start with Your Current Healthcare Provider

Begin by discussing your symptoms and concerns with your primary care physician or gynecologist. They can provide valuable guidance, recommend specialists in your area, and facilitate the referral process. Your current healthcare provider may also have access to your medical history, which can help inform the specialist about your unique situation.

Step 2: Research and Referrals

Expand your search by conducting thorough research and seeking referrals from trusted sources. Online platforms like iCareBetter can be an excellent resource for finding vetted surgeons and endometriosis experts. Additionally, reach out to support groups or online communities dedicated to endometriosis. These communities often have members who can share their personal experiences and recommend healthcare providers in your area.

Step 3: Consider the Specialist’s Expertise

When evaluating potential endometriosis specialists, consider their areas of expertise and experience. Look for doctors who have a specific focus on endometriosis and have a track record of successfully treating this condition. Consider factors such as their surgical skills, knowledge of complementary approaches, and their willingness to listen and involve you in your healthcare decisions.

Step 4: Verify Certifications and Credentials

Ensure that the specialist you are considering has undergone additional training and maintains up-to-date knowledge in laparoscopic surgery.

Step 5: Establish a Connection

Building a strong doctor-patient relationship is crucial when managing a complex condition like endometriosis. During your initial consultation, pay attention to how the specialist communicates and interacts with you. Do they take the time to listen to your concerns? Do they explain complex medical terms in a way that you can understand? Trust your intuition and choose a specialist who makes you feel comfortable, heard, and supported.

Step 6: Check Insurance Coverage

Before finalizing your decision, ensure that your health insurance provider covers the specialist and any potential treatments or procedures they may recommend. Review your insurance policy or visit your provider’s website to determine the coverage options available to you. It is essential to understand the financial implications of your treatment plan to avoid any unexpected costs. Unfortunately, many top endometriosis specialists are out of network for your insurance, but you can still seek help from your insurance or other resources to have the funding to go through treatment.

Read more: What was your out-of-pocket cost for endometriosis surgery?

Taking Control of Your Endometriosis Journey

Finding an endometriosis specialist is a significant step towards taking control of your endometriosis journey. With their specialized knowledge, surgical expertise, and holistic approach to care, these specialists can provide the support and guidance you need to manage your condition effectively. Remember, seeking a second or third opinion is always an option if you feel uncertain or would like to explore different treatment approaches. Empower yourself with knowledge, trust your instincts, and never settle for anything less than the best care for your endometriosis.

5 months ago Endometriosis

Understanding Cervical Endometriosis: Symptoms, Diagnosis, and Treatment

In endometriosis, cells that are similar to endometrium grow outside of it. A place that can have endometriosis is the cervix of the uterus.

Cervical endometriosis is a condition that can cause several different symptoms. Symptoms include spotting, pelvic pain, irregular periods, and bleeding or pain during sex. These symptoms can be difficult to diagnose as they can also indicate other conditions, but if you experience any of these, it is important to discuss them with your doctor.

While cervical endometriosis is rare, research has shown that it can impact the quality of life of individuals who experience it. This highlights the need for more research and awareness about this condition.

Diagnosis and Treatment:

There are several ways that cervical endometriosis can be diagnosed, including pelvic exams, Pap smears, colposcopy, and biopsy. It is important to note that the diagnosis of cervical endometriosis can be difficult. Your doctor might also suggest additional tests, including imaging scans or laparoscopic surgery.

Treatment options for cervical endometriosis vary depending on the severity of symptoms and fertility goals. Hormonal therapy, such as birth control pills, can be an effective way to manage cervical endometriosis. Surgery may be recommended if hormonal therapy is not enough to manage symptoms or if there is a desire for pregnancy.

Cervical endometriosis is a rare but significant condition that can impact the quality of life for many women. Treatment options vary and depend on individual needs and goals. It is essential to talk with your doctor about any symptoms you may be experiencing or if you have any concerns. Research efforts and awareness of cervical endometriosis are crucial to help those who experience this condition. Hopefully, this blog post has shed light on this important topic.

More resources:

How to Get an Endometriosis Diagnosis

Find an Endometriosis Specialist for Diagnosis, Treatment, & Surgery

A Guide to Endometriosis Surgery and Its Success Rate

5 months ago Endometriosis

Living with Peritoneal Endometriosis: Symptoms, Causes, and Management

Endometriosis is a painful condition that affects millions of people worldwide. Endometriosis affects the peritoneum, the outer layer of tissue that lines the pelvic cavity. Peritoneal endometriosis can be a debilitating disease that can significantly affect a person’s quality of life, causing severe pain, inflammation, and infertility. This post will delve into the world of peritoneal endometriosis, discussing its symptoms, causes, and management options.

What is Peritoneal Endometriosis?

Peritoneal endometriosis involves the peritoneum, the membrane that lines the abdominal cavity. This tissue can form lesions and nodules, leading to inflammation, pain, and infertility. There are two types of peritoneal endometriosis: pigmented or non-pigmented and superficial or deeply infiltrating. Pigmented endometriosis is characterized by dark-colored lesions, which can be easier to spot visually during surgery. Superficial peritoneal endometriosis is found on the surface of the peritoneum, while deeply infiltrating peritoneal endometriosis penetrates the tissue beneath the surface of the peritoneum.

Prevalence and Impact

Peritoneal endometriosis is estimated to affect around 60-70% of individuals with endometriosis, making it the most common subtype of endometriosis. The symptoms of peritoneal endometriosis can significantly impact a person’s quality of life, leading to chronic pain, fatigue, and even depression. 


The exact cause of peritoneal endometriosis remains unknown, but several theories exist, including Coelomic metaplasia and retrograde menstruation.

Diagnosis and Treatment

Diagnosing peritoneal endometriosis can be challenging, as symptoms can be similar to other conditions, such as irritable bowel syndrome or pelvic inflammatory disease. Diagnosis often involves a medical history, physical examination, and imaging tests such as pelvic ultrasound. However, the most definitive way to diagnose peritoneal endometriosis is through laparoscopy, a surgical procedure allowing doctors to visualize the peritoneum directly and take biopsies if necessary.

The treatment of peritoneal endometriosis can depend on the severity of symptoms and a woman’s desire for fertility preservation. Treatment options include analgesics to relieve pain, hormonal therapy, and surgery to remove lesions or nodules. Hormonal treatment can consist of medications such as birth control pills or gonadotropin-releasing hormone agonists, which can be effective in reducing pain and inflammation. Surgery, meanwhile, can involve a laparoscopic procedure where the lesions or nodules are removed.

Peritoneal endometriosis can be a challenging condition to live with, affecting a woman’s physical, emotional, and social well-being. However, with the right diagnosis and management, women with peritoneal endometriosis can find relief and improve their quality of life. More research and awareness are needed to better understand this condition and develop effective treatments. If you suspect you may have peritoneal endometriosis, speak to your healthcare provider and seek appropriate medical attention. Remember, you are not alone, and there is help available.

More resources:

How to Get an Endometriosis Diagnosis

Managing Endometriosis: What You Need to Know 

Find an Endometriosis Specialist for Diagnosis, Treatment, & Surgery

5 months ago Endometriosis

Coping with Endometriosis Ovulation Pain

Endometriosis is a common condition often affecting the ovaries, fallopian tubes, and pelvic cavity. One of the most common and distressing symptoms of endometriosis is ovulation pain, which occurs during the middle of the menstrual cycle when an egg is released from the ovary. In this article, we will provide some statistics on the prevalence and impact of endometriosis ovulation pain, explain the possible causes and risk factors, describe the symptoms and signs, and offer some tips and resources for coping with this condition.

Statistics and Impact of Endometriosis Ovulation Pain

According to research studies, endometriosis ovulation pain affects up to 50% of women with endometriosis. This type of pain can be as severe and disabling as menstrual cramps and can last from a few hours to several days. It can also interfere with daily activities, work, and social life and contribute to anxiety, depression, and infertility. Moreover, ovulation pain is often underdiagnosed or misdiagnosed as other conditions, such as ovarian cysts, pelvic inflammatory disease, or irritable bowel syndrome, leading to delayed treatment and unnecessary procedures.

Causes and Risk Factors

Ovulation pain can have several causes, including the stretching of the follicle or cyst that contains the egg, the rupture of the follicle or cyst, the contraction of the fallopian tube, and the irritation of the nerves and tissues near the ovary. In women with endometriosis, however, ovulation pain can be due to the presence of endometrial lesions, adhesions, nerve inflammation, or endometriomas, which can affect the function of the ovaries and exacerbate the pain.

Symptoms and Signs

The most common symptom of ovulation pain is a dull or sharp pain on one side of the abdomen or pelvis, which can be accompanied by bloating, nausea, fatigue, or changes in the menstrual cycle. However, in women with endometriosis, ovulation pain can be more severe, long-lasting, and associated with other symptoms, such as pain during intercourse, bowel movements, or urination. If you experience any of these signs, seeking medical advice and undergoing appropriate tests to rule out other conditions and confirm endometriosis is essential.

Diagnosis and Treatment

To diagnose ovulation pain, your doctor will take a detailed medical history, perform a pelvic exam, and order imaging tests, such as ultrasound or magnetic resonance imaging. If endometriosis is still not confirmed, a laparoscopy may be needed to visualize the inside of the abdomen and take samples. Depending on the severity and stage of endometriosis, various treatments may be recommended, such as pain relievers, hormonal medications, and surgical removal of the lesions. Moreover, some lifestyle changes, such as reducing stress, improving nutrition, and exercising regularly, may help reduce the frequency and intensity of ovulation pain.

Endometriosis ovulation pain is a challenging but manageable condition that affects many women worldwide. By being aware of the symptoms and signs, seeking medical advice, and adopting healthy habits and coping strategies, women with endometriosis ovulation pain can improve their quality of life and reduce the impact of this condition on their physical and mental health. If you have any concerns or questions about endometriosis ovulation pain, do not hesitate to consult a qualified healthcare provider or join a support group. Remember, you are not alone; there is always hope for better health and well-being.

More resources:

Managing Endometriosis

How to Get an Endometriosis Diagnosis

Find an Endometriosis Specialist for Diagnosis, Treatment, & Surgery

5 months ago Endometriosis

Everything You Need to Know About Umbilical Endometriosis

Endometriosis is a common yet often misunderstood condition that affects many people worldwide. While most people associate endometriosis with pelvic pain and menstrual issues, it can also manifest in unusual and unexpected parts of the body. One of those unusual locations is the umbilicus, or belly button, where endometrial cells can grow and cause a range of symptoms. In this blog post, we will delve into the world of umbilical endometriosis and explore its symptoms, causes, diagnosis, and treatment. Whether you have been recently diagnosed with umbilical endometriosis or are just curious about this condition, keep on reading to learn more.

Symptoms of Umbilical Endometriosis

Umbilical endometriosis can present differently in each person. However, there are some typical signs and symptoms that you should watch out for:

You may experience pain or discomfort in the belly button, which can range from mild to severe during or outside your period.

Your navel might appear swollen, red, or tender, especially if pressed.

You may notice bleeding or discharge from your belly button, which can be light or heavy and have a foul smell.

Some people with umbilical endometriosis might also have pelvic endometriosis and complain of painful sex, bowel movements, urination pain, infertility, or constipation.

Causes of Umbilical Endometriosis

The cause of umbilical endometriosis is not entirely clear and probably multifactorial. However, researchers have proposed a few mechanisms that might contribute to it. For instance, retrograde menstruation is when some menstrual blood flows backward instead of out of the body, which could transport endometrial cells to the umbilicus through the lymphatic or vascular system. Peritoneal metaplasia refers to the process of normal cells transforming into endometrial cells due to hormonal or environmental factors, which could occur near the umbilicus. Surgery-related umbilical endometriosis can result from accidental implantation of endometrial cells during laparoscopy or c-section.

Diagnosis and Treatment of Umbilical Endometriosis

If you suspect that you have umbilical endometriosis, the first step is to see a gynecologist who has experience with endometriosis. The doctor will likely examine your belly button, ask about your medical history and symptoms, and order some tests to confirm the diagnosis. These tests may include blood tests, imaging scans, like ultrasound or MRI, or a biopsy to remove a tissue sample for analysis. If the diagnosis is confirmed, you can discuss the best treatment options with your doctor. The treatment depends on the severity of your symptoms, age, desire for fertility, and overall health. The treatment may include pain relief medication, hormonal therapy, surgery, or a combination of these. Removing the endometrial tissue through surgery, like excision, is often the most effective and long-term solution for umbilical endometriosis.

Umbilical endometriosis is a rare yet significant manifestation of endometriosis that can cause discomfort, pain, and distress for affected patients. While the condition is not entirely understood, research has shed some light on possible causes and treatments. If you experience any of the symptoms we described earlier, do not ignore them or assume they are normal. Instead, seek medical advice from a specialist who can provide you with a proper diagnosis and treatment plan. Remember that you are not alone in this journey, and many people have successfully managed their umbilical endometriosis with the proper care and support.

More resources:

Managing Endometriosis: What You Need to Know 

How to Get an Endometriosis Diagnosis

Find an Endometriosis Specialist for Diagnosis, Treatment, & Surgery

5 months ago Endometriosis

What is the Best Doctor to See for Endometriosis? A Comprehensive Guide

Endometriosis is a painful condition where tissue similar to the lining of the womb grows in other places in the body, such as the ovaries and fallopian tubes. It affects millions of people worldwide and causes a range of symptoms, including pelvic pain, heavy periods, pain during sex, and infertility. If you suspect you may have endometriosis, it’s essential to see the right doctor to get an accurate diagnosis and effective treatment. But who is the best doctor to see for endometriosis? In this blog, we’ll explore the different types of doctors who can help manage endometriosis and discuss the pros and cons of each approach.

Diagnosing and treating endometriosis:

Diagnosing endometriosis can be challenging, as symptoms can vary widely from person to person and can mimic other conditions such as irritable bowel syndrome or pelvic inflammatory disease. The gold standard for diagnosing endometriosis is laparoscopy, a minimally invasive surgery. However, before this step, your doctor will perform a pelvic exam and may order an ultrasound scan or MRI to assess your condition.

The first doctor you’ll likely see for endometriosis is a gynecologist, a doctor who specializes in female reproductive health. Gynecologists with great experience treating endometriosis have expertise in diagnosing and treating endometriosis. They can offer a range of treatments, such as pain management techniques, hormone therapy, and surgery to remove endometrial tissue. They can also provide advice on fertility preservation options for women who want to conceive in the future.

While seeing a gynecologist is essential for managing endometriosis, more is needed. Some patients may benefit from seeing additional specialists or seeking alternative therapies. For example, a physical therapist can help with spasms and other pelvic dysfunctions. A pain specialist can help manage the chronic pain associated with endometriosis, while a gastroenterologist can evaluate and treat any gastrointestinal symptoms. A urologist can address endometriosis-related bladder and urinary tract issues, while a psychologist can offer support for mental health concerns like anxiety or depression. Some patients may also benefit from seeing an integrative medicine practitioner who can help manage symptoms through traditional medicine and complementary therapies like acupuncture, yoga, or meditation.

Find an Endometriosis Specialist for Diagnosis, Treatment, & Surgery

While seeing multiple doctors can be overwhelming, it’s important to remember that endometriosis is a complex condition that requires a multi-disciplinary approach. Each specialist brings unique skills and expertise to the table, and working collaboratively with your healthcare team can improve your outcomes and enhance your quality of life.

In conclusion, gynecologists with experience in endometriosis are the first doctors to see for endometriosis. However, the most effective approach for treating endometriosis is to work with a team of specialists who can provide comprehensive care and support. A gynecologist is an essential part of this team and can offer diagnosis, treatment, and management of endometriosis symptoms. However, seeing additional specialists or exploring complementary therapies may benefit some patients. As always, it’s important to advocate for yourself and seek the care you need to live your best life with endometriosis.

5 months ago Endometriosis

Understanding the Relationship between Sex and Endometriosis

Endometriosis is a painful condition that affects millions of women around the world. It occurs when tissue similar to the lining of the uterus grows outside of the uterus, causing inflammation, pain, and other symptoms. The pain can be so severe that it can affect women’s daily activities, including their sex lives. For many women, sex and endometriosis do not mix well. In fact, many women report that sex exacerbates their symptoms. In this blog post, we will explore the relationship between sex and endometriosis, explore some sex tips for managing endometriosis, and discuss the psychological and emotional effects of the condition.

How endometriosis can affect sex life

Endometriosis tissue can attach to the ovaries, fallopian tubes, or other pelvic organs and can cause pain, swelling, and sometimes infertility. It can cause pain during or after sex, painful periods, and chronic pain. This can make it challenging for women to enjoy their sexual partners or have comfortable sex. During sexual activity, endometriosis can cause pain, especially during deep penetration or certain positions. It can also cause pain during orgasms.

Read more: Endometriosis Pain after Orgasm: What You Need to Know

Pain during sex can be due to adhesions, scar tissue, or inflammation in the pelvic area. Endometriosis tissue can also grow in the vagina or cervix, making intercourse painful. In addition, vaginal dryness can exacerbate the problem, and many women taking hormone medicines for endometriosis may experience a decrease in libido, which can further affect their sex drives.

Ways to manage pain from endometriosis

If you are struggling with painful sex due to endometriosis, there are things you can do to manage your symptoms. Firstly, you should communicate with your partner about your symptoms and pain levels. This can help your partner know how to support you and modify sex positions to ease the pain. Additionally, you can try different positions to find the ones more comfortable for you. Lubricants and non-penetrating sexual acts might also be some strategies to think about.

Endometriosis can also affect women’s emotional and psychological health, leading to depression, anxiety, and other mental health issues. This can further affect women’s sex lives by reducing their interest in sex, increasing their fear or anxiety during sex, and making it difficult to enjoy intimacy. It is important to seek professional help if you are experiencing any mental health issues related to endometriosis. Counseling, therapy, or medication can help you manage your emotional and psychological symptoms, leading to a healthier sex life.

In addition to planning sexual activity, you can also manage pain from endometriosis by using pain-relieving medications or hormone therapy. Your doctor may also recommend surgery to remove endometriosis tissue or other affected organs. 

Sex and endometriosis may not always mix well, and many women may find it difficult to enjoy intimacy due to pain and other symptoms. However, with the right communication, management strategies, and emotional support, women with endometriosis can still have a satisfying sex life. It is important to communicate with your partner, try different positions, and seek professional help if the condition affects your emotional and psychological health. Remember, endometriosis does not define your worth or your ability to enjoy intimacy. With the right support, you can still have meaningful, fulfilling relationships and happy sex lives.

Read more:

5 Signs You Need to See a Gynecologist

Find an Endometriosis Specialist for Diagnosis, Treatment, & Surgery

5 months ago Endometriosis

Endometriosis and Pelvic Floor Dysfunction

Pelvic pain and abnormal pelvic floor muscle (PFM) tension are common among individuals with endometriosis and can persist even after surgical removal of endometriosis lesions. Since endometriosis is a hormonally dependent, inflammatory disease that affects several physiological systems, multiple factors could contribute to chronic pelvic pain (CPP). 

Pain management methods that target myofascial pain are becoming more popular among practitioners since myofascial sources could continue to cause CPP even after surgical and hormonal treatment. Pelvic pain can also result from musculoskeletal disorders that may go unnoticed during a traditional pelvic exam. Screening the inferolateral pelvic floor musculature during a routine pelvic exam is useful for identifying spasms and trigger points contributing to, or resulting from, a patient’s pelvic pain. 

Nonrelaxing pelvic floor dysfunction may present with nonspecific symptoms such as pain, and problems with defecation, urination, and sexual function, which can adversely affect the quality of life. Proper evaluation can facilitate the diagnosis of spasms or trigger points, and physical therapy often significantly improves the quality of life in these cases.

Pelvic pain in women with different stages of endometriosis can be strongly associated with bladder/pelvic floor tenderness and painful bladder syndrome, independent of endometriosis-related factors. This suggests the involvement of myofascial or sensitization pain mechanisms for some patients suffering from deep dyspareunia. Pelvic floor physical therapy (PT) has proved to be helpful in women with myofascial or pelvic floor pain. This type of PT aims to release tightness in muscles by manually “releasing” it; treatment is directed at the abdomen, vagina, hips, thighs, and lower back muscles. This requires a specially trained physical therapist.

It is imperative for women to recognize and treat pelvic pain with physical therapy and other interventions to alleviate pain and improve their quality of life.


5 months ago Endometriosis

Sciatic Endometriosis: Uncommon or Not?

Sciatic nerve endometriosis is widely considered a rare occurrence, but leg pain in patients with endo is relatively common, up to 50%.  Why?  Is it being underdiagnosed?  Since endometriosis itself is often misdiagnosed or diagnosed years after initial symptoms, the true incidence of direct and indirect sciatic nerve symptoms caused by endo is also suspect. 

The sciatic nerve is located very deep within the pelvis but not inside the intraperitoneal area where the uterus is situated. Instead, the sciatic nerve is found in the “retroperitoneum,” the deep anatomic region behind the peritoneum, containing bones, muscles, and major nerves. It exits the pelvis right behind the Piriformis muscle, which is part of the pelvic floor. 

Endometriosis mainly involves intraperitoneal pelvic structures and organs such as the bladder, cul-de-sac, large and small bowel sections, uterus, ovaries, and Fallopian tubes.  In advanced cases, it can extend into the midline retroperitoneum by involving the recto-vaginal septum.  However, endometriosis has been identified in atypical and distant locations by unclear means of spread, and a certain percentage is deeply infiltrating.  In the latter case, the retroperitoneum, sciatic nerve, and pelvic floor muscles are anatomically very close and vulnerable to direct deep infiltration or indirect spread (e.g., lymphatic system).   The precise prevalence of endometriosis that grows outside the pelvic intraperitoneal cavity by location, including the sciatic nerve area, remains to be discovered due to the limited number of published studies on the subject. 

Learn more about Dr. Steve Vasilev


Lower back, leg, and buttock pain, which may or may not extend down your leg, may indicate the presence of direct sciatic endometriosis or indirect inflammation-related pressure on the nerve. The symptoms may be the same or very similar since the endometriosis is either directly growing and pressing on or involving the sciatic nerve or leading to pelvic floor inflammation and scarring, which also affect the sciatic (and other nerves) and trigger pain signals.  The latter is typically called Piriformis syndrome.  

Sciatic endometriosis may or may not be uncommon. Still, it must always be included in the “differential diagnosis” (identifying root causes of symptoms) of pain and signs in the region or area where sciatic nerve sensation fibers are known to extend. 

Testing and Diagnosis:

Lab tests are generally not helpful in diagnosing sciatic endometriosis. A CA-125 level (an ovarian cancer tumor marker) or hsCRP (generalized inflammatory marker) can be elevated in endometriosis due to inflammation but are not specific for endometriosis, let alone sciatic nerve involvement. 

Arguably the best imaging study for possible endo-related extraspinal sciatica is the MRI.  It may reveal whether an endo lesion is directly growing in or around the nerve, most frequently at the sciatic notch, or compressing it, such as inflammation causing Piriformis syndrome. However, unless endometriosis has already been confirmed from prior surgery, these scans will only sometimes help diagnose endo or endometriosis-related sciatica. But the running message is this.  Given the diagnostic uncertainty of endometriosis, extra pelvic symptoms should never be dismissed as unrelated when an endo diagnosis is being considered.

Symptoms and Findings:

Pain may or may not be cyclical, similar to rectal pain caused by endometriosis. It may start before menstruation and persist for several days after a period has ended. The pain may be accompanied by motor deficits (weakness or gait/walking issues), foot drop, and discomfort or tingling radiating down the back of the leg from the buttock. Walking, especially long distances, may exacerbate these symptoms. Deep buttock tenderness may also be present, specifically in the area of the sciatic notch where the sciatic nerve passes. If left untreated, sciatic endometriosis may lead to long-term nerve damage, as any prolonged direct pressure or inflammation around a major nerve can cause this.

A doctor or pelvic floor therapist may identify “deficits” (abnormalities) in the sciatic nerve distribution during a physical examination. For example, Lasègue’s test, which is a straight leg raise test when lying on your back, may point to sciatic involvement by endo.  Localized deep tenderness over the sciatic notch might also be present, although it can be difficult to reproduce. On the other hand, a regular pelvic exam may be normal, depending on the extent of endometriosis in the pelvis.  

Treatment of Sciatic Endometriosis:

The treatment of sciatic endometriosis will most likely begin with surgery. In fact, it may be the only definitive treatment. But this is not always the case.  Endometriosis excision of an endometriosis lesion in this area is the gold standard, just as in other areas.  But if direct sciatic involvement by endo is suspected, choosing the right surgeons is especially crucial. The sciatic nerve is located so deep within the pelvis that a general gynecologist most likely has never encountered it during surgery. Endo-excision surgeons do not typically operate in this retroperitoneal area either. Gynecologic oncologists, who often work on lymph nodes or remove cancer in the region, are more likely to be familiar with the anatomy. However, if the nerve is more likely to be directly affected by endo based on imaging, a neurosurgeon should also be part of the team. Therefore, a gynecologic oncologist and/or an endo excision surgeon very experienced in advanced endo and a neurosurgeon are likely the best options for this aspect of endometriosis excision surgery.

Given that some percentage of endo-related sciatica may be due to pelvic floor inflammation and dysfunction, as opposed to direct endo growth on or near the nerve, pelvic floor physical therapy is worth trying first.  If it is effective and if imaging does not show evidence of deep infiltrating endo that might be directly involving the sciatic nerve, then radical and more risky retroperitoneal surgery to get to that area may be safely deferred.  

In cases where direct involvement is suspected and surgery is not immediately feasible, a short-term medical treatment regimen with anti-inflammatory and possibly anti-estrogenic properties may be beneficial. Adopting an anti-inflammatory diet may also help. Pelvic floor physical therapy and medical support therapy, including vaginal Valium, may offer additional temporary benefits. The bottom line is that treatment for pain along sciatic nerve distribution should be tailored to each individual’s needs and integrated into a comprehensive, personalized medical-surgical treatment plan.  

The first confirmed case of sciatic endometriosis was reported in 1946 by Schlicke. The primary takeaway from this fact is that sciatic endometriosis has been a known entity for over half a century.  Since then, other cases have been documented in medical journals.  However, overall, it is still considered a rare condition. But given the percentage of endo patients who report leg pain, this may not be so, especially when endo-induced Piriformis syndrome is added to the mix.  If endometriosis has already been diagnosed or strongly suspected and sciatic nerve distribution pain is part of the symptoms, a consultation with an expert who focuses on advanced endometriosis patients may save you a lot of grief.   

Learn more and contact Dr. Steven Vasilev 

More articles from Dr. Steve Vasilev:

Endometriosis And Menopause: Everything You Need To Know

How to tell the difference between endometriosis and ovarian cancer

What would happen to the signs and symptoms of endometriosis after menopause?


Yanchun, L., Yunhe, Z., Meng, X., Shuqin, C., Qingtang, Z., & Shuzhong, Y. (2018). Removal of an endometrioma passing through the left greater sciatic foramen using a concomitant laparoscopic and transgluteal approach: case report. BMC Women’s Health, 19(1), 95.

Missmer SA, Bove GM. A pilot study of the prevalence of leg pain among women with endometriosis. J Bodyw Mov Ther. 2011; 15:304–308.

Osório, F., Alves, J., Pereira, J., Magro, M., Barata, S., Guerra, A., & Setúbal, A. (2019). Obturator internus muscle endometriosis with nerve involvement: a rare clinical presentation. Journal of Minimally Invasive Gynecology, 25(2), 330-333.

Possover, M.  Laparoscopic morphological aspects and tentative explanation of the aetiopathogenesis of isolated endometriosis of the sciatic nerve: a review based on 267 patients   Facts Views Vis Obgyn. 2021 Dec; 13(4): 369–375.

S. Chen, W. Xie, J. A. Strong, J. Jiang, and J.-M. Zhang. Sciatic endometriosis induces mechanical hypersensitivity, segmental nerve damage, and robust local inflammation in rats. Eur J Pain. 2016 Aug; 20(7): 1044–1057.

Lemos, N., D’Amico, N., Marques, R., Kamergorodsky, G., Schor, E., & Girão, M. J. (2016). Recognition and treatment of endometriosis involving the sacral nerve roots. International Urogynecology Journal, 27(1), 147-150.

Vilos, G.A., Vilos, A. W., & Haebe, J. J. (2002). Laparoscopic findings, management, histopathology, and outcomes in 25 women with cyclic leg pain. The Journal of the American Association of Gynecologic Laparoscopists, 9(2), 145-151.

T Ergun, H Lakadamyali. CT and MRI in the evaluation of extraspinal sciatica. Br J Radiol. 2010 Sep; 83(993): 791–803.

6 months ago Endometriosis

Spotting the Signs of Endometriosis Returning

Endometriosis is a painful and challenging condition. While there is no cure for this condition, treatments are available to manage the symptoms, making it easier for patients to lead healthy lives. However, endometriosis can recur, and it is crucial to identify the signs and symptoms to avoid complications. In this post, we will discuss the symptoms of endometriosis recurrence and how to spot them early enough so you can seek medical attention.

Painful periods

One of the signs of endometriosis returning is pain during your period. This pain can range from minor discomfort to excruciating cramps that require you to take painkillers. If you notice that your periods are more painful than usual or that the pain increases over time, it may be a sign that your endometriosis is returning. Keep a record of your symptoms, including any changes in frequency, intensity, and duration of your period, so you can discuss them with your doctor.

Pelvic pain

Another sign of endometriosis recurrence is persistent pelvic pain or discomfort. This pain can be mild, moderate, or severe and may come and go, depending on hormonal fluctuations. Some patients may also experience pain during sex or ovulation. If you notice persistent pelvic pain, scheduling an appointment with your doctor to discuss your treatment options is essential.


Endometriosis can cause fatigue due to the pain and stress that comes with the condition. If you notice that you are more exhausted than usual, despite enough rest, it could be a sign that your endometriosis is returning. Speak with your doctor and seek support from a therapist or counselor to manage the mental impact of endometriosis.

Gastrointestinal symptoms

Endometriosis can affect the digestive system, causing symptoms such as bloating, constipation, or diarrhea. These symptoms may worsen during or after your period, and they may not improve with changes to your diet or bowel habits. If you notice gastrointestinal symptoms, mentioning them to your doctor is essential, as they may be a sign of endometriosis recurrence.

Other symptoms

Endometriosis presents itself in many ways. We mentioned some of it here, but there are undoubtedly many other symptoms that can help diagnose the recurrence of endometriosis. You should keep track of your well-being and mention any unusual symptoms or abnormalities to your doctor.

Endometriosis can cause severe pain and discomfort and impact your quality of life. While timely diagnosis and treatment can help manage the symptoms and prevent complications, there are risks of recurrence after surgery. The signs of recurrence are pelvic pain, period pain, fatigue, gastrointestinal symptoms, and other symptoms. If you notice any signs of endometriosis returning, speak with your doctor.

Read more: Managing Endometriosis: What You Need to Know 

Please share the signs that made you suspect you had endometriosis returning.

6 months ago Endometriosis

Managing Stress with Endometriosis: A Guide for Patients

Endometriosis is a chronic condition that affects approximately 10% of women between 15-50 and other genders. This condition is characterized by the growth of tissue similar to endometrium outside of the uterus, leading to painful menstrual cramps, heavy bleeding, and infertility. Living with endometriosis can be extremely challenging due to its physical and emotional toll on an individual. Stress can exacerbate symptoms of endometriosis and make coping with the condition even more difficult. In this blog post, we will discuss the effects of stress on endometriosis and provide some tips on managing stress for individuals with this condition.

Stress is a common issue that affects patients with endometriosis. When you experience stress, your body releases the hormone cortisol, which can trigger inflammation and potentially exacerbate endometriosis symptoms. Stress also affects our immune system, making fighting diseases and infections harder for our bodies. To help manage stress, it’s essential to develop healthy coping mechanisms. Some practical techniques include meditation, yoga, deep breathing, or guided imagery.

Exercise is another effective way to manage stress and improve endometriosis symptoms. Physical activity has been shown to release endorphins, which are natural painkillers, and reduce inflammation. However, it’s essential to be cautious when exercising if you have endometriosis. High-impact activities like running or jumping can trigger pain and discomfort. Instead, try low-impact exercises like swimming, walking, or cycling.

It’s also essential to pay attention to what you eat when managing endometriosis and stress. A diet rich in anti-inflammatory foods can help reduce inflammation and improve endometriosis symptoms. Include foods like leafy greens, berries, fatty fish, and nuts in your diet to provide your body with the necessary nutrients. Avoid caffeine, sugar, and processed foods that can exacerbate inflammation and trigger hormonal imbalances.

Getting enough sleep is also essential for managing stress and endometriosis. Lack of sleep can lead to fatigue, mood swings, and anxiety. Try to establish a regular sleep schedule and avoid using electronic devices before bed, as they can disrupt your sleep pattern. Creating a relaxing bedtime routine, like taking a warm bath or reading a book in bed, can help promote a peaceful sleep environment and reduce stress.

Finally, seeking support from others can help alleviate stress and improve endometriosis symptoms. Talking to a therapist can provide you with tools to manage stress and emotional challenges. Joining a support group or online community can also help you connect with other people who experience similar challenges and find comfort in sharing experiences.

Living with endometriosis can be challenging, but managing stress can help alleviate symptoms and improve the overall quality of life. Incorporating healthy habits like exercise, a nutritious diet, and stress-reducing activities into your everyday routine can reduce anxiety and inflammation and promote physical and emotional wellness. Remember that you are not alone in this journey, and seeking support from others can help alleviate stress and provide you with the necessary tools to manage endometriosis.

Read more: Managing Endometriosis

6 months ago Endometriosis

Understanding Thoracic Endometriosis

As a patient, you may already know that endometriosis is not just a painful condition of the uterus. It is an abnormal tissue growth similar to the endometrium that can occur in other body parts. One such place is the thoracic cavity, the space in your chest containing your heart, lungs, and other vital organs. Endometriosis in the thoracic cavity is called thoracic endometriosis.

Thoracic endometriosis is not a common condition, but it can be serious. It can cause chest pain and shortness of breath and, in severe cases, can lead to lung collapse. If you have been experiencing unexplained chest pain or breathing difficulties, this may be caused by thoracic endometriosis. In this blog, we will explain what thoracic endometriosis is, what causes it, and how it can be treated.

What is thoracic endometriosis?

As mentioned earlier, thoracic endometriosis is when endometriosis tissue grows in the thoracic cavity. This tissue can grow on your lungs, diaphragm, chest wall, or any other part of your thoracic cavity. In severe cases, it can even cause the lung to collapse.

Thoracic endometriosis can cause a range of symptoms, which include:

  • Chest pain
  • Shortness of breath
  • Dry cough
  • Fatigue

What causes thoracic endometriosis?

The exact cause of thoracic endometriosis is still unknown. However, there are several theories that suggest it may be caused by:

  • The coelomic metaplasia theory suggests that endometriosis cells can develop from germ cells in the thoracic cavity.
  • The lymphovascular spread theory suggests that the endometrial cells can latch onto lymph nodes or vessels, which then transport them to the thoracic cavity.
  • The retrograde menstruation theory refers to the backward flow of menstrual blood through the fallopian tubes and into the pelvic cavity. But it can not explain how the cells reach the thoracic space from the pelvic cavity.

How can thoracic endometriosis be treated?

The treatment of thoracic endometriosis will depend on the severity of your condition, your symptoms, and other factors such as age and desire for future fertility.

Here are some common treatments for thoracic endometriosis:

  • Palliative therapy: 

Pain medication: Over-the-counter pain medication such as ibuprofen or naproxen can help relieve mild to moderate pain.

Hormonal therapy: Hormone therapy can help reduce the amount of estrogen in your body, slowing down the growth of endometrial tissue. Hormone therapy can include birth control pills, gonadotropin-releasing hormone (GnRH) agonists, progestins, or danazol.

  • Removing the lesions with excision surgery

Surgery may be necessary if your thoracic endometriosis is severe or causing significant symptoms. Surgery can help remove the endometriosis tissue, repair any damage it may have caused, and restore normal lung function.

Thoracic endometriosis is a rare but serious condition that can cause chest pain, shortness of breath, and other symptoms. If you are experiencing any of these symptoms, seeking medical attention right away is important. Although the exact cause of thoracic endometriosis is still unknown, various treatment options are available to help manage your symptoms and improve your quality of life. Remember to speak to your doctor about any concerns about thoracic endometriosis.

Managing Endometriosis: What You Need to Know 

The Different Tests Used to Diagnose Endometriosis 

6 months ago Endometriosis

Breaking the Cycle: Understanding Endometrioma Recurrence After Surgery

Endometriomas, commonly known as ovarian “chocolate cysts,” occur in 20 to 40% of endometriosis patients. Abnormal implantation and growth of endometrial-like tissue can cause these cysts to form on the ovaries, which can cause more pain, discomfort, and fertility issues. With each cycle, the cyst bleeds into itself, just like what occurs typically inside the uterus.  Except that uterine endometrial tissue is expelled during menses vaginally, whereas endometriotic blood is trapped inside the ovarian cyst and with each cycle, the cyst slowly gets larger.  So, this blood also becomes old and turns brown over the years, resembling chocolate.  While surgery can be an effective treatment for endometriomas, the recurrence of these cysts after surgery is a common problem. We will explore why this occurs and what can be done to reduce the risk of recurrence. 

Several factors contribute to the recurrence of endometriomas after surgery. One of the main factors is the nature of the condition itself. The presence of endometriomas may signal more aggressive endo disease, and this chronic and progressive inflammatory disease on the ovary can continue to grow. Endometriosis tissue might be left behind after surgery because it can be buried deep in the ovary and even be microscopic.  So, the nature of the disease is to grow back in various parts of the ovary, superficial and deep. 

Surgically removing an ovary will certainly prevent endo from growing back in that area and that was the standard approach for many decades. However, in recent years, there has been a shift towards more conservative surgical techniques for treating endometriomas. These techniques aim to remove as much of the endometriosis tissue as possible while preserving as much of the ovary as possible. This is called a cystectomy and is often used for the removal of other ovarian cysts such as dermoids (teratomas) or cystadenomas (benign ovarian tumors).  The problem is that, unlike these other cysts, endometriomas are more inflammatory and the edges are irregular, so they do not easily separate from ovarian tissue.  So, microscopically incomplete removal is common even if it appears that the entire cyst was removed.  

Another surgical factor contributing to recurrence is rupture of the endometriotic cyst during the surgical removal. Rupture can release not only old blood but also endometriosis cells and tissue into the pelvis.  It’s crucial to repeat that it is not just old blood that is spilled.  This can lead to a higher risk of recurrence of endo on the ovary and elsewhere because these spilled cells can create new implants.

Here is an important side note. Although rare, endo can degenerate into a type of cancer or increase the risk of ovarian cancer.  The older you are and the more there is a concerning family history, the more an atypical looking endometrioma may be more than that.  If an early cancer is ruptured, the treatment can be more difficult.  How rare? It is on the order of 1% or less increased risk.  But given that there are millions of women with endo, even a fraction of 1% means thousands at risk.  If you are at higher risk due to age, genetics, or family history, especially if the imaging shows the endometrioma is not typical, getting a consult with a gynecologic oncologist may be prudent. 

A study published in the Journal of Minimally Invasive Gynecology found that the recurrence rate for endometriomas was significantly higher in cases where the cyst had ruptured during surgery than cases where the cyst was removed intact. The study found that the recurrence rate for ruptured cysts was 50%, compared to a recurrence rate of 8% for intact cyst removal.   

Having said all the above, while it seems like removing the endometrioma intact is a no-brainer strategy, this is far easier said than done.  As we mentioned before, these cysts do not readily separate from the ovary, can be stuck to surrounding structures like the uterus or bowel, and can be very thin walled.  So, even in a skilled surgeon’s hands, this often leads to inadvertent rupture.  But read on.  There are still things an expert surgeon can do to minimize this risk of rupture and spill inside the pelvis. So, spoiler alert #1 is to make sure you are under the care of an expert endometriosis surgeon.  But there is more to it, much more. 

Non-Surgical Recurrence Factors

Endometriomas are largely estrogen-dependent, meaning that they grow and spread in response to the hormone estrogen.  So, suppose at least one of the ovaries is left behind. In that case, the estrogen can stimulate growth of any endometriosis tissue left behind on the ovary or anywhere else that any endo implants may be hiding.  

To address this main hormonal non-surgical risk factor, there are several proactive steps that women can take to reduce endo recurrence. One of the most important steps is maintaining a healthy lifestyle, reducing total estrogen. This includes eating a healthy diet, getting regular exercise, reducing stress, using probiotics to metabolize excess estrogen, and avoiding exposure to toxins that can act as xenoestrogens. These steps can help to balance estrogen and progesterone in the body and reduce the risk of endometriosis growth and recurrence.

In many cases, pharmaceutical hormone therapy may be recommended to reduce the risk of recurrence. However, hormone therapy is not suitable for everyone and may have serious side effects.  Work with an endo specialist on this. 

There is much more to the non-surgical risk for recurrence and other proactive steps can be taken.  I

The Endometriosis Roller Coaster: Understanding Recurrence and How to Prevent It

Surgical Innuendoes

Laparoscopy has been a standard for endometriosis surgery for over 40 years.  It was invented almost a hundred years ago, but video cameras achieved acceptable quality only during the latter part of the 20th century.  While this is still the standard bearer for most endo surgery, the more complex the surgery the more one can strongly argue that a 2-dimensional camera (no depth perception) and instruments that are like inflexible chopsticks with graspers and scissors at the end are just too clunky and plain inadequate for finesse meticulous surgery.    

Robotic surgery is a newer surgical tool and technique that has become increasingly popular over the past decade, with very good reasons.  It is minimally invasive, just like laparoscopy and the incisions are just as hidden in expert surgeons’ hands.  However, this technique involves the use of several robotic arms that are controlled by a surgeon to perform minimally invasive surgery.  This is where the magic happens. The robotic arms are equipped with exchangeable tiny instruments that wrist or flex like human hands and a magnified 3-D camera, which allows incredibly precise visualization and depth perception.  Also, even the slightest tremor in a surgeon’s hand is not transmitted to the instrument like it is in regular laparoscopy.  In fact, with traditional laparoscopy, any tremor or inadvertent motion of the surgeon’s hand is amplified at the instrument tip.   So robotic surgery translates into less trauma to the body, more accurate dissection, and less blood loss, all of which may mean faster recovery.   For simple cases, there may not be much of a difference.  But, unfortunately, it is not possible to predict what might be found in the pelvis until the surgery actually starts.  So, having the robotic equipment available and an expert surgeon in its use is quite helpful to cover all options.      

One of the key advantages of robotic surgery for treating endometriomas is that, in expert hands, it may allow for more complete removal of lesions, especially endometriomas. This is simply because the robotic camera and equipment are more precise and technologically far superior to laparoscopic equipment. Of course, at the end of the day, in most cases, the level of expertise of the surgeon trumps equipment.  But in any given complex and anatomically distorted surgical situation an uber expert in robotics will likely fare better than an uber expert in laparoscopy.   

In advanced endo, endometriomas are often stuck to each other in the middle (“kissing ovaries”), pulling the rectum up into an inflammatory mess.  Deeper they are also stuck to the uterosacral ligaments supporting the uterus, which also pulls the ureters dangerously close to harm’s way (a few millimeters at most).  Removing these endometriomas intact and avoiding damage to the rectum or ureters requires both an uber good surgeon and the very best technology, which is embodied in robotics.  Suppose the surgeon is good at retroperitoneal surgery (deep tissues behind the peritoneum where the ureters are). In that case, it is possible to mobilize the whole ovary or ovaries up out of the pelvis without rupture.  Then, even if it appears that removing endometriomas might result in rupture (extreme inflammation), a special containment bag can be placed underneath to catch the fluid and endometriosis cells in the event of a rupture.  Finally, if all else fails, a very controlled evacuation of an endometrioma using specialized suction equipment is better than overt rupture.  Unfortunately, most surgeons, even some advanced surgeons, are incapable of or do not routinely employ these steps.  The result is higher risk of recurrence if there is uncontrolled spill. 

In conclusion, the rupture of endometriomas during surgical removal can significantly increase the risk of recurrence. Careful and precise surgical techniques, such as those used in robotic surgery, may help to reduce the risk of cyst rupture and subsequent recurrence. However, other factors, such as hormonal imbalances, the presence of endometrial implants, and lifestyle and environmental factors, should also be considered when developing a treatment plan. 

Get in touch with Dr. Steve Vasilev

More articles from Dr. Steve Vasilev:

Endometriosis And Menopause; Everything You Need To Know

How to tell the difference between endometriosis and ovarian cancer

What would happen to the signs and symptoms of endometriosis after menopause?


Roman H, Auber M, Marpeau L, et al. Recurrence of ovarian endometriomas: risk factors and predictive index. Hum Reprod. 2011;26(9):2489-2497. doi: 10.1093/humrep/der230.

Pakrashi T, Madden T, Zuna RE, et al. Recurrence Rates After Robotic-Assisted Laparoscopic Surgery for Endometriosis: A Single-Center Experience. J Minim Invasive Gynecol. 2016;23(5):755-761. doi: 10.1016/j.jmig.2016.04.008.

Donnez, J., & Spada, F. (2016). New concepts in the diagnosis and treatment of endometriosis: from surgery to chronic disease management. Fertility and Sterility, 105(3), 552-559. doi: 10.1016/j.fertnstert.2016.01.002.

American College of Obstetricians and Gynecologists. (2019). Endometriosis. Retrieved from

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Niu, F. (2019). Risk factors for recurrence of ovarian endometrioma after laparoscopic excision. Journal of Minimally Invasive Gynecology, 26(3), 517-523. doi: 10.1016/j.jmig.2018.07.018.

Pearce, C. L., Templeman, C., Rossing, M. A., Lee, A., Near, A. M., Webb, P. M., … & Cramer, D. W. (2012). Association between endometriosis and risk of histological subtypes of ovarian cancer: a pooled analysis of case–control studies. The Lancet Oncology, 13(4), 385-394. doi: 10.1016/S1470-2045(11)70335-7. 

Vercellini, P., Viganò, P., Somigliana, E., & Fedele, L. (2014). Endometriosis: pathogenesis and treatment. Nature Reviews Endocrinology, 10(5), 261-275.

Young, V. J., Ahmad, S. F., & Duncan, W. C. (2017). The role of apoptosis in the pathogenesis of endometriosis: a systematic review of the literature. Journal of reproductive immunology, 123, 81-85.

Zhang, T., De Carolis, C., & Manerba, M. (2016). Endometriosis: Novel insights into pathogenesis and new therapeutic approaches. CRC Press.

6 months ago Endometriosis

What You Need to Know About Endometriosis and Intimacy

Endometriosis is a common health condition that affects millions of women of reproductive age. This condition can cause extreme pain, cramping, and fatigue and affect a woman’s intimate relationships. Women diagnosed with endometriosis need to understand its effects on their intimate life and how to manage these symptoms.

The Effects of Endometriosis on Intimacy

Endometriosis can have a negative impact on physical intimacy in many ways. The pain associated with the condition can make it difficult for some women to be comfortable enough for sex at any time. And the accompanying fatigue can leave them feeling too tired for sex. In addition, endometriosis often causes pelvic inflammation, which can make penetration painful or even impossible. The emotional toll of endometriosis can also take its toll; depression and anxiety may arise due to physical pain or fear that sex will be painful.

Managing Endometriosis-Related Intimacy Issues

The good news is that there are ways to manage endometriosis-related intimacy issues. One way is to talk openly with your partner about your symptoms so they understand what you’re going through. Explaining exactly how endometriosis affects you and what challenges you face regarding physical intimacy is key to ensuring your partner fully understands the situation. It’s also important to practice self-care; this could mean anything from getting plenty of restful sleep each night or taking time out of your day for relaxation activities such as yoga or meditation. Additionally, talking with your doctor about treatments available for managing your symptoms may be beneficial in managing any pain or inflammation related to endometriosis during intercourse.

Living with endometriosis does not have to mean living without physical intimacy—it just means finding new ways of managing its effects on your relationships. Talking openly with your partner about how it affects you, practicing self-care, and talking with your doctor about treatments available are all great ways of managing the symptoms associated with endometriosis and fostering healthy intimacy in relationships while living with this condition.

Managing Endometriosis: What You Need to Know 

6 months ago Endometriosis

All You Need to Know About Endometriosis Lesions

Endometriosis is when tissue similar to the endometrium grows outside of it. This disorder can cause pain, infertility, and other issues. In this blog post, we’ll explore what endometriosis lesions are, how we diagnose them, and what treatments are available.

What Are Endometriosis Lesions?

Endometriosis lesions are small areas of tissue that form when endometrial-like cells grow outside the uterus. These lesions can develop anywhere in the body but are most common in the pelvic area. They usually range from 1 cm to 5 cm in size and can appear in different colors, such as red, white, or blue spots.

How Are Endometriosis Lesions Diagnosed?

You should see your doctor if you have any symptoms associated with endometriosis—such as chronic pelvic pain or heavy menstrual bleeding. Your doctor will likely perform an ultrasound or MRI scan to look for any signs of endometriosis lesions. If these tests reveal an area with an endometriosis lesion, they may also recommend a laparoscopy to get a better look at it. During the laparoscopy, your doctor will make a small incision in your abdomen and then insert a thin tube with a lighted camera attached to it so they can take pictures of any lesions inside your body.

What Treatments Are Available for Endometriosis Lesions?

Once you’ve been diagnosed with endometriosis lesions, your doctor will likely recommend one or more treatments depending on your symptoms’ severity. Treatments can include pain management, hormonal manipulation, lifestyle changes, and diet programs. However, the ultimate therapy for removing the disease is surgery. This surgery is often done through laparoscopic surgery and can help reduce symptoms significantly if successful.

Endometriosis lesions are relatively common and often cause pain, discomfort, and other issues for those who suffer from them. Fortunately, many treatment options are available for those diagnosed with this condition, ranging from over-the-counter medications to hormone therapy and even surgery if necessary. Suppose you have endometriosis lesions or any other symptoms associated with this condition. In that case, it’s important to speak with your doctor so they can provide you with an accurate diagnosis and appropriate treatment plan as soon as possible.

The Different Tests Used to Diagnose Endometriosis 

How to Get an Endometriosis Diagnosis

6 months ago Endometriosis

The Endometriosis Roller Coaster: Understanding Recurrence and How to Prevent It

The Endometriosis Roller Coaster: Understanding Recurrence and How to Prevent It

Surgery is a cornerstone for initial diagnosis of endometriosis and is an effective treatment option. But, it is not a guaranteed cure, because endometriosis can recur after surgery.  What? Why? 

The reasons for endo recurrence are complex and multifactorial and involve a combination of factors.  These include incomplete removal of the endometriosis tissue, hormonal imbalances, immune influences, toxin influences, molecular influences and probably even more we still do not fully understand. So, while thorough and meticulous initial excision is key, a poor excision is not the only reason for recurrence and progression.  Let’s look at these factors in more detail, and, more importantly, explore what you might be able to proactively do to help reduce the recurrence risk.   

Incomplete Excision:

Incomplete removal of endometriosis lesions is probably the most common cause of recurrence after surgery.  Endo can be difficult to remove completely, especially if it has grown deep into the pelvic tissues and organs, and if an affected uterus and/or ovaries are being preserved. Of course, expert surgeons are trained to optimize excision and minimize recurrence.  But in some cases, the remaining lesions can be obscured by inflammation or microscopic and not visible to the surgeon, making it difficult or impossible to remove no matter what level skillset the surgeon has.  If even a small amount of endometriosis is left behind after surgery, it can and probably will grow back over time.  The more that is left behind, potentially the faster it may grow back.  However, this is not a linear growth relationship because of the factors we explore below.  Some lesions simply grow slower than others for various reasons, and some might not grow at all to a symptom-producing level.   

So, what can be done to improve the chances of initially optimal surgery?  We’ll explore the pros and cons of available tools below.  But first, what about the surgeon?  Depending on your situation and resources available to you, some combination of advanced surgeons will be key to your treatment in most cases. The details about your options are as follows.   

Published research generally favors excision (removal) over fulguration (burning) of endometriosis implants, especially in deep infiltrating endo and for endometriomas. While there is some debate over this, fulguration near delicate structures like the ureters or bowel can be very unsafe and fulguration generally causes more scarring or fibrosis.  Fibrosis itself may increase pain as your body heals, even if all the endo itself was destroyed.  

So, the first step is to make sure that your potential surgeon is trained and capable of excision surgery and not just fulguration.  There are a number of pathways to this.  General gynecologists that are trained to perform thorough excisions are very far and few between.  So the trail leads to gynecologists that have had additional training in excision and minimally invasive surgery.  Who are they?  

Most advanced endo excision surgeons have trained in a one to three year minimally invasive surgery or “MIGS” fellowship. These are not regulated or accredited by any boards but are usually sponsored by the AAGL (American Association of Gynecologic Laparoscopists). This means the training is usually quite good, but not all mentors are created equal and there is no board required standardization.  Hence, some surgeons graduate being far better at excision than others.  So, you should still do your due diligence about the surgeon you select, based on as much information as possible, including their background, their results, what patients say, and so on.  

The other consideration is that this MIGS training, at least in the United States, may not include bowel and urologic surgery and usually does not provide  the credentials to obtain hospital privileges in these procedures.  So, an excision surgeon will often work with general surgeons, urologists and others as a team to cover the bowel and urinary tract aspects of surgery.  This can be very effective, but in some centers, logistic coordination of multiple surgeons works better than in others.   Unless this coordination is well worked out, it might be better to seek someone that is trained to do all or most excision without requiring a large team of supporting surgeons.

The other main way that gynecologic surgeons get advanced complex surgical training is through a three to four year gynecologic oncology fellowship accredited by the American Board of Obstetrics and Gynecology (ABOG) and American Council for Graduate Medical Education (ACME). This training includes the ability to operate on any organ in the abdomen and pelvis, including the diaphragm.  However, the training focus is on cancer and not much, if anything, on the pathophysiology of endometriosis.  So, while this surgical training leads to the absolute pinnacle of gynecologic surgeon expertise, not many of them understand and/or know how to treat endometriosis beyond what they learned in residency.  So, in some cases, an excisionist works with a gynecologic oncologist instead of a general surgeon or urologist.  On the other hand, a relative handful of gynecologic oncologists do focus on advanced endometriosis. 

If chest endo is strongly suspected on imaging, a thoracic surgeon is required as part of the team for formal lung surgery.  Similarly, if large nerves such as the sciatic nerve to the leg is likely to be involved on imaging, a neurosurgeon may also be part of a team or backup.   

Regarding fertility issues, an ABOG/ACGME board-accredited fellowship leading to specialization in Reproductive Endocrinology also exists and such physicians may be involved in your care with advanced technologies such as in vitro fertilization (IVF).  This was historically a more surgically focused specialty in the United States.  Today it is not, but some REI specialists have retained an interest in things surgical and may be trained in excision surgery.    

Determining the surgical strategy in your specific case can influence the outcome as well.  Related potential contributors to endometriosis recurrence after surgery include age, disease severity, and the type of planned surgical procedure performed. Older patients and those with more severe endometriosis are at higher risk of recurrence after surgery, unless perhaps the uterus and both ovaries are removed.  Patients who undergo conservative surgery, which aims to preserve fertility by removing as little normal tissue as possible, may also be at higher risk of recurrence compared to those who undergo more aggressive surgery.  This depends on the disease locations and the skill of the surgeon.  Conservative surgery can still result in removal of all visible endometriosis in many cases, with the right surgeon and right equipment.  So, discussion of your ranked, and possibly competing, priorities with your surgeon is essential for the best outcome.   For example, is the main goal pain relief or is it fertility preservation?  Or is it both? What is most important to you?  Being on the same page with your main surgeon, especially if there is a team involved with potential multiple opinions, is crucial to get the results you want. 

Hormonal Influences:

Hormonal imbalances play a crucial role in the development and recurrence of endometriosis. Endometriosis is believed to be strongly influenced by an excess of estrogen in the body, which can cause the endometrial-like tissue to grow outside the uterus. Hormonal therapies such as hormonal contraceptives, progestins, and gonadotropin-releasing hormone (GnRH) agonists and antagonists can be used to manage these hormonal imbalances.  The problem is that Mother Nature is infinitely smarter than the best doctor(s) and some of these therapies are worse than the disease, in terms of symptoms and side effects.  It really depends on the individual situation. 

Even after menopause, whether natural or by surgical excision of the ovaries, estrogen does not completely disappear.  Endo affected tissues can produce estrogen locally, other hormones and toxins you take in can convert to estrogen in your fat cells and, of course, hormonal replacement are all additional sources which can contribute to endometriosis recurrence. 

So, if the hormonal imbalances are not addressed, the endometriosis tissue can grow back after surgery.  But what does that really mean and what can you do to favorably influence this risk factor?   

One thing is for sure, doing something beyond surgery is better than nothing.  Anything you can do to reduce your estrogen load is first priority and use of progestins to balance this overload may also be recommended.  Whether or not to go for complete ovarian shutdown of estrogen production (GnRH analogs) is situation specific but usually not ideal due to the significant health effects of basically being in menopause.  The newer variations which provide some estrogen giveback are better but still have their limitations.  More often the pharmaceutical solution is oral contraceptives, which is far easier to handle in terms of potential side effects.   

One of the easiest things you can do yourself to reduce excess estrogen fairly quickly is to make sure your gut microbiome is functioning optimally.  This requires a close look at your diet, avoiding toxic junk food, and using probiotics and prebiotics.  When your gut bacteria are working well they metabolize the excess estrogen in your body and this leaves your body through bowel movements.  If not, excess estrogen is reabsorbed, recirculated and contributes to estrogen load.  

Another natural strategy is to lose weight.  Your fat cells store xenoestrogens from the toxins we all take in daily and slowly release this estrogen back into the bloodstream.  Also, the more fat cells you have the more other hormones are converted to estrogens which are also released into your blood stream. Weight loss is not a rapid proposition, but the best time to get started is yesterday.   

Reducing stress through mind-body techniques can also reduce estrogen levels.  Reducing alcohol intake improves your liver’s ability to break down estrogen.  Finally, some supplements, notably seaweed, can reduce estrogen in your body.  Others that top the list are Vitamin D, Magnesium, Milk Thistle, Omega 3 fatty acids (fish oil), Vitamin B6 and DIM (diindolylmethane).  DIM is found in cruciferous veggies, so you can up that intake easily through diet.  

Only after doing some of these things should you get radical on altering your hormones through medical pharmaceuticals.  There is a whole range of hormonal strategies including more natural compounded preparations.  Having said that, work with your doctor for the best strategy for your specific situation.   This is not something you should do on your own beyond diet and lifestyle modification.  The main take home message is that there is plenty of data which supports doing something to balance your estrogen and progesterone after surgery to reduce recurrence.   

Immune Influences:

The immune system plays a critical role in the development and progression of endometriosis. Endometriosis implants produce inflammatory factors that attract immune cells to the site, which can cause inflammation and pain. However, immune cells can also help to fight recurrence.  

Surgery may temporarily disrupt the balance between pro-inflammatory and anti-inflammatory immune cells, but acute inflammation helps with healing and this is self-limited in almost all cases.  This type of inflammation you do not want to interfere with in the short term.  On the other hand, inflammation can contribute to recurrence if it is allowed to become chronic.   Research suggests that immune-modulating therapies such as immunosuppressive agents and immunomodulatory cytokines could be effective in preventing the recurrence of endometriosis after surgery.  However, there are no reliable pharmaceutical treatments along this line yet.  On the other hand, research suggests that natural killer cells (NK) are deficient in endo patients.  An integrative nutritional approach to enhancing NK number and function is mushroom consumption.  Work with an integrative specialist on this.  

A recent sub-theory for endo development and recurrence is the “bacterial contamination hypothesis”.  This is based on the role of bacterial endotoxin (lipopolysaccharide, LPS) stimulating the pelvic inflammatory immune response.  Since patients with a history of pelvic infection, chronic endometritis and SIBO are known to have higher incidence of endometriosis, the commonality is a bacterial endotoxin (LPS).  So, regardless of whether the bacterial LPS got there via intestinal translocation (micro-leaking) or retrograde menstruation, its presence is potentially key in stimulating endo growth and regrowth.  Along these lines, treatment with either natural or pharmaceutical antibiotics may help attenuate chronic low level infection related inflammation. 

This is certainly not mainstream thought but plausible and based on at least animal model evidence with some human study support as well.  Attention to keeping your microbiome healthy and minimizing leaky gut as well as vigilance for any gynecologic infections may be prudent and is low risk. 

Toxin Influences:

Exposure to toxins and pollutants can also contribute to the development and recurrence of endometriosis. Certain toxins, such as dioxins and polychlorinated biphenyls (PCBs), have been shown to disrupt hormone levels, acting mainly as xenoestrogens, and increase the risk of endometriosis growth.  Therefore, lifestyle modifications such as avoiding environmental toxins and adopting a healthy diet may be beneficial in preventing the recurrence of endometriosis after surgery.  

Molecular Influences:

Recent research has shown that molecular changes in endometriosis implants may also contribute to the development and recurrence of endometriosis. Mutations in certain genes involved in regulating inflammation and hormone levels are examples.  Environmental and inflammatory influences can also upregulate hormone receptors, which means less estrogen is required to stimulate regrowth from micro-foci of endometriosis.   All these changes can be genetic mutations or epigenetic influences which turn normal and abnormal genes on and off. 

There is a lot of molecular crosstalk that regulates hormonal, inflammatory, immune, neurologic and other processes.  This is the glue that interconnects all of these factors that affect progression of endo and symptom causation.   

If your endo recurrence seems to be too rapid after a good excision surgery, or you have multiple recurrences and especially if you are older and/or have a family history of cancer or endo, please consider the following.  While rare, endo can degenerate into cancer or increase ovarian cancer risk and, even before that might happen, some gene mutations (e.g. ARID1A, KRAS, PIK3CA) can contribute to a more aggressive variant of endometriosis.  To determine if this is a contributor to your disease, genetic counseling and testing may be a good idea. 

Surgical Equipment Influences:

Minimally invasive surgery is the gold standard of endometriosis surgery these days, not surgery though a big incision called a laparotomy.  Having said that, after multiple prior surgeries, a surgeon may try to convince you that a laparotomy is what you need because you probably have too many scars or fibrosis and, therefore, minimally invasive surgery may be too risky.  While this may be true in very rare cases, it is not true in the vast majority of cases and you should probably seek other opinions.  Laparotomy surgery often leaves behind much more scarring than minimally invasive surgery.  There is always a possibility you may need yet another surgery, so find an expert to minimize all risks for this surgery and possibly subsequent ones. 

Minimally invasive surgery may mean laparoscopy or it may mean robotically assisted laparoscopy, depending on the surgeon you choose.  While laparoscopy has been around much longer, there are major technologic differences.  For simple to moderate cases, either is fine. However, for more complex cases and recurrence, you should understand the technical differences and what they mean.  Imaging may suggest but it is often not possible to accurately predict how much disease is present, or how much anatomic distortion there is, until the actual surgery starts.  But you can bet that if you are facing a repeat surgery, the anatomy may be more distorted than the first time.   

The following represents the opinion of this author surgeon who has used both laparoscopy and robotics over the past three decades, but, due to the reasons noted, has converted almost exclusively to robotics.  Having said that, it is important to understand that at the end of the day the skill of the surgeon trumps the equipment in most cases.  However, at some point, better technology does offer some clear advantages for most surgeons, should they choose to avail themselves of it.  Herein lies the problem.  Many have chosen to only dabble in robotics or ignore it altogether as an option.  So, beware of any surgeon who says that robotics is just a fad or training wheels for laparoscopy.  This is likely a surgeon who never took the time to master the superior technology offered by robotics to appreciate the difference.  The final major argument against robotics is that it costs too much or takes a little longer.  This does not affect the patient whatsoever because the costs to you are exactly the same.  In terms of surgery length, that is measurable in minutes.  So, wouldn’t you rather have a difficult surgery done properly or simply be the first one in the post-anesthesia recovery area?

  • Benefits of Robotic Surgery over Laparoscopy

Robotic surgery is a minimally invasive surgical technique that uses robotic arms to help perform the surgery with more precision. This offers several benefits over traditional laparoscopy that may help to reduce the risk of endometriosis recurrence. These benefits include more precise removal of endometriosis implants, less damage to surrounding tissue, reduced risk of complications, and possibly a shorter recovery time. 

  • Precise Instrumentation

Robotic surgery allows for more precise surgical movements, especially in delicate and anatomically distorted areas, reducing the risk of incomplete excision. The robotic arms move with reliably greater precision, dexterity and control than laparoscopic instruments.  During laparoscopy the surgeon is directly controlling the straight inflexible instruments with graspers and scissors at the tip.  This means that any undue exaggerated movements or tremors are amplified by the time they get to the tips, located twelve to seventeen inches away.  That is a long distance.  Try writing with a pen that long.  This does not happen with robotics which is micro-controlled.  In addition, the instruments at the tips of the robotic apparatus are wristed, meaning they are flexible and move like tiny human hands.  This also allows for more precision in difficult anatomical areas and in the presence of scar or fibrosis.   

Traditional laparoscopic instruments are limited by the possible motions at the surgical tips.  These motions are cutting, pushing, pulling and tearing, can be awkwardly unreliable and are reminiscent of eating with chopsticks.  One can certainly get good at it, but there are limitations. No question, the better the surgeon and the more that anatomy is normal, the smoother the surgery. However, at the end of the day, this can never match the smooth reliability of robotics. 

Due to the more precise control of instruments, robotic surgery can help reduce the risk of damage to surrounding tissues and organs. This helps reduce complications (e.g inadvertent damage to bowel, ureters or blood vessels) and, in this manner, enhances and accelerates the healing process. 

  • Superior 3-Dimensional Optics

Robotics offers a 3-D magnified camera, which means there is depth perception as compared to laparoscopy.  In other words, you can see minute differences in how far one object is compared to one right next to it. There are laparoscopic simulated 3-D options available (3-D glasses as opposed to real binocular lenses as found in robotics), but most surgeons use a 2–D camera.  Using this, the surgeon cannot appreciate the distances accurately.  So, without depth perception, the surgeon can’t precisely tell the separation between tissues in a highly distorted anatomical situation. For example, there may be a section of bowel stuck to an endometrioma, or the blood vessels to the ovary may be obscured in inflammation. Dissecting this all safely is facilitated by a 3-D view. You can prove to yourself why 3-D is better. Put an eye patch on and try to (very carefully) try to do things around the house with only one eye to help you navigate. You will find that you underestimate or overestimate the distance between objects when you try to pick them up and might even bump into things too often. Hence you should not try this experiment without someone to help keep you steady. Humans are created with and are best equipped to function with 3-D vision, powered by two eyeballs. We can accommodate to 2-D but it is not natural or optimal.  This means with traditional laparoscopy your surgeon is operating with a handicap and, regardless of skill, that may make all the difference in some cases. 


In conclusion, endometriosis recurrence after surgery is a complex issue. Incomplete excision due to surgeon experience or technology differences, hormonal imbalances, immune influences, toxin influences, and molecular influences can all contribute to endometriosis recurrence after surgery.  Take time to digest all of this information and seek the best endometriosis specialist and surgeon available to you for your specific needs.  

Get in touch with Dr. Steve Vasilev

More articles from Dr. Steve Vasilev:

Endometriosis And Menopause; Everything You Need To Know

How to tell the difference between endometriosis and ovarian cancer

What would happen to the signs and symptoms of endometriosis after menopause?


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Abbott, J., Hawe, J., Hunter, D., Holmes, M., Finn, P., & Garry, R. (2004). Laparoscopic excision of endometriosis: a randomized, placebo-controlled trial. Fertility and Sterility, 82(4), 878-884.

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Nezhat, C., Saberi, N. S., Shahmohamady, B., & Nezhat, F. (2006). Robotic-assisted laparoscopy in gynecological surgery. JSLS: Journal of the Society of Laparoendoscopic Surgeons, 10(3), 317–320.

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6 months ago Endometriosis

Endometriosis and Adenomyosis: Decoding Their Contribution To Pelvic Pain

Endometriosis and adenomyosis affect millions of women worldwide. While they share certain similarities, they also exhibit differences in their pathophysiology, clinical presentation, and management. Let’s compare and contrast endometriosis and adenomyosis, shedding light on their associations and highlighting relevant references.


Both endometriosis and adenomyosis involve the growth of endometrial-like tissue outside the uterine cavity. This ectopic tissue remains responsive to hormonal changes, leading to inflammation, pain, and other similar symptoms that can significantly interfere with the quality of life (1).

Both conditions predominantly affect women of reproductive age and are associated with dysmenorrhea (painful periods), dyspareunia (painful intercourse), and infertility (2). The exact cause of these conditions remains unclear, but a combination of genetic, hormonal, and immune factors is thought to be involved in both (3). Both can also continue beyond or even be present initially after menopause.


  1. Anatomical location 

While both endometriosis and adenomyosis involve the growth of ectopic endometrial-like tissue, they differ in anatomical location. Endometriosis is characterized by the presence of endometrial-like tissue outside the uterus, commonly on the ovaries, fallopian tubes, the peritoneum (pelvic and abdominal skin-like lining), and other organs (4). In contrast, adenomyosis is defined by the invasion of endometrial-like tissue into the myometrium (muscular wall) of the uterus (5).

  1. Prevalence

Endometriosis affects approximately 10% of women of reproductive age, while adenomyosis is thought to impact between 20% and 35% of women in this age group (6). But the true prevalence of both conditions may be underestimated due to the invasive nature of diagnostic procedures and non-specific symptoms (7).

  1. Diagnosis

The gold standard for diagnosing endometriosis is surgery using laparoscopy or robotics, both minimally invasive surgical procedures that allow for direct visualization and, if necessary, excision of endometrial-like tissue lesions (8). In contrast, adenomyosis is typically suspected using imaging techniques such as transvaginal ultrasound or magnetic resonance imaging (MRI). It can usually only be confirmed by the pathologist when the uterus is removed (9). An accurate preoperative biopsy is very difficult, although removal of discrete adenomyomas, leaving the uterus behind, is sometimes possible when the adenomyosis is not diffuse throughout the myometrium of the uterus.

  1. Treatment

Both conditions are managed with a combination of medical and surgical therapies, depending on the severity of symptoms and reproductive goals. Hormonal therapies, including oral contraceptives, progestins, and gonadotropin-releasing hormone (GnRH) agonists and antagonists, are commonly used to manage symptoms in both endometriosis and adenomyosis (10). Integrative measures, including anti-inflammatory and anti-oxidant hormone-modulating nutrition and lifestyle modification, can also help not just control symptoms but also contribute to treating the root causes. 

However, surgical approaches differ between the two conditions. In endometriosis, the preferred surgical intervention is laparoscopic and robotic excision of the ectopic tissue (11). For adenomyosis, hysterectomy (removal of the uterus) may be considered in severe cases where fertility preservation is not a concern (12). Again, in some cases, when discrete adenomyomas are identified by imaging, they can be removed while leaving the uterus intact—this decision of removing the uterusis a highly individualized issue. 


It is not uncommon for endometriosis and adenomyosis to coexist in the same patient. One study found that the prevalence of adenomyosis was significantly higher among women with endometriosis (13). The coexistence of these conditions may exacerbate symptoms and pose additional challenges in diagnosis and management (14).

Both endometriosis and adenomyosis have been linked to a variety of other health conditions, some of which include:

  1. Chronic pelvic pain: Women with either endometriosis or adenomyosis may experience chronic pelvic pain, which can be debilitating and significantly impact daily life (15).
  1. Uterine fibroids: Although they are distinct conditions, adenomyosis and uterine fibroids (leiomyomas) can coexist in the same patient, further complicating the diagnosis and treatment (16). 
  1. Autoimmune and inflammatory diseases: Women with endometriosis have an increased risk of developing autoimmune and inflammatory disorders, such as rheumatoid arthritis, systemic lupus erythematosus, and inflammatory bowel disease (17). This association is less well-established for adenomyosis but has been suggested in some studies (18).
  1. Mental health: Both endometriosis and adenomyosis have been linked to mental health issues, including depression, anxiety, and decreased quality of life due to chronic pain and infertility (19).

Research and Future Directions

There is a growing body of research focused on understanding the pathophysiology, diagnosis, and treatment of endometriosis and adenomyosis. Some key areas of interest include:

  1. Biomarkers: Identifying specific biomarkers for endometriosis and adenomyosis could greatly improve the diagnostic process and allow for earlier intervention, potentially improving patient outcomes (20).
  1. Non-invasive imaging techniques: The development of more accurate, non-invasive imaging techniques for diagnosing both endometriosis and adenomyosis is a priority for researchers, as this would reduce the need for invasive diagnostic procedures (21).
  1. Novel treatment approaches: Researchers are exploring novel treatment approaches, such as targeted hormonal therapies, immunomodulators, and anti-inflammatory agents, to improve symptom management and fertility outcomes in both endometriosis and adenomyosis (22).
  1. Genetic and epigenetic factors: Investigating the genetic and epigenetic factors that contribute to the development and progression of endometriosis and adenomyosis may lead to a better understanding of these conditions and inform future therapeutic strategies (23).

Get in touch with Dr. Steve Vasilev

More articles from Dr. Steve Vasilev:

Endometriosis And Menopause; Everything You Need To Know

How to tell the difference between endometriosis and ovarian cancer

What would happen to the signs and symptoms of endometriosis after menopause?


  1. Vercellini P, Viganò P, Somigliana E, Fedele L. (2014). Endometriosis: pathogenesis and treatment. Nat Rev Endocrinol. 10(5): 261-75.
  2. Parazzini F, Esposito G, Tozzi L, Noli S, Bianchi S. (2017). Epidemiology of endometriosis and its comorbidities. Eur J Obstet Gynecol Reprod Biol. 209: 3-7.
  3. Zondervan KT, Becker CM, Koga K, Missmer SA, Taylor RN, Viganò P. (2018). Endometriosis. Nat Rev Dis Primers. 4(1): 9.
  4. Giudice LC, Kao LC. (2004). Endometriosis. Lancet. 364(9447): 1789-99.
  5. Vannuccini S, Tosti C, Carmona F, Huang SJ, Chapron C, Guo SW, Petraglia F. (2017). Pathogenesis of adenomyosis: an update on molecular mechanisms. Reprod Biomed Online. 35(5): 592-601.
  6. Garcia L, Isaacson K. (2011). Adenomyosis: review of the literature. J Minim Invasive Gynecol. 18(4): 428-37.
  7. Chapron C, Marcellin L, Borghese B, Santulli P. (2019). Rethinking mechanisms, diagnosis and management of endometriosis. Nat Rev Endocrinol. 15(11): 666-82.
  8. Johnson NP, Hummelshoj L, Adamson GD, Keckstein J, Taylor HS, Abrao MS, et al. (2017). World Endometriosis Society consensus on the classification of endometriosis. Hum Reprod. 32(2): 315-24.
  9. Champaneria R, Abedin P, Daniels J, Balogun M, Khan KS. (2010). Ultrasound scan and magnetic resonance imaging for the diagnosis of adenomyosis: systematic review comparing test accuracy. Acta Obstet Gynecol Scand. 89(11): 1374-84.
  10. Vercellini P, Buggio L, Berlanda N, Barbara G, Somigliana E, Bosari S. (2016). Estrogen-progestins and progestins for the management of endometriosis. Fertil Steril. 106(7): 1552-71.e2.
  11. Yeung P Jr, Sinervo K, Winer W, Albee RB Jr. (2011). Complete laparoscopic excision of endometriosis in teenagers: is postoperative hormonal suppression necessary? Fertil Steril. 95(6): 1909-12, 1912.e1.
  12. García-Solares J, Donnez J, Donnez O, Dolmans MM. (2018). Pathogenesis of uterine adenomyosis: invagination or metaplasia? Fertil Steril. 109(3): 371-9.
  13. Mijatovic V, Florijn E, Halim N, Schats R, Hompes P. (2010). Adenomyosis has no adverse effects on IVF/ICSI outcomes in women with endometriosis treated with long-term pituitary down-regulation before IVF/ICSI. Eur J Obstet Gynecol Reprod Biol. 151(1): 62-7.
  14. Pinzauti S, Lazzeri L, Tosti C, Centini G, Orlandini C, Luisi S, et al. (2015). Coexistence of endometriosis and adenomyosis in women with chronic pelvic pain. J Obstet Gynaecol Res. 41(6): 909-14.
  15. Howard FM. (2003). Chronic pelvic pain. Obstet Gynecol. 101(3): 594-611.
  16. Stewart EA. (2015). Uterine fibroids. Lancet. 387(10022): 1189-99.
  17. Sinaii N, Cleary SD, Ballweg ML, Nieman LK, Stratton P. (2002). High rates of autoimmune and endocrine disorders, fibromyalgia, chronic fatigue syndrome and atopic diseases among women with endometriosis: a survey analysis. Hum Reprod. 17(10): 2715-24.
  18. Benagiano G, Brosens I, Habiba M. (2015). Structural and molecular features of the endomyometrium in endometriosis and adenomyosis. Hum Reprod Update. 21(4): 445-58.
  19. Roomaney R, Kagee A. (2016). The association between pain, disability, fatigue and depression in women diagnosed with endometriosis: a moderated mediation analysis. J Psychosom Obstet Gynaecol. 37(4): 137-44.
  20. Nisenblat V, Bossuyt PM, Shaikh R, Farquhar C, Jordan V, Scheffers CS, et al. (2016). Blood biomarkers for the non-invasive diagnosis of endometriosis. Cochrane Database Syst Rev. 5: CD012179.
  21. Brosens I, Gordts S, Campo R, Benagiano G. (2016). Non-invasive methods of diagnosis of endometriosis. Curr Opin Obstet Gynecol. 28(4): 267-76.
  22. Stratton P, Berkley KJ. (2011). Chronic pelvic pain and endometriosis: translational evidence of the relationship and implications. Hum Reprod Update. 17(3): 327-46.
  23. Zondervan KT, Rahmioglu N, Morris AP, Nyholt DR, Montgomery GW, Becker CM, et al. (2016). Beyond endometriosis genome-wide association study: from genomics to phenomics to the patient. Semin Reprod Med. 34(4): 242-54.
7 months ago Endometriosis

The Importance of Endometriosis Awareness Month

Every March, the world comes together to recognize and raise awareness for endometriosis. This global health issue affects hundreds of millions of humans worldwide yet is rarely discussed due to a lack of education and knowledge. Endometriosis Awareness Month allows us to learn more about this debilitating condition and how it impacts those who suffer from it.

What Is Endometriosis?

Endometriosis is a chronic disorder affecting up to 10% of women worldwide. Endometriosis can impact other genders as well. This disease occurs when tissue similar to the lining of the uterus grows outside the uterus and on other organs in the body, such as the ovaries, bladder, bowels, and abdomen. While endometriosis can occur at any age, it most commonly impacts women between 15-50 years old.

Common Symptoms

The most common symptom of endometriosis is pelvic pain. This pain can range from mild cramping or discomfort to severe period pain lasting days or weeks. Other symptoms include heavy periods (with large clots), painful bowel movements or urination during menstrual cycles, painful sex, fatigue, and infertility. Unfortunately, these symptoms are often misdiagnosed as menstrual cramps or irritable bowel syndrome (IBS).

Read more: 20 Signs and Symptoms of Endometriosis

Treatment Options & Management Strategies

Endometriosis cannot be cured, but treatment options are available to help manage its symptoms. These include surgical removal of endometrial growths, hormone therapy, pain management, and dietary changes. Additionally, lifestyle modifications like stress reduction techniques and exercise can help alleviate some symptoms of endometriosis.

Endometriosis Awareness Month is important in educating everyone about this chronic disorder that affects hundreds of millions globally. We must learn more about endometriosis so that those suffering from this condition can get the proper diagnosis and care they need. Together we can make a difference in raising awareness for this disease!

Read more:

Endometriosis: What to Do After Diagnosis

How to Find an Endometriosis Specialist for Diagnosis, Treatment, & Surgery.

7 months ago Endometriosis

Integrative Therapies for Endometriosis

While there is no known cure for endometriosis, several mainstream treatment options can help manage the symptoms and improve quality of life. These are primarily focused on surgery and hormonal therapy.   Research is ongoing to find additional multidisciplinary treatment options on the basis of immunomodulation, anti-inflammatory therapy, and molecular pathway signal alteration. Absent curative mainstream therapy, an approach that has gained popularity in recent years to help reduce symptoms and treat some underlying endo pathology, is “integrative therapy,” which adds a holistic natural component. 

What is integrative therapy?

Integrative therapy is an approach to healthcare that takes into account the whole person, including their physical, emotional, and spiritual health. It involves combining conventional medical treatment with complementary therapies such as nutrition, supplementation, botanicals, acupuncture, massage, yoga, and much more. Integrative therapy aims to address the underlying causes of a person’s health concerns rather than simply treating the symptoms. While it often employs some aspects of Eastern medicine, it is not the same as “alternative therapy,” which can be ineffective, costly, and even dangerous in some situations. This overview article only scratches the surface of available options and is not meant to be authoritative in scope or depth. 

Some of the complementary therapies that may be used in integrative therapy for endometriosis include:


Everybody has heard of this, but briefly, acupuncture is a form of Traditional Chinese Medicine that involves the insertion of extremely thin needles into specific points along body pathways called meridians. These meridians and acupoints are close to where we know peripheral nerves course through your body. It has been used for centuries to treat a wide range of conditions, including chronic pain, headaches, anxiety, and infertility.

Acupuncture is believed to work by stimulating the body’s natural healing mechanisms, promoting the flow of energy, or Qi, throughout the body. It could also have an effect on the nerves from a mainstream perspective. In the context of endometriosis, acupuncture is thought to help by reducing inflammation and promoting the relaxation of the pelvic muscles, which can reduce pain and improve fertility.  

One thing is for sure; it is not just a placebo effect. A systematic review published in the Cochrane Library in 2018 evaluated the effectiveness of acupuncture in treating pelvic pain associated with endometriosis. The review included seven randomized controlled trials involving a total of 527 participants. The authors found that acupuncture was associated with a statistically significant reduction in pain intensity compared to no acupuncture or sham acupuncture. 

Another systematic review published in the Journal of Obstetrics and Gynecology in 2021 evaluated the effectiveness of acupuncture in treating endometriosis-related dysmenorrhea. The review included 17 randomized controlled trials involving a total of 1232 participants. The authors found that acupuncture was associated with a statistically significant reduction in pain intensity and duration compared to no acupuncture or sham acupuncture. They concluded that acupuncture might be a safe and effective therapy for managing endometriosis-related dysmenorrhea.

While the evidence for the effectiveness of acupuncture in treating endometriosis is promising, it is important to note that acupuncture is not a cure for endometriosis. Acupuncture may help to manage pain and other symptoms associated with the condition, but it does not address the underlying disease process other than helping reduce inflammation. Therefore, it should be used as part of a comprehensive treatment plan that includes conventional medical treatment as well as lifestyle modifications and other complementary therapies.


Acupressure is a related form of traditional Chinese medicine that involves applying pressure to specific points on the body to promote healing and reduce pain. Acupressure points that are commonly used in the treatment of endometriosis include the lower abdomen, lower back, and inner ankle. These points are believed to help regulate menstrual flow, reduce inflammation, and promote relaxation.

A randomized controlled trial published in the Journal of Complementary and Alternative Medicine in 2013 evaluated the effects of acupressure on pain and quality of life in women with endometriosis. The study included 60 participants who received either acupressure or a placebo. The authors found that acupressure was associated with a statistically significant reduction in pain intensity and an improvement in quality of life.

Another study published in the Journal of Obstetrics and Gynaecology Research in 2018 evaluated the effects of acupressure on menstrual pain and quality of life in women with endometriosis. The study included 62 participants who received either acupressure or a placebo. The authors found that acupressure was associated with a statistically significant reduction in menstrual pain intensity and an improvement in quality of life.

Massage therapy

Massage therapy is a complementary therapy that involves the manipulation of soft tissues in the body, such as muscles and tendons, to promote relaxation and reduce pain. It has been used for centuries to treat a variety of conditions, including chronic pain, anxiety, and depression. We are talking about massage that is in addition to 

Endometriosis can cause significant pain and discomfort, particularly during menstruation. Massage therapy can help ease tension in the pelvic muscles and reduce pain. A systematic review published in the Journal of Nursing Scholarship in 2019 evaluated the effectiveness of massage therapy in reducing pain and improving the quality of life in patients with endometriosis. The review included 13 studies involving a total of 602 participants. The authors found that massage therapy was associated with a statistically significant reduction in pain intensity and duration and improvements in quality of life and anxiety levels. 

Massage therapy may also be beneficial for reducing stress and anxiety, which are common symptoms of endometriosis. Chronic pain can cause significant emotional distress, and massage therapy has been shown to be effective in reducing anxiety levels and promoting relaxation. A randomized controlled trial published in the Journal of Psychosomatic Obstetrics and Gynecology in 2018 evaluated the effects of massage therapy on anxiety levels in women with endometriosis. The study included 60 participants who received either massage therapy or no treatment. The authors found that massage therapy was associated with a statistically significant reduction in anxiety levels compared to no treatment.

In addition to its potential benefits for reducing pain and anxiety, massage therapy may also help to improve circulation and promote lymphatic drainage, which can help to reduce inflammation and promote healing. A review published in the Journal of Manual and Manipulative Therapy in 2016 evaluated the effectiveness of massage therapy for managing chronic pelvic pain, including endometriosis. The authors concluded that massage therapy might be a safe and effective therapy for managing chronic pelvic pain, mainly when used with other therapies.

Mind-body Techniques

Meditation, yoga, Tai chi, and others are complementary therapies that can be used in the treatment of endometriosis to help manage physical, emotional, and mental support. These techniques focus on the connection between the mind and the body and are designed to help individuals learn how to use their thoughts and emotions to promote healing and reduce pain.

Endometriosis is often associated with significant emotional and mental distress, including anxiety, depression, and stress. Mind-body techniques can help to manage these symptoms by promoting relaxation and reducing stress levels. A systematic review published in the journal Obstetrics and Gynecology Clinics of North America in 2020 evaluated the effectiveness of mind-body therapies for managing chronic pain, including endometriosis. The review included 20 studies involving a total of 1126 participants. The authors found that mind-body therapies, including meditation, yoga, and Tai chi, were associated with statistically significant reductions in pain intensity, pain duration, and stress levels.

Meditation is a mind-body technique that involves focusing the mind on a particular object or thought to promote relaxation and reduce stress levels. A randomized controlled trial published in the journal Pain Medicine in 2018 evaluated the effects of mindfulness meditation on pain and quality of life in women with endometriosis. The study included 20 participants who received either mindfulness meditation or no treatment. The authors found that mindfulness meditation was associated with a statistically significant reduction in pain intensity and an improvement in quality of life.

Yoga is a mind-body technique that combines physical postures, breathing exercises, and meditation to promote relaxation and reduce stress levels. A randomized controlled trial published in the journal Obstetrics and Gynecology in 2018 evaluated the effects of yoga on pain and quality of life in women with endometriosis. The study included 90 participants who received either yoga or no treatment. The authors found that yoga was associated with a statistically significant reduction in pain intensity and improved quality of life.

Tai chi is a mind-body technique that involves slow, gentle movements and deep breathing exercises to promote relaxation and reduce stress levels. A systematic review published in the journal Pain Medicine in 2015 evaluated the effectiveness of Tai chi for managing chronic pain, including endometriosis. The review included ten studies involving a total of 494 participants. The authors found that Tai chi was associated with statistically significant reductions in pain intensity and duration and stress levels.

Diet and Nutrition

Diet modification can directly impact inflammation, hormone balance, and immune system function. While no specific diet has been shown to cure endometriosis, dietary changes, and nutritional supplements may be beneficial in reducing inflammation and pain associated with the condition.  

Inflammation is a key factor in the development and progression of endometriosis. Certain foods and nutrients can contribute to inflammation in the body, while others have anti-inflammatory properties that can help to reduce inflammation. Omega-3 fatty acids, found in fatty fish such as salmon and mackerel, as well as in flaxseeds and chia seeds, have been shown to have potent anti-inflammatory effects. Magnesium, found in leafy greens, nuts, and whole grains, can also help to reduce inflammation and muscle tension. Vitamin D, found in fatty fish, eggs, and fortified dairy products, may help to regulate immune system function and reduce inflammation. Overall, the most anti-inflammatory antioxidant diet is whole-food plant-based.

Hormone balance is another important consideration in the management of endometriosis. Certain foods can help to balance hormones, while others can disrupt hormone balance and exacerbate symptoms. Phytoestrogens, found in foods such as soy products, flaxseeds, and lentils, can help to balance estrogen levels and reduce symptoms of endometriosis. On the other hand, foods high in saturated and trans fats, such as red meat and processed foods, can increase inflammation and disrupt hormone balance.

A systematic review published in the journal Nutrients in 2021 evaluated the effectiveness of dietary interventions for managing endometriosis. The review included 17 studies involving a total of 1311 participants. The authors found that dietary interventions, such as increasing intake of fruits and vegetables, omega-3 fatty acids, and phytoestrogens, and decreasing intake of saturated and trans fats, were associated with improved pain and quality of life, and other symptoms of endometriosis.


Similar to diet, supplements may be beneficial in managing endometriosis by reducing inflammation, promoting hormonal balance, and supporting immune system function. While it is best to focus on transitioning to an anti-inflammatory, antioxidant diet, targeted supplementation may enhance the effect in some cases. 

A randomized controlled trial published in the Journal of Reproductive Medicine in 2013 evaluated the effects of omega-3 fatty acids on pain and quality of life in women with endometriosis. The study included 59 participants who received either omega-3 fatty acids or a placebo. The authors found that omega-3 fatty acids were associated with a statistically significant reduction in pain intensity and improved quality of life.

A systematic review published in the European Journal of Obstetrics, Gynecology, and Reproductive Biology in 2017 evaluated the effectiveness of magnesium for managing menstrual pain, including endometriosis-related pain. The review included 13 studies involving a total of 1870 participants. The authors found that magnesium was associated with a statistically significant reduction in menstrual pain intensity and duration.

The study mentioned above also evaluated the effectiveness of vitamin D for managing menstrual pain, including endometriosis-related pain. The review included five studies involving a total of 238 participants. The authors found that vitamin D was associated with a statistically significant reduction in menstrual pain intensity and duration. Vitamin D supplementation is often essential because even in sunbelt areas of the world, up to 30% of the population is deficient.  

It is important to note that supplements can have side effects and may interact with other medications, so it is essential to consult with a healthcare provider before using supplements for endometriosis. 

Herbal Medicine 

Herbal medicine, also known as herbalism, is the use of plants or plant extracts to treat or prevent disease. Many herbs have anti-inflammatory and pain-relieving properties, making them useful in managing endometriosis. While further research is needed to understand the effectiveness of herbal medicine for endometriosis fully, many women have reported positive outcomes from using herbal remedies as a complementary therapy.

Turmeric is one herb that has been suggested to effectively reduce inflammation and pain associated with endometriosis. Turmeric contains a compound called curcumin, which has potent anti-inflammatory effects. A randomized controlled trial published in the journal Complementary Therapies in Medicine in 2013 evaluated the effects of curcumin on pain and quality of life in women with endometriosis. The study included 67 participants who received either curcumin or a placebo. The authors found that curcumin was associated with a statistically significant reduction in pain intensity and an improvement in quality of life.

Ginger is another herb that has been suggested to be effective in reducing inflammation and pain associated with endometriosis. Ginger contains compounds called gingerols and shogaols, which have anti-inflammatory and pain-relieving effects. A randomized controlled trial published in the journal Pain in 2014 evaluated the effects of ginger on pain and menstrual symptoms in women with endometriosis. The study included 70 participants who received either ginger or a placebo. The authors found that ginger was associated with a statistically significant reduction in pain intensity and an improvement in menstrual symptoms.

Chasteberry, also known as vitex, is an herb that has been suggested to be effective in regulating hormones and reducing symptoms of endometriosis. Chasteberry contains compounds that can help to balance estrogen and progesterone levels, which can help to reduce inflammation and pain. A systematic review published in the journal Complementary Therapies in Medicine in 2018 evaluated the effectiveness of chasteberry for managing endometriosis-related pain. The review included six studies involving a total of 596 participants. Chasteberry was associated with a statistically significant reduction in pain intensity and duration compared to no treatment in this study.

Just as in the case of supplements, work with an expert in the field to avoid interactions with prescription medications. 


Aromatherapy is a form of complementary therapy that involves using essential oils to promote health and well-being. Essential oils are concentrated plant extracts that are believed to have therapeutic properties. They can be used in several ways, such as inhaled, applied topically, or added to a bath.

While there is limited scientific research on the effectiveness of aromatherapy for endometriosis, some women with the condition have reported that it has helped to manage their symptoms. Aromatherapy may be particularly helpful for managing emotional symptoms, such as anxiety and depression, which are all too common. 

A short list of essential oils that may be helpful for women with endometriosis includes Lavender, Clary sage, Rose, Peppermint, and Eucalyptus. 

When using aromatherapy, it is important to dilute the essential oils with a carrier oil, such as coconut oil or almond oil, as they can be irritating to the skin when used undiluted. Aromatherapy should also be used with caution in women who are pregnant or breastfeeding, as some essential oils may not be safe for use during pregnancy or while breastfeeding.

Hyperbaric Oxygen Therapy (HBOT)

The theory behind using HBOT for endometriosis is that the increased oxygen levels in the body may help to reduce inflammation and promote the healing of damaged tissues. Some preliminary studies have suggested that HBOT may be effective in reducing pain and improving quality of life in women with endometriosis, although larger studies are needed to confirm these findings.

It is important to note that HBOT is not currently approved by the U.S. Food and Drug Administration (FDA) for the treatment of endometriosis, and it should only be used under the guidance of a qualified healthcare provider. There are also some risks associated with HBOT, including ear pain, sinus pressure, and oxygen toxicity, which can be serious in rare cases.


By addressing both the physical and emotional aspects of endometriosis, integrative therapy can help women to achieve a better quality of life and attach some of the suspected root causes of endo as well. This can include improvements in energy levels, sleep quality, and overall sense of well-being.

Integrative therapy is not a replacement for conventional medical treatment for endometriosis but rather a complementary approach that can be used in conjunction with conventional treatments to achieve better outcomes. 

In conclusion, endometriosis is a complex condition that requires a multidisciplinary approach to treatment. Integrative therapy offers a promising addition to managing the symptoms of endometriosis by combining conventional medical treatments with complementary therapies that address the physical, emotional, and spiritual aspects of care. 

Your endometriosis specialist can help guide you to practitioners who may be best suited for applying integrative therapies to endometriosis. It is ideal if you can find a specialist who is also certified in some aspect of East-West integrative medicine. These are hard to find but are out there. 

Get in touch with Dr. Steve Vasilev

More articles from Dr. Steve Vasilev:

Endometriosis And Menopause; Everything You Need To Know

How to tell the difference between endometriosis and ovarian cancer

What would happen to the signs and symptoms of endometriosis after menopause?


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7 months ago Endometriosis

Endometriosis: What to Do After Diagnosis

If you’ve been diagnosed with endometriosis, you may wonder what your next steps should be. Here’s a quick overview of some things you can do after receiving a diagnosis of endometriosis.

Educate yourself about the condition.

One of the best things you can do after an endometriosis diagnosis is to educate yourself about the condition. Knowledge will help you better understand your symptoms and give you an idea of available treatments. Some resources that you should consider:

iCareBetter instagram page

Nancy’s Nook Endometriosis Education Facebook group

Extra Pelvic Not Rare

You can also ask questions about your diagnosis to your doctor or another healthcare provider.

Find an endometriosis doctor

When treating and managing endometriosis, all doctors are not the same. If you have or suspect you might have endometriosis, you should never just walk into the office of a random obstetrics/gynecology (OB-GYN) surgeon.

However, it can be tricky to find an endometriosis specialist who is highly skilled and follows the best treatment practices for this disorder. To learn more about endometriosis, read this article that introduces the condition, signs and symptoms, causes, complications, and treatments.

With so many myths about endometriosis (endo) – it’s essential to separate facts from fiction. Arm yourself with research and a solid foundation of knowledge to help you simplify the process and to get in touch with a trusted endo expert. Please keep reading to find out why using an endo expert is important, red flags your doctor/surgeon is not the right fit, and how to find an endometriosis specialist near you.

Learn more: How to Find an Endometriosis Specialist for Diagnosis, Treatment, & Surgery.

Talk to your doctor about treatment options.

There is no cure for endometriosis, but there are treatments that can help lessen your symptoms and improve your quality of life. Some common treatments for endometriosis include excision surgery, medications for symptom management, and lifestyle changes. Talk to your doctor about which treatment or combination of options may be right for you.

Make lifestyle changes.

Specific lifestyle changes can help lessen the symptoms of endometriosis. These include regular exercise, managing stress, and eating a healthy diet rich in fruits, vegetables, whole grains, and lean protein. Making these changes can help improve your overall health and well-being.

Join a support group.

It can be helpful to talk to other women dealing with endometriosis. There are many online and in-person support groups available for women with endometriosis. Joining one of these groups can help you feel less alone and provide you with valuable information and support from others who understand what you’re going through.

Here are some support groups:

Nancy’s Nook Endometriosis Education Facebook group

Extra Pelvic Not Rare

If you’ve been diagnosed with endometriosis, you’re not alone. And there are things you can do to manage your symptoms and improve your quality of life. Educate yourself about the condition, talk to your doctor about treatment options, make lifestyle changes, and join a support group if possible. These steps will help you better cope with your diagnosis and live a fuller life despite having endometriosis.

7 months ago Endometriosis

5 Signs You Need to See a Gynecologist

Regular gynecologist visits are essential to maintaining sexual and reproductive health. However, many women put off making an appointment until they are pregnant or facing a problem. There are several reasons to visit a gynecologist. If you’re unsure whether you need to see a gynecologist, here are five signs that it’s time to schedule an appointment.

You Haven’t Been in a While (Or Ever)

The American College of Obstetricians and Gynecologists (ACOG) recommends that women have their first gynecological visit when they turn 18 or become sexually active, whichever comes first. If you’re overdue for a checkup, it’s time to schedule an appointment. Remember that you don’t need to be sexually active to see a gynecologist – they can provide comprehensive care for all aspects of your reproductive health, even if you’re not sexually active.

You’re Experiencing Abnormal Bleeding

If you’re bleeding between periods, after sex, or after menopause, it’s time to see a gynecologist. Abnormal bleeding can be caused by everything from uterine fibroids to endometriosis to cervical cancer, so getting checked out as soon as possible is important.

You Have Painful Periods

Periods are supposed to be discomforting, but they shouldn’t be so painful that they interfere with your daily life. If you miss work or school because of period pain, it’s time to see a gynecologist. They may be able to diagnose the underlying reason for your pain and help with the treatment. 

You Have Pelvic Pain Outside of Your Periods

If you’re experiencing pelvic pain at any time other than during your period, it could be a sign of endometriosis, pelvic inflammatory disease, or another condition. Many conditions that cause pelvic pain can be treated if they’re caught early, so don’t hesitate to make an appointment with your gynecologist.

You Have New and Unusual Symptoms

If you’ve started experiencing new and unusual symptoms – like changes in your vaginal discharge or burning during urination – it’s time to go to the gynecologist. These could be signs of infection or another problem, so getting checked out as soon as possible is best.

If you’re experiencing any of the above symptoms, don’t wait – schedule an appointment with your gynecologist today! The sooner you get checked out, the sooner you can start feeling better and return to your normal routine. In addition to the five signs we reviewed here, there are countless other reasons to visit a gynecologist. So it would be best to stay informed about your health and communicate with your doctors about any questions or concerns.

How to Find an Endometriosis Specialist for Diagnosis, Treatment, & Surgery

Read more: 7 Ways to Prepare For First Endometriosis Specialist Appointment

Find an Endometriosis Specialist for Diagnosis

7 months ago Endometriosis

Understanding the Link Between Endometriosis and Insomnia

People living with endometriosis often struggle to get a good night’s rest. While it may seem like a mystery, there is a strong connection between endometriosis and insomnia. In this blog post, we’ll look at how endometriosis can lead to insomnia and what you can do to get better sleep if you have endometriosis.

What Is Endometriosis?

Endometriosis is a chronic medical condition that mostly affects women of reproductive age. It occurs when tissue similar to the lining of the uterus grows outside of the uterus, usually in the abdominal cavity or on other organs in the pelvic area. This tissue can cause pain, inflammation during menstruation, and other symptoms such as fatigue, nausea, and bloating.

How Can Endometriosis Lead To Insomnia?

There are several ways that endometriosis can contribute to insomnia. The most common way is through chronic pain. Painful cramps, bloating, and nausea can make it difficult for an individual with endometriosis to fall asleep or stay asleep throughout the night. Additionally, many women experience increased pain during their period—when they usually try to get some rest—making it even more challenging to sleep well while living with endometriosis.

Another factor contributing to insomnia in women with endometriosis is anxiety and stress associated with managing this chronic condition. It’s not uncommon for people with endometriosis to feel overwhelmed or anxious about managing their symptoms on top of everything else going on in their lives. Unfortunately, this anxiety can lead to difficulty falling asleep or staying asleep at night.

What To Do With Endometriosis And Insomnia

Endometriosis has been linked directly to insomnia in many studies. However, there are steps you can take if you’re experiencing difficulty sleeping due to this condition. First and foremost, talk with your doctor about your options for treating your endo-related pains. Additionally, reducing stress levels by finding healthy coping mechanisms such as yoga or meditation may also help improve your overall sleep quality since stress has been known to contribute to insomnia in those living with endo-related complications. Finally, getting enough exercise during the day (but not too close before bedtime), eating healthier foods, avoiding caffeine late in the day, and creating an ideal sleeping environment may all help promote a better quality of restful sleep at night. These steps improve your chances of getting a good night’s rest despite having endo-related complications.

Endometriosis can result in insomnia because of pain, anxiety, and other endo-related issues. However, you can help yourself to have a better sleep by talking with your doctor to plan a treatment that reduces your pain and other issues. Meanwhile, some lifestyle hacks such as relaxation techniques, regular exercise, healthy eating, less caffeine, and a good sleep environment can also be helpful.

7 months ago Endometriosis

Silent Endometriosis: What You Need to Know

Endometriosis is a condition where a tissue similar to the lining of the uterus grows outside of it, causing pain and other symptoms. But many people don’t realize there is a type of endometriosis that is often “silent,” meaning it does not cause any symptoms. Let’s explore silent endometriosis and what it means for a person.

What is Silent Endometriosis?

Silent endometriosis, also known as asymptomatic endometriosis, is a condition in which the endometriosis tissue does not cause any pain or other symptoms. This may sound like an oxymoron—how can something be endometriosis if it doesn’t cause pain? But this type of endometriosis occurs more often than you might think. Up to 25% of women with endometriosis have no symptoms. Diagnosis only happens when they have infertility or have another surgery in their pelvis or abdomen.

It’s important to note that silent endometriosis does not mean the condition won’t eventually become symptomatic. Sometimes, silent endometriosis can become symptomatic (painful) endometriosis over time. That’s why people need to be aware of this condition and get tested for it if they experience any signs or symptoms.

How Is Silent Endometriosis Diagnosed?

The only way to diagnose silent endometriosis definitively is through laparoscopic surgery and biopsy. During this procedure, a doctor will make incisions in your abdomen and insert a tiny camera into it so they can see inside your body and examine any endometriosis lesions or growths on your organs. They may also take samples from these lesions for further testing to determine whether or not they are cancerous or benign (noncancerous). However, due to the invasive nature of this procedure, many doctors will only recommend it if signs or symptoms of endometriosis are present.

Silent endometriosis is an often overlooked form of endometriosis due to its lack of obvious signs and symptoms. While some people may never experience any issues related to their silent endometriosis diagnosis, some silent endometriosis can turn into symptomatic conditions. 

7 months ago Endometriosis

Endometriosis in Teens – What You Need to Know

Endometriosis is a painful and often misunderstood condition that affects 1 in 10 individuals assigned female at birth between the age of 15-50. The condition can be particularly difficult for teen girls as they are just beginning to navigate the world of menstrual health. Knowing the signs and symptoms of endometriosis by parents, schools, and individuals can help teens get the treatment they need and make it easier to manage their pain.

What is Endometriosis?

Endometriosis is when cells similar to the lining of the uterus (endometrium) grow outside the uterus onto other organs such as the ovaries or fallopian tubes. Endometriosis causes inflammation, pain, and tissue scarring, making it difficult for some women to become pregnant. Symptoms vary from mild to severe, including pelvic pain during menstruation, heavy periods, pain during intercourse, gastrointestinal issues like cramps or diarrhea, fatigue, and more.

Diagnosing Endometriosis in Teens

If a teen experiences any of these symptoms, taking them seriously and seeking medical attention is essential. Diagnosing endometriosis can be tricky because its symptoms resemble normal period discomfort, ovarian cysts, or uterine fibroids. The doctor may perform a pelvic exam or an ultrasound to look for signs of endometriosis deposits on other organs. In some cases, a laparoscopy might be necessary, which involves using a camera through a tiny incision in the abdomen.

Treatment Options for Teens with Endometriosis

Once a teen has been diagnosed with endometriosis, several treatment options are available depending on their individual needs. Hormonal medications such as birth control pills can help reduce inflammation and regulate hormone levels which may improve symptoms. Other treatments, such as surgery, may also be necessary if the symptoms are severe and do not respond to medications or if infertility is an issue. Physical therapy may also help relieve endometriosis pain by strengthening core muscles or teaching relaxation techniques. On top of it, lifestyle management, including healthy eating, regular exercise, meditation, and mental health, can be beneficial.

Read more: How to Find an Endometriosis Specialist for Diagnosis

Endometriosis is a complex condition that affects many people throughout their lives, but teens especially need extra care due to their developing bodies and hormones. Knowing what symptoms to look out for can help teens get early diagnosis and appropriate treatment, so they don’t have to suffer needlessly from this often debilitating condition any longer than necessary! With proper care and support, a teen can manage their condition and live abundantly despite endometriosis!

7 months ago Endometriosis

How to tell the difference between endometriosis and ovarian cancer

Ovarian cancer and endometriosis are two conditions that can affect a woman’s reproductive system. It is very important to know how they might be related and how they differ. Ovarian cancer is relatively uncommon, with approximately 20,000 new cases found annually in the United States (lifetime risk is 1 in 78). At the same time, millions of women live with endometriosis (up to 1 in 10). Since they share some similar symptoms, you should know the differences between the two to get an accurate diagnosis and proper treatment. This article will explore how to tell the difference between ovarian cancer and endometriosis. 

What is Endometriosis?

Endometriosis is a condition where tissue similar to the lining of the inside of the uterus grows outside of the uterus, such as on the ovaries, fallopian tubes, and other organs in the pelvis and beyond. It can cause pain, infertility, and many other problems. A diagnosis can be suspected by symptoms, blood tests, and various scans, but surgery is the only way to determine if endo is present accurately. 

Learn more about Dr. Steve Vasilev

Symptoms of endometriosis include:

  • Painful periods
  • Pain during sex
  • Chronic pelvic pain
  • Bloating and pain after eating
  • Fatigue
  • Infertility

What is Ovarian Cancer?

Ovarian cancer is a type of cancer that begins in the ovaries and Fallopian tubes. It is often called the “silent killer” because it is difficult to detect in the early stages when it is more curable. Similar to endometriosis, a diagnosis can be suspected using scans and blood tests but the only way to be sure is a biopsy, which is usually performed during surgery. 

Symptoms of ovarian cancer may include:

  • Bloating
  • Pelvic pain or pressure 
  • Abdominal pain, initially vague
  • Difficulty eating or feeling full quickly
  • Urinary symptoms, such as urgency or frequency

So, the symptoms are similar. But there are subtle innuendoes and some clear differences in Endometriosis and Ovarian Cancer findings and symptoms. 

  1. / Pain: While both endometriosis and ovarian cancer can cause pelvic and abdominal pain, the pain from endometriosis tends to be more cyclical, happening around the time of the menstrual cycle. The pain from ovarian cancer, on the other hand, is often more constant and dull. However, there is a lot of overlap, and endometriosis pain is variable.
  1. / Bloating: Bloating due to endometriosis can come and go and is usually caused by intestinal gas caused by endo-induced inflammation and related conditions such as small intestinal bacterial overgrowth (SIBO). Ovarian cancer bloating can also be due to gas and an accumulation of a fluid called ascites. This bloating of ovarian cancer usually worsens and does not come and go. 
  1. / Age: Endometriosis is typically diagnosed in women of reproductive age, while the most common type of ovarian cancer is usually found in women over 50. Again, there is some overlap, and endo can persist into menopause, or symptoms can even begin after menopause.  
  1. / Family history: Women with a family history of ovarian cancer are at a higher risk of developing the disease, and there are genetic links that can be tested for. Conversely, endometriosis does not have a clear genetic link but also runs in families. 
  1. / Symptom duration: The symptoms of endometriosis tend to develop gradually over time (years), while the symptoms of ovarian cancer may come on more suddenly (weeks to months), and bloating can be more pronounced and unremitting.  

In general, ovarian cancer presents an immediate threat to life. Endo, on the other hand, presents a lifelong threat to the quality of life, which may stretch over decades. Unfortunately, the two can overlap because the risk of developing ovarian cancer in women with endometriosis is elevated by 1.5 to 3-fold. That worrisome increase in risk still represents a tiny percentage. But even a fraction of one percent of millions of women means thousands or tens of thousands can be affected. Expert opinion from a specialist and possibly genetic testing can help determine your risk. Research is underway to discover gene-driven biomarkers that will allow more accurate diagnosis. 

It is important to note that both endometriosis and ovarian cancer can have overlapping symptoms, and some women may end up with both conditions simultaneously. If you are experiencing any of the symptoms mentioned above, it is important to talk to your healthcare provider. Many other conditions can cause the symptoms listed. But it’s better to be safe than sorry if they seem to persist and not go away. In other words, for example, everyone can have a bout of stomach flu with bloating, nausea, and painful diarrhea, but it usually passes over a few days to a week. Any unusual symptoms that go longer than that should be evaluated.

Read more: Postmenopausal Malignant Transformation of Endometriosis.


In conclusion, endometriosis and ovarian cancer are distinct conditions affecting the female reproductive system. While they share some similar symptoms, such as pelvic pain, there are substantial differences that can help distinguish between the two. By understanding the differences between endometriosis and ovarian cancer, you and your doctor can take appropriate steps to get the right diagnosis and treatment.  

Getting an expert opinion from a specialist can be critical to get you on the right path for diagnosis and treatment. But, in a situation where you may be worried about both endo and cancer, perhaps because you are older or have a worrisome family history, what type of specialist should you seek for that opinion? In most cases, a general gynecologist can point you in the right direction. But if the concern is not heard and you are left wondering, an endometriosis specialist would be a good bet if endo seems to be most likely. If both are a concern due to your symptoms, age, or family history, then a gynecologic oncologist may be the better bet or an additional opinion to seek. There are a few gynecologic oncologists out there that truly specialize in both endo and ovarian cancer.  

Serdar EB et al Epithelial Mutations in Endometriosis: Link to Ovarian Cancer. Endocrinology 2019 Mar 1;160(3):626-638.

Get in touch with Dr. Steve Vasilev

More articles from Dr. Steve Vasilev:

Endometriosis And Menopause: Everything You Need To Know

Understanding the Connection between Endometriosis and Cancer

What would happen to the signs and symptoms of endometriosis after menopause?

8 months ago Endometriosis

Understanding the Connection between Endometriosis and Cancer

Endometriosis and cancer are very different conditions, but unfortunately, they share some connections. Endometriosis is a benign, painful condition where the tissue that resembles the internal lining of the uterus grows outside of it inside your abdomen and pelvis (and sometimes beyond), causing inflammation and scarring. That reaction causes pain and usually impacts fertility as well. On the other hand, cancer is an uncontrolled malignant growth of abnormal cells that can spread throughout the body and kill.

While endometriosis is not cancerous, it can still act like cancer by directly invading tissues and organs or spreading through the lymphatic and blood systems. Research suggests that there may be molecular links between endometriosis and certain types of cancer, rooted in genetics and epigenetics (the study of how your environment turns genes on and off). Here’s what you need to know.

The overall risk of developing cancer of different types seems to be slightly increased in women with endometriosis. Additional studies point to increased cancer risk in patients with the closely related condition of adenomyosis. The reasons for this are unclear, although molecular connections are being uncovered, and the risk differs by cancer type. 

Endometriosis Cancer Transformation

Endometriosis cells themselves can directly transform or degenerate into cancer. The specific types are clear cell, endometrioid, and, more rarely, stromal sarcoma. No one knows the exact percentage because of the under-reporting of both endometriosis and these cancer transformation events. However, the estimation is only a fraction of 1%. This transformation is a tiny percentage, but if you consider that millions of women have endometriosis, even a tiny percentage means tens of thousands of women may be at risk. 

Endometriosis and Ovarian Cancer

Endometriosis has been linked to an increased risk of developing certain types of ovarian cancer. Studies have found that women with endometriosis are more likely to develop clear cell and endometrioid ovarian cancers than women without the condition. In fact, the risk is estimated to be between 1.5 to 3 times higher in women with endometriosis. The risk is highest when endometriosis significantly involves the ovaries, such as the presence of endometriomas. 

The reasons for this link are not entirely clear. Still, it is thought that the inflammation and scarring caused by endometriosis may increase the risk of cancerous mutations or epigenetic events in the cells. It’s important to note that while the risk has increased, most women with endometriosis will not develop ovarian cancer. However, just as with direct malignant transformation, a small percentage of millions of women with endo can still mean thousands to tens of thousands of women can be affected.  

Endometriosis and Thyroid Cancer

A smaller but statistically significant 1.4-fold higher risk for thyroid cancer has been consistently reported in multiple studies. The reason for this is unknown, but some researchers suggest this link may be based on autoimmunity disorders, which can be shared between endometriosis, thyroid disease, and cancer.

Endometriosis and Breast Cancer

There is also some evidence to suggest that there may be a tiny link between endometriosis and breast cancer, amounting to only about 4% increased risk. Other studies point to a somewhat higher risk. However, this link is not as well established as the link between endometriosis and ovarian cancer, and more research is needed to confirm it.

Endometriosis and Cervical Cancer

Unlike ovarian and breast cancer, there is no clear link between endometriosis and cervical cancer. In fact, a handful of studies suggest that there may be a reduced risk of cervical cancer in women with endometriosis. The reason for this is unknown. 

Endometriosis and Other Cancers

While one might think there may be an association with uterine endometrial cancer, this may or may not be the case. A recent meta-analysis (review of multiple studies) suggested no risk, while other studies have reported a significantly increased risk of endometrial cancer in women with endometriosis and adenomyosis. 

Similarly, there is conflicting information regarding colorectal cancer or skin cancers, including melanoma, leukemia, lymphoma, urinary cancers, and gastric or liver cancer. Of note, while a number of studies reported no increased risk for colon cancer, one study suggested the risk may be as high as thirteen-fold.

Read more: Understanding Endometriosis Through Blood Tests

Managing Your Risk

If you have endometriosis, it’s important to be aware of the potential risks of cancer and take steps to manage your risk. These steps may include regular cancer screening, maintaining a healthy lifestyle, and talking to your doctor about any concerns. In some cases, you may have a genetically founded increased risk. If cancer and/or endometriosis runs in the family, it may be best to consult with an expert. If you are older and have endometriosis, it may also be best to seek expert consultation. It’s important to be aware and proactive, but it’s also important to remember that while the risk may be increased, most women with endometriosis will not develop cancer.

Read more: Postmenopausal Malignant Transformation of Endometriosis

Read more: Managing Endometriosis

Endometriosis and cancer: a systematic review and meta-analysis 

Marina Kvaskoff, Yahya Mahamat-Saleh, Leslie V Farland, Nina Shigesi, Kathryn L Terry, Holly R Harris, Horace Roman, Christian M Becker, Sawsan As-Sanie, Krina T Zondervan … Show more 

Human Reproduction Update, Volume 27, Issue 2, March-April 2021, Pages 393–420,

Get in touch with Dr. Steve Vasilev

More articles from Dr. Steve Vasilev:

Endometriosis And Menopause; Everything You Need To Know

How to tell the difference between endometriosis and ovarian cancer

What would happen to the signs and symptoms of endometriosis after menopause?

8 months ago Endometriosis

Endometriosis vs. PCOS: What’s the Difference?

 Endometriosis and polycystic ovarian syndrome (PCOS) are both conditions that can have a significant impact on a woman’s health. However, despite their similarities, these two conditions are different. In this blog post, we will take a closer look at endometriosis vs PCOS and explain the differences between the two in order to help women better understand what they might be facing.

What is Endometriosis?

Endometriosis is where tissue similar to the internal lines of the uterus grows outside of it. This tissue tends to grow in areas such as the fallopian tubes, ovaries, bladder, or bowel. It can cause pain and infertility. Other symptoms include nausea, constipation or diarrhea during your period, fatigue, and infertility.

Meanwhile, endometriosis is usually treated with surgery to remove any lesions and adhesions that have formed in the pelvic area. Some patients might also take hormones and painkillers for short-term relief from severe pain caused by endometriosis. In some cases, hormone therapy may be recommended to stop ovulation and reduce inflammation associated with endometriosis.

What is PCOS?

Polycystic ovarian syndrome (PCOS) is a hormonal disorder commonly found in women of reproductive age. PCOS can cause enlarged ovaries containing cysts around them (hence its name). Symptoms of PCOS include irregular menstrual cycles, excess body hair growth known as hirsutism, acne breakouts on the face or chest area, and weight gain. PCOS patients have elevated levels of male hormones known as androgens. They also have an imbalance in estrogen and progesterone production, leading to irregular bleeding and fertility issues if left untreated over time. Managing PCOS can include lifestyle changes such as eating healthier foods and exercising regularly. However, if these lifestyle modifications do not work, doctors use medications like metformin to help with insulin resistance and birth control pills to regulate hormones. Surgery is another option for those looking for more permanent solutions.

Despite having similar symptoms, such as irregular periods and difficulty getting pregnant, endometriosis and PCOS are very different conditions with different causes, treatments, and complications. Therefore, it’s essential for women who experience these symptoms to see their doctor immediately so they can get properly diagnosed and begin treatment. By understanding these two conditions better, we can ensure that women receive accurate diagnoses so they can get treatment quickly. Proper care can help the patient manage either of these conditions. It’s important for all women, regardless of age or background knowledge about these types of conditions so that they can stay informed about their reproductive health. As always, communication with your physician will go a long way toward helping you stay healthy!

8 months ago Endometriosis

Endometriosis Pain after Orgasm: What You Need to Know

If you have endometriosis, you know pain is a common symptom. But did you know that some women experience more intense pain after an orgasm? This post will explain what endometriosis pain after orgasm is and what you can do to manage it.

Pain during and after sex is not uncommon for those with endometriosis. Endometriosis occurs when tissue similar to the lining of the uterus (endometrial tissue) grows outside the uterus, resulting in pain and other symptoms. The severity of this condition varies from person to person, but it can cause significant discomfort during sexual activity, especially if the endometriosis lesions are in the pelvic area.

Pain after orgasm is one of the most common side effects of endometriosis. It typically occurs due to increased pressure on the pelvic organs or inflammation in these areas due to sexual activity. This pain may be especially severe if there are adhesions between nearby organs, such as between the uterus and bladder or rectum. In some cases, women may also experience cramping or sharp pains in their abdomen during or shortly after orgasm.

Dr. Steve Vasilev, an endometriosis surgeon, explains it:

Uterine and pelvic floor spasms are part of regular orgasms. When these areas are hypersensitive due to endometriosis, spasms lead to continued contractions and pain that lasts for a while. In addition, rectal fusion to the posterior vaginal wall will also cause more direct pain and inflammation by the vaginal area pulling on the rectal wall. Also, as you probably recognize, any event that stirs up the pelvis and causes some trauma leads to increased molecular signaling, further amplifying the problem. “

Learn more and contact Dr. Steven Vasilev

Fortunately, there are steps you can take to reduce your risk of experiencing painful orgasms due to endometriosis. First and foremost, it’s important to practice good communication with your partner about any discomfort you feel during sex so that they can adjust accordingly. Additionally, certain surgeries and treatments may help reduce endometrial lesions and alleviate associated symptoms. Talk to your doctor about options to find one that works for you!

Endometriosis pain after orgasm is an unfortunately common symptom for those living with this condition. However, you can take steps to minimize this discomfort and ensure that your sexual experiences remain pleasurable! Talk to your doctor about potential treatments and communicate openly with your partner about any discomfort you feel during sex. 

Read more: 20 Signs and Symptoms of Endometriosis

8 months ago Endometriosis

Understanding and Finding Relief from Endometriosis Cramps

If you’re living with endometriosis, you’ve likely experienced the intense cramping and pain that comes along with it. Endometriosis is a chronic condition that can seriously impact your life with pain, cramps, and other symptoms. But there are ways to find relief and get back to living your life. Let’s review endometriosis cramps and how you can relieve endometriosis cramps.

Table of contents:

What is Endometriosis?

Endometriosis Cramps

Finding Support for Endo Pain Management

Managing Endometriosis Cramps

What is Endometriosis?

Endometriosis is a chronic condition in which tissue similar to the lining inside the uterus grows outside of it. This tissue growth can cause severe pain and inflammation during menstruation and throughout the month. Common symptoms include painful periods, cramps, heavy bleeding, pelvic pain, infertility, and fatigue.

Read more: Signs and Symptoms of Endometriosis : Everything You Need to Know

Endometriosis Cramps

Endometriosis cramps are most commonly present in the lower abdomen or pelvis. Patients describe the cramps as sharp and stabbing, severe gnawing or throbbing, and feel like their insides are being pulled down. Cramps might start before the period and last several days. Common causes of cramps include stress, inadequate sleep, and inflammatory foods such as alcohol and red meat.

Finding Support for Endo Pain Management

Living with chronic pain can be difficult for anyone, but resources are available for those with endo pain management needs. Local support groups are excellent options for those seeking community support from individuals who understand firsthand what they are going through. Many online communities also exist where individuals can share their experiences and offer support to one another while learning more about managing their condition on a daily basis. It’s important to remember that you don’t have to suffer alone if you are living with endo pain management needs—there are plenty of resources out there ready to help!


Getting rid of endometriosis cramps needs treating endometriosis and its inflammation. Besides excision surgery and medical management of endometriosis, which are the pillars of endometriosis care, lifestyle modification might have some benefits. Lifestyle habits that might be beneficial include regular exercise, stress management techniques like yoga or meditation, dietary changes such as avoiding processed foods or foods high in sugar or fat, getting enough sleep every night, and taking time for self-care each day. Please consult your doctor for the appropriate care for your cramps.

Endometriosis is a common chronic condition affecting many people worldwide each year. While there is no cure yet for this condition, there are ways to manage its symptoms, such as endo cramps through lifestyle changes, medication options as prescribed by your doctor, or even surgery if necessary. Additionally, online resources and local support groups provide invaluable community support for those living with this condition, so they don’t have to go through it alone! Whether you’re just beginning your journey towards finding relief from endo cramping or have been dealing with this issue for years, you deserve access to resources and care that will help make your life easier!

8 months ago Endometriosis

Three types of endometriosis

Endometriosis is a medical condition that affects an estimated 10% of women in the U.S. alone. It occurs when tissue similar to the endometrium grows outside the uterus. Endometriosis can cause pain and other symptoms that vary in severity depending on your type of endometriosis. Let’s look at the different types of endometriosis and what they mean for your health.

Endometriosis Types

There are three main types of endometriosis, each with its symptoms and treatments. The three categories are superficial peritoneal, ovarian cysts, and deep infiltrating. Here’s a brief overview of each type:

Superficial Peritoneal Endometriosis: This type involves growths on the surface layer of tissue lining the abdomen (the peritoneum). These growths usually appear as small spots or lesions. They can cause pain during periods or intercourse. Treatment typically includes surgery, medication, or lifestyle modification, depending on the patient’s preference and symptoms.

Deep Infiltrating Endometriosis: This type involves growths penetrating deeper into tissues and organs. It can cause extensive scarring, severe pelvic pain, and difficulty getting pregnant. Treatment for this type may include surgical removal of the endometriosis lesions, medical therapy, lifestyle modification, and physical therapy. Deep infiltrating endometriosis can impact any organ in the body, such as the bowel, bladder, diaphragm, etc.

Ovarian Cysts: Also known as “chocolate cysts” because they contain dark-colored tissue and blood. These cysts form on or near the ovaries and can cause pain. Treatment for ovarian cysts may include the removal of the cyst through surgery. 

Read more: The Different Tests Used to Diagnose Endometriosis 

Read more: Understanding the Different Stages of Endometriosis 

Endometriosis is a complex condition with many potential treatments available. In general, there are three types of endometriosis which include superficial endometriosis, deep infiltrating endometriosis, and endometrioma. The type of endometriosis might impact your treatment plan. It’s important to talk with your doctor about your specific case so that you can better understand your diagnosis and treatment options in the future. If you are experiencing any concerning symptoms related to endometriosis, such as pelvic pain or painful sex, make sure you get checked out by a qualified healthcare professional who can provide further guidance on managing your condition effectively!

Read more: 20 Signs and Symptoms of Endometriosis

8 months ago Endometriosis

What would happen to the signs and symptoms of endometriosis after menopause?

Endometriosis in menopause was first recognized over fifty years ago. But, because it is reported in only about 2-5% of women with endo, it is simply not discussed much. The actual percentage may be higher, but the talking points still focus on endometriosis somehow going away after menopause. This is simply not true in all endo patients; in some cases, endo can even start after menopause. 

Unfortunately, there is still much unknown about endometriosis after menopause. Some studies have shown that the severity of symptoms may lessen with age. In contrast, others have found that endometriosis can worsen after menopause, especially when you consider adenomyosis of the uterus which can persist for decades into menopausal years. So, managing the symptoms for many women suffering from this condition becomes a lifelong battle. Suppose you are experiencing pelvic pain or intestinal symptoms that may be related to endometriosis near or after menopause. In that case, it’s important to talk to your doctor about your options for accurate diagnosis and treatment.

Endometriosis and scarring can cause continued pain, cramping, and bowel symptoms after menopause.

Whether it be endometriosis resolving or the effects of prior surgery, scarring is one of the normal processes your body uses to heal. Either persistent active endo or adenomyosis or the scars or fibrosis on various organs and the peritoneum can cause persistent symptoms. Assuming you do not take estrogen replacement with a known history of endometriosis, estrogen in your body still exists in varying amounts because your fat cells convert other hormones or toxins into estrogen. On top of that, the amount of estrogen required to make endo grow varies between individuals, and estrogen is not the only molecular driver to make endo grow. For all these reasons, pain from endo persists into menopause in at least 2-5% of patients. The treatment overlaps regardless of why the symptoms may be present but is not exactly the same.

Reducing the severity of endometriosis symptoms after menopause

What about surgery? Since accurate blood test biomarkers are still not available, surgery can’t be ignored as a possible part of the plan. Regardless of whether it is persistent endo or newly developing endo, scars from endo healing or progressive scarring from prior excisions, expert evaluation for possible surgical intervention should be a cornerstone in planning. Based on a risk vs. benefit discussion with an expert surgeon, a consult with an expert is the best way to determine what is going on after menopause. This consult can help form the best treatment plan beyond the excision of endometriosis, scar, or even possible hysterectomy. If, for example, persistent adenomyosis is the cause of your pain, then surgery may be hands down the best option to eliminate the pain. 

If active endo is responsible for the symptoms, it is possible to reduce symptom severity through some general adjustments. This adjustment includes diet and lifestyle modifications. Reducing stress levels by finding calming activities like yoga or meditation, eating an anti-inflammatory diet high in fiber (to absorb excess estrogen in the gut), and engaging in regular physical activity can all help ease endometriosis pain in some. These are general recommendations and depend on what else, like SIBO or irritable bowel syndromes, may be going on.  

Combining mainstream medication options with integrative support could significantly reduce the discomfort of endometriosis symptoms post-menopause, allowing many women a chance to reclaim their quality of life. The following are some specific considerations. 

Read more: Postmenopausal Malignant Transformation of Endometriosis

– Taking hormone replacement therapy (HRT)

Taking hormone replacement therapy (HRT) is an important treatment decision. HRT is a form of medication that uses hormones to relieve menopausal symptoms. If the uterus is still present, then both estrogen and progesterone are required in order to reduce the risk of uterine cancer. If not, then estrogen replacement therapy (ERT) alone may be better because this means a lower risk of developing breast cancer. However, it is controversial whether HRT or ERT can make endo grow. Scientific data suggests that HRT may be better in this regard, but this is not clear-cut. Similarly, it is unclear if herbal or plant-based estrogen replacement is safe, and, based on complex molecular biology factors, it is probably different in each individual. Always keep in mind that your body is never in a zero-estrogen state because your fat cells convert other hormones into estrogen, and toxins you are constantly exposed to (xenoestrogens) can also factor in.

Read more: Navigating HRT for Menopause in Women with Endometriosis

– Taking pain relievers like ibuprofen or acetaminophen

Taking pain relievers like ibuprofen or acetaminophen might be an effective way to manage intermittent mild to moderate endometriosis pain. Of course, there are side effects that are usually mild, which must be balanced when compared to the benefit of longer-term use. A pain specialist may recommend using stronger medications such as narcotics, gabapentin, or related drugs. Generally, it is not recommended to take any of these medications continuously. More importantly, relying on pain medications alone is like putting a band-aid on a gaping wound without repairing the wound. A better strategy is to deal with the root cause and try to correct it. Determining if the root cause for pain is endo or adenomyosis related in menopause requires a consult with an endometriosis specialist and, ideally, one who specializes in peri and postmenopausal endo.

– Reducing stress with relaxation techniques like yoga or meditation

Yoga and meditation have been demonstrated to effectively mitigate stress levels, which may reduce endometriosis-related symptoms. How this happens is poorly understood, but it may be mediated by cortisol level alterations or epigenetic regulation of pain receptor-related gene expression. This is a very subjective area and hard to study objectively, but research is ongoing. One can’t go wrong with this option because it does not carry risk and can benefit your health in multiple ways. 

– Exercising regularly

Regular exercise is a meaningful way to maintain physical and mental health, whatever your age or circumstances. For endometriosis patients, in particular, being physically active can help reduce inflammation and adapt the body’s response to pain. Studies have also shown that regular workouts may help endometriosis sufferers manage endocrine problems, anxiety, and stress levels. With physical exercise, endometriosis patients benefit from improved quality of sleep too. So this is another low-risk lifestyle modification that can reap many benefits. 

– Pelvic floor therapy

The inflammation from endometriosis and/or direct nerve impingement at the pelvic floor can cause pain in menopause, just like during the reproductive years. The muscles and fascia over-react and spasm, which can be relieved with pelvic floor physical therapy. In some cases, it can help with fibrosis or scar-related pain by restoring normal motion. Usually, this requires a program and is not a one-time deal, so a consultation with a pelvic floor therapist is definitely worth considering. Pelvic floor therapy may or may not be the solution for you. If pain persists, surgical options may still need to be considered to get to the root of the problem.

Don’t suffer with prolonged severe symptoms

After menopause, many women find that their endometriosis and other symptoms still impact their life significantly, even if they follow prudent diet and lifestyle modifications. If you are in this situation, don’t hesitate to speak to an endometriosis expert about the potential benefits and risks of surgery and other treatment options available. Molecular markers for endo may be coming soon, but today surgery is the only way to accurately diagnose endo. Especially when pain persists into menopause or starts in menopause, other conditions may be the cause or overlapping endometriosis and adenomyosis. Surgical treatment may or may not be the right answer for you, but expert guidance and complete evaluation is better than waiting the pain out and hoping it will go away. 

Get in touch with Dr. Steve Vasilev

More articles from Dr. Steve Vasilev:

Endometriosis And Menopause: Everything You Need To Know

How to tell the difference between endometriosis and ovarian cancer

Understanding the Connection between Endometriosis and Cancer

8 months ago Endometriosis

Explaining Endometriosis Pain

Endometriosis is a complex condition affecting over 176 million people worldwide. It can cause pain and other difficult symptoms to explain to friends, family, and medical professionals. Understanding the basics of endometriosis and how to explain its pain can help you advocate for your health. Let’s take a closer look at what endometriosis is and how to discuss its symptoms.

What Is Endometriosis?

Endometriosis is a chronic disorder that occurs when tissue similar to the lining of the uterus grows outside the uterus. This tissue can grow on ovaries, fallopian tubes, or other organs in the pelvic area. Common symptoms include intense cramping during menstruation, pelvic pain throughout the month, and heavy menstrual bleeding. Other common signs include digestive issues like constipation, nausea, or diarrhea; fatigue; painful intercourse; and infertility.

What Does Endometriosis Pain Feel Like?

Endometriosis pain can vary from person to person depending on where the endometrial tissue is. Some common symptoms include pelvic cramping before and during periods; sharp pains in the lower abdomen; pain during or after sex; painful bowel movements; lower back pain; painful urination during periods; and bloating all month long. For some women living with endometriosis, these symptoms may be mild enough to ignore or easily manage with over-the-counter medications like ibuprofen or acetaminophen. However, for many others, these symptoms are severe enough to interfere with their daily activities and require medical intervention for relief.

Explaining Your Endometriosis Pain

If you have been diagnosed with endometriosis, it’s crucial to articulate your condition and its associated pain to get the help you need from medical professionals, friends, and family members. One helpful way to explain your symptoms is by comparing them to something relatable—for example, if you experience sharp pains as part of your endo pain cycle, try saying that they feel like “stabbing pains” or “piercing sensations” in your lower abdomen or back. You could also describe any muscle pain as akin to having bad PMS cramps all month long.

When discussing your condition with others, please provide some context about what endometriosis is and why it causes so much discomfort for those suffering from it. This context will help people better understand why your pain levels fluctuate. Additionally, be sure not to downplay any of your experiences. Instead, focus on being honest about how severe your symptoms are and how they directly impact your life. Give at least one or two real-life examples of how endometriosis has disrupted your life.

Endometriosis is an incredibly painful condition that affects many people worldwide every day. Understanding what this condition entails and the language for articulating its associated pains can help those affected by endo get the treatment they need from their peers and medical professionals. Explaining endometriosis pain to someone who hasn’t experienced it firsthand can be not easy. But understanding what exactly endometriosis is and what type of symptoms it can cause can make it easier for you to express how you’re feeling to others. With knowledge comes power, so learn and try to explain it well!

Now let’s hear from you. How would you explain your endometriosis pain?

8 months ago Endometriosis

20 Signs and Symptoms of Endometriosis

Endometriosis is a chronic, sometimes debilitating condition. Endometriosis means tissue similar to the lining of the uterus (the endometrium) grows outside the uterus. It affects 1 in 10 women between 15-50 and other genders. While there is no cure for endometriosis, understanding the common signs and symptoms can help you get an earlier diagnosis and manage your symptoms more effectively.

Here we discuss 20 symptoms of endometriosis.

Painful Periods 

The most common symptom of endometriosis is pain during or around periods ranging from mild to extreme. This pain may start before or after your period begins. It may be localized in the pelvic region or spread to other parts of your body. The pain may also become worse over time if endometriosis is left untreated. 

Pain During Intercourse 

Intercourse may be uncomfortable or even painful with endometriosis. This type of pain is called dyspareunia and occurs because of endometriosis mass in the pelvis and around the vagina or the adhesions of endometriosis in the pelvis. Adhesions form when scar tissue binds organs together, causing them to stick together instead of sliding against each other as they usually do during intercourse. 

Heavy Bleeding 

Women with endometriosis often experience heavy bleeding during their periods. Heavy bleeding means they must change their pads or tampons more frequently than normal—as often as every hour—or pass large blood clots during their menstrual cycle. Some women also experience spotting throughout their cycles and bleeding between cycles due to endometriosis-related changes in hormones. This heavy bleeding or spotting can be a sign of adenomyosis, which is very common in endometriosis patients.

Fertility Issues 

Endometriosis can cause fertility issues for some women. Infertility can result from inflammation, adhesion, or mass effect of endometriosis lesions on reproductive organs such as ovaries, fallopian tubes, and the uterus. Infertility due to endometriosis can cause a range of emotions, including anger, sadness, and frustration.


Fatigue is a lack of energy and motivation. It is one of the most common signs of endometriosis.

Do you have endometriosis? Contact an endometriosis specialist:

Dr. Andrea Vidali, Endometriosis Specialist, Reproductive Endocrinologist

Dr. Steve Vasilev, Endometriosis Specialist, Integrative Medicine specialist


It might start before a period and last several days. Patients describe it as stabbing, searing, debilitating pain.

Read more: Understanding and Finding Relief from Endometriosis Cramps


Bloating is a complaint in 82.8% of patients with endometriosis. Inflammation, bacterial, immunologic, and hormonal changes might be the likely reasons.


Vomiting might result from endometriosis’s mass effect and hormones on the gastrointestinal tract. It could also be secondary to severe pain and discomfort.


Severe pain and cramps can lead to nausea. Also, with heavy bleeding, you may feel lightheaded or dizzy during your periods which can lead to nausea.


Generally, constipation means the passage of small amounts of hard, dry stool, usually fewer than three times a week.

Chronic constipation in women with endometriosis varies from 12% to 85%. Constipation can result from multiple causes. These causes for constipation include inflammation, scar tissue, damage to pelvic autonomic nerves, pelvic floor muscle dysfunctions, and hypertonic (too much muscle tone) pelvic floor muscles. 


Diarrhea means loose, watery stools that occur more frequently than usual. Endometriosis diarrhea is most likely related to high patient anxiety and hormonal imbalances such as increased prostaglandins.

Read more: Endometriosis and Diarrhea: What You Need to Know

Rectal bleeding

Deep infiltrating endometriosis of the colon can cause cyclic or midcycle rectal bleeding.

Pain with bowel movement

Deep infiltrating endometriosis of the colon can cause a painful bowel movement. Moreover, lesions behind the rectum or anus can cause the same painful bowel movement. 

Rectal fullness

Deep infiltrating endometriosis of the colon can cause the feeling of rectal fullness. Similarly, lesions behind the rectum or anus can cause rectal fullness.

Blood in urine

Deep endometriosis lesions in the bladder and ureter can cause bloody urine during the period or off cycle.

Pain with urination

It is also known as “dysuria.” Deep infiltrating endometriosis of the bladder can cause pain with urination (dysuria).

Excessive urination

It is also known as “frequency.” Deep infiltrating endometriosis of the bladder can cause excessive urination, AKA frequency.

Flank pain

Endometriosis lesions impacting kidneys and ureters can lead to pain in the flank. Also, other pelvic sidewall lesions can have similar flank pain.

Back pain

Low back pain can be present due to the direct impact of endometriosis lesions on lumbosacral bones or nerve roots. Some other explanations of this pain include referral pain of visceral pelvic pain, hypersensitization, and adhesion in the pelvic area that impacts low back joints.

Leg pain

Leg pain occurs due to nerve inflammation or hypersensitization. Nerve inflammation happens due to endometriosis covering nerves such as the sciatic nerve. Another reason for nerve inflammation is the presence of endometriosis in distant places, such as ovaries and pelvic side walls, that compress and inflame nerves.

Ovarian mass 

Endometriosis of ovaries can result in endometrioma. An ovarian endometrioma is a cyst that contains endometriosis tissue and a thick, brown, tar-like fluid. Some may call it a “chocolate cyst.” It can grow to 10-15 cm and present with a mass in the abdomen.

Postcoital bleeding

Bleeding after sex, known as postcoital bleeding, can result from endometriosis lesions in the uterine cervix. With penetration, the endometriosis tissue on the cervix becomes irritated and wounded and starts bleeding.

Read more: What were your uncommon symptoms of endometriosis?

Read more: Does Endometriosis Go Away After Menopause?

There are many other signs and symptoms associated with endometriosis, including shortness of breath, headaches, depression, and anxiety. Suppose you experience any individual or combination of these symptoms regularly. In that case, you must seek medical advice from your doctor so that they can properly diagnose and treat your condition accordingly. An early diagnosis can help you manage your symptoms more effectively, so don’t hesitate to speak with your doctor if you think you suffer from this condition!

Read more:

How to Get an Endometriosis Diagnosis

How to Find an Endometriosis Specialist for Diagnosis, Treatment, & Surgery

8 months ago Endometriosis

A Guide to Ultrasound for Endometriosis Diagnosis

Endometriosis is a chronic and often painful condition that affects many people. One way to diagnose endometriosis is with an ultrasound, which can help your doctor identify most abnormalities in the uterus, ovaries, fallopian tubes, or abdomen and pelvis. Read on to learn more about this diagnostic tool and how it can help you better understand your endometriosis.

What Is Endometriosis?

Endometriosis is a condition in which tissue similar to the lining of the uterus grows outside the uterus. This tissue can grow on or near the ovaries, fallopian tubes, bladder, rectum, or other organs. Symptoms of endometriosis include pelvic pain, heavy menstrual bleeding, and infertility. Most commonly experienced by women during their reproductive years, it’s estimated that 1 in 10 women have endometriosis.

How Can Ultrasound Help?

An ultrasound is a noninvasive imaging test that uses sound waves to create an image of organs or tissues inside your body. An ultrasound may help diagnose abnormalities in your uterus, ovaries, fallopian tubes, or other organs resulting from endometriosis. Using Ultrasound, doctors can get images of these organs and look for signs of abnormal growth or other issues associated with endometriosis. Doctors might suggest transvaginal Ultrasound if they need a better vision of some specific area.

 In some cases, such as suspected ovarian cysts—which are prevalent with endometriosis—your doctor may also order additional tests, such as a blood test. These tests measure cancer markers and hormone levels to determine whether they are high. Your doctor might also need an MRI scan if necessary.

How to Find an Endometriosis Specialist for Diagnosis, Treatment, & Surgery

What Are the Benefits of Ultrasound for Endometriosis?

Ultrasounds are invaluable tools for diagnosing issues related to endometriosis. That is because ultrasounds are quick and noninvasive procedures that allow doctors to see what’s happening inside your body without resorting to surgery or other invasive measures. Additionally, ultrasounds can provide valuable information about the severity of the condition and allow doctors to develop a treatment plan tailored specifically for you based on those results.

What Are the Downsides of Ultrasound for Endometriosis?

A significant downside to Ultrasound is that it is highly operator dependent and requires high skills. This skill dependence means that if your operator has ample experience, they can detect lesions that another operator with less experience might miss. However, some deep endometriosis lesions are invisible in Ultrasound and seem normal even when an expert performs it. These lesions are mostly deep lesions with less visible abnormal mass. Therefore, a negative ultrasound test could be a false negative. 

All in all, ultrasounds are valuable diagnostic tools for diagnosing endometriosis and other conditions related to reproductive health. They offer detailed images without the need for invasive procedures. Therefore they can provide valuable insight into the severity of the situation so you and your doctor can devise an individualized treatment plan together. However, it has downsides of being operator dependent and unable to detect some endometriosis lesions. If you suspect you have endometriosis or another reproductive health issue, talk with your doctor about whether an ultrasound could help them make an accurate diagnosis sooner rather than later.


Patients Use These Strategies to Manage Endometriosis Flare-Ups

Endometriosis is a chronic condition that affects millions of women, causing pain and discomfort. Flare-ups are especially difficult and can be debilitating. Flare-up occurs when the symptoms become exacerbated. Flares amplify symptoms of the disease and ultimately decline after a while. Fortunately, some patients have found ways to cope with flare-ups to manage the pain and other symptoms. Let’s look at some strategies that others use for dealing with endometriosis flare-ups. Please notice that none of these discussions are medical tips.

What Causes Endometriosis Flare-Ups?

Flare-ups often occur when there is a trigger, such as hormonal imbalance, physical activity, stress levels, or certain environmental factors like heat or humidity. These triggers can lead to an increase in pain and discomfort for those affected by endometriosis.

Practice Relaxation Techniques

It can be hard to relax when you’re in the middle of an endometriosis flare-up. But relaxation techniques like meditation and deep breathing can help reduce stress levels and give your mind and body a much-needed break from the pain. If you’re feeling overwhelmed or anxious, try taking some slow breaths or focusing on an object in front of you until your mind calms down. You can also practice progressive muscle relaxation by tensing one muscle group at a time before releasing it. This relaxation will help release tension throughout your body while also helping to lower your heart rate and blood pressure.

Manage Your Stress Levels

Stress is known to trigger endometriosis flare-ups, so it’s important to find ways to manage your stress levels. Exercise is a great way to reduce stress and provide numerous other health benefits, such as improved mood, better sleep quality, and increased energy levels. Yoga is another great option as it combines physical activity with relaxation techniques which can be beneficial for managing endometriosis flare-ups. Other stress management strategies include talking about your feelings with someone who understands what you’re going through or writing in a journal about how you’re feeling.

Take Time for Yourself

When dealing with an endometriosis flare-up, it’s also important to take time for yourself, even if it’s just a few minutes each day! Do something that makes you happy, whether listening to music, reading a book, or watching your favorite movie – whatever brings you joy! Taking time out for yourself will give your mind and body a chance to rest and recharge.

Endometriosis flare-ups can be difficult, but some patients have found ways to cope with them that can make them more manageable. Taking some time out for yourself, practicing relaxation techniques such as meditation or yoga, exercising regularly, managing stress levels effectively, and talking about how you feel are all effective strategies for dealing with endometriosis flare-ups. By taking these steps consistently, people with endometriosis might manage their flares up more easily!

9 months ago Endometriosis

Pregnancy and Endometriosis: What to Expect

Endometriosis is a common health condition in women. It is caused by tissue similar to the lining of the uterus growing outside the uterus. This tissue can cause painful symptoms and can lead to infertility. Although it may seem impossible for those with endometriosis, options are available for those who want to become pregnant. Let’s look at what you need to know about pregnancy and endometriosis.

Treating the Pain of Endometriosis Before Getting Pregnant

When it comes to getting pregnant with endometriosis, one of the first steps should be controlling your pain. The pain associated with endometriosis can make it difficult for some women to conceive, as intercourse becomes too uncomfortable or even dangerous for many patients. It is important to discuss treatment options with your doctor before attempting to get pregnant. Depending on your symptoms, these treatments could range from oral or topical medications, intrauterine devices (IUDs), hormone therapy, and, ultimately, surgery.

Options for Getting Pregnant With Endometriosis

Once your severe pain is under control, you can consider potential fertility treatments to become pregnant. In some cases, simply taking hormone therapies such as Clomid can be enough to help induce ovulation and conception. If this does not work, more invasive techniques such as IUI or IVF (in vitro fertilization) may be used. During IVF, eggs are collected from the woman’s body and combined with sperm in a laboratory dish before being implanted into her uterus. IVF gives doctors greater control over the process than traditional methods of conception. It has a high chance of success because, in this method, you bypass any blockages in the reproductive organs. But pregnancy is still not guaranteed.

Managing Your Symptoms During Pregnancy

Once pregnant, you must manage your symptoms carefully to ensure healthy delivery and minimize any risks associated with endometriosis during childbirth. Women who have endometriosis should speak with their doctor regularly throughout their pregnancy so they can monitor any changes in symptoms or side effects that occur due to hormonal changes within the body during pregnancy. Additionally, it is essential that women who have had fertility treatments closely follow their doctor’s instructions regarding diet and exercise.

For many women suffering from endometriosis, getting pregnant can seem impossible—but this doesn’t have to be true! By speaking with an expert about endometriosis treatment options and following any instructions during pregnancy, women with endometriosis might be able to successfully conceive and carry a baby full-term. Ultimately, becoming pregnant and delivering a healthy baby despite having endometriosis is possible but might require extra steps and close monitoring for everything to go smoothly!

9 months ago Endometriosis

How to Get an Endometriosis Diagnosis

Endometriosis is a common disorder. According to the Office on Women’s Health, it affects an estimated 1 in 10 women between the ages of 15 and 44. Although endometriosis can be painful, one can manage it with the proper diagnosis and treatment. So if you think you have endometriosis, here’s how to get an appropriate diagnosis.

Seek Out a Medical Professional

The first step in getting an endometriosis diagnosis is to seek help from a medical professional. If you already have one, start by discussing your symptoms with them, mention the word endometriosis, and ask for their advice on how to proceed. It’s important to note that endometriosis can manifest itself in different ways depending on the individual, so it’s essential to talk about all of your symptoms with your doctor or gynecologist.

Get Tested

After speaking with your doctor or gynecologist, they may recommend getting tested for endometriosis. The most common diagnostic tests are ultrasound imaging and laparoscopy (a minimally invasive surgical procedure). Ultrasound imaging uses sound waves to create images of internal organs and tissues, which can help identify abnormalities associated with endometriosis. But ultrasound can still miss some endometriosis lesions. So if the ultrasound results came negative, there is still a chance you have endometriosis. Laparoscopy involves surgically inserting a thin tube (called a laparoscope) into the abdomen through small incisions. Then surgeons look inside the abdominal cavity for any signs of endometriosis. The surgeon typically takes several biopsies to send for histopathology to confirm endometriosis. Histopathology is the gold standard of diagnosis for endometriosis.

Follow Up Care

Once you receive your positive test results, you must follow up with your doctor or gynecologist for further care and advice on managing your symptoms, such as pain, bloating, fatigue, and infertility. Depending on the severity of the condition, your doctor may recommend lifestyle changes such as diet modifications or exercise regimens, as well as hormonal therapies or medications such as birth control pills or anti-inflammatory drugs. The ultimate treatment for endometriosis is excision surgery, removing the endometriosis lesions from your body. Many experts consider excision surgery the gold standard of treatment for endometriosis. This excision surgery needs an experienced and skilled surgeon to deliver the desired results.

After speaking with your doctor or gynecologist about any possible signs of endometriosis, they may recommend ultrasound imaging or laparoscopic surgery to confirm and properly diagnose it. Once diagnosed, following up with them for additional care is essential to ensure proper management of symptoms and reduce pain levels associated with this disorder. With the right treatment plan, living with endometriosis doesn’t have to be difficult–so don’t hesitate; seek out help today!

Top Endometriosis Specialists/doctors

How to Find an Endometriosis Specialist for Diagnosis, Treatment, & Surgery

9 months ago Endometriosis

What to Expect Before and After Endometriosis Surgery

 Endometriosis is a condition that affects millions of people worldwide. As a result, many patients opt for endometriosis surgery to manage the symptoms and reduce the discomfort associated with the disease. If you’re considering endometriosis surgery, you may have questions about what to expect before and after the procedure. Let’s dive into the details.

Table of contents:

What Happens Before Endometriosis Surgery?

What Happens During Endometriosis Surgery?

What Happens After Endometriosis Surgery?

What Happens Before Endometriosis Surgery?

Your doctor will likely perform some tests before scheduling your surgery, including imaging tests such as an ultrasound or MRI and hormone tests to check your estrogen levels. Your doctor will also take a medical history and discuss your current symptoms to better understand how your endometriosis has progressed. It’s essential, to be honest about medications, allergies, and other health conditions that could affect your treatment options or surgical outcome. There will also be a physical exam, including a pelvic exam. Your doctor tries to learn your body and pinpoint any tumors, pain, or abnormality during this physical exam. The result of that physical exam might guide the surgery strategy.

What Happens During Endometriosis Surgery?

This surgery often needs general anesthesia, so doctors put you to sleep during the surgery. Endometriosis surgery is typically performed laparoscopically or with a robot. That means your surgeon will make three to four small incisions in the abdomen and pelvic area. Then they insert a surgical tool with a tiny camera to help them see inside your body during the procedure. The primary goal of endometriosis surgery is to remove any areas of abnormal tissue or scarring caused by endometriosis growth while preserving healthy tissue as much as possible. Depending on the severity of your condition, the surgeon may remove specific organs partially or entirely to reduce pain and improve fertility outcomes. Your surgeon should discuss these possibilities and ask for your consent before surgery.

What Happens After Endometriosis Surgery?

After your surgery, it’s important to rest for several days or weeks so your body can heal properly. Your doctor may prescribe medications to help manage pain or inflammation during the post-surgical period. You must take these medications exactly as prescribed to minimize potential complications. You should also avoid strenuous activities such as heavy lifting or running during recovery; instead, with your doctor’s permission, stick with light exercises like walking or yoga until your doctor clears you for more demanding activity levels.

Endometriosis is a common condition among patients, but it doesn’t have to impede their quality of life. With modern treatments such as endometriosis surgery, patients can find relief from their symptoms while still preserving healthy tissues whenever possible. It’s crucial for those considering endometriosis surgery to understand what happens before, during, and after the procedure to know what steps they need to take to ensure successful recovery afterward. With proper preparation and informed decision-making about treatment options, you can have less anxiety during this period and get back on track with living your life after surgery.

9 months ago Endometriosis

Understanding the Different Stages of Endometriosis 

Endometriosis is a condition that affects nearly 10% of women in the United States. It occurs when tissue similar to the lining of the uterus grows outside the uterus, causing pain and other symptoms. The severity of endometriosis can vary from person to person and impact the treatment strategy. So it’s essential to know the different stages of endometriosis and how they affect your body. Here we review the most common classification of endometriosis introduced by ASRM (American Society for Reproductive Medicine.)

Stage 1 Endometriosis (Minimal): superficial small lesions or implants outside the uterus or near pelvic organs.  

Stage 2 Endometriosis (Mild): encompasses more and deeper implants in the pelvic area. 

Stage 3 Endometriosis (Moderate): This is a deep infiltrating endometriosis stage. In this stage, many deep implants are in the pelvic area and other body parts. There are small cysts on one or both ovaries. Some adhesions are present in the abdomen and pelvis. 

Stage 4 Endometriosis (Severe): A deep infiltrating endometriosis stage. This is the most severe stage. There are many deep lesions, large cysts on one or both ovaries, and dense abdomen and pelvis adhesions.

Three types of endometriosis

Knowing what stage of endometriosis you have can help you understand your condition better and guide your doctor in developing an appropriate treatment plan. If you suspect you have endometriosis, make sure to speak with your gynecologist for proper diagnosis and treatment. No matter what stage you are at with your endometriosis diagnosis, good management will help improve your quality of life and reduce pain and long-term complications from this condition.

How to Find an Endometriosis Specialist for Diagnosis, Treatment, & Surgery

9 months ago Endometriosis

Endometriosis and Diarrhea: What You Need to Know

Endometriosis is an often misunderstood condition estimated to affect up to 10% of women. It also affects other gender groups. The primary symptom of endometriosis is pelvic pain, but it can also cause a wide range of other symptoms, including diarrhea. If you are experiencing chronic diarrhea and pelvic pain, it may be worth exploring whether endometriosis could be the cause. 

What is Endometriosis? 

Endometriosis occurs when tissue similar to the lining of the uterus grows outside the uterus. Endometriosis can lead to inflammation and scarring in the pelvic area, resulting in many symptoms, from painful periods to infertility. It is unclear what causes endometriosis, but experts believe that hormones, genetics, and immune system issues may play a role. 

Diarrhea and Endometriosis 

Diarrhea is one of the many potential symptoms associated with endometriosis. People with endometriosis may experience chronic diarrhea or bouts of diarrhea during their period or ovulation days. It’s important to note that other conditions could cause similar symptoms, such as IBS (Inflammatory Bowel Symptoms), infections, or food allergies. So if you’re experiencing chronic diarrhea, you must speak to your doctor about getting tested for these conditions and endometriosis.  

The underlying cause of endo-related diarrhea likely involves hormonal imbalances, which result in changes in gut flora and motility (movement) in the intestines. Additionally, inflammation resulting from endo lesions can put pressure on organs like the bladder or intestines, which can contribute to digestive issues like diarrhea. Treatments for this type of symptom include surgery, hormone therapy, diet modification (such as avoiding dairy products), stress reduction techniques, and over-the-counter medications such as Pepto-Bismol or Imodium for short-term relief. Your doctor will help you have a treatment plan based on your specific needs.

If you are experiencing chronic diarrhea along with other symptoms like pelvic pain or cramping, then it may be worth exploring whether endometriosis could be causing your discomfort. Speak with your doctor about getting tested for this condition and other underlying causes, such as IBS or food allergies. Treatment options depend on what type of symptom you’re experiencing. Still, they typically involve surgery, hormone therapy, dietary modifications, stress reduction techniques, and over-the-counter medications for short-term relief while waiting for treatment effects to take hold. If you think you might have endometriosis, don’t hesitate to talk to a doctor today!

Read more: 20 Signs and Symptoms of Endometriosis

9 months ago Endometriosis

Endo Belly: A Guide to Understanding the Symptoms and Causes

Endo belly—sometimes referred to as endometriosis-related bloating—is a symptom of endometriosis. Endometriosis is a chronic inflammatory disorder affecting millions of people worldwide. This condition can be painful and cause significant disruption to daily life. In this blog post, we’ll cover what endo belly is, its symptoms, and potential causes. 

What is Endo Belly? 

Endo belly is a common symptom of endometriosis in which individuals experience bloating or swelling in their abdominal region. The bloating often causes pain and discomfort. Some women may find that their stomachs look visibly larger during an episode of endo belly. This disorder can occur before or after menstruation and can last for days or weeks. 

Read more: Understanding and Managing Endo Belly: A Comprehensive Guide.

Symptoms of Endo Belly 

In addition to bloating and swelling of the abdomen, other symptoms of endo belly may include pain in the lower back, cramping, fatigue, nausea and vomiting, constipation or diarrhea, and difficulty sleeping due to discomfort. It’s important to note that not all women with endometriosis will experience endo belly. 

Potential Causes of Endo Belly 

The exact cause of endometriosis is still unknown, but there are several possible theories as to why it occurs. One theory is that hormones play a role in causing inflammation in the abdominal area; another suggests that the bacteria in the gut system can create severe bloating. Some others suggest that retrograde menstruation—in which menstrual blood flows backward through the fallopian tubes into the abdomen instead of out through the vagina—may be responsible for some cases. Yet another suggests immune system dysfunction or genetic factors could also be involved in causing endometriosis-related bloating. Regardless of the cause(s), it is a physically and mentally painful symptom. 

Endo belly is a common symptom in many individuals with endometriosis. While the exact cause remains unclear, understanding how this condition affects your body can help you better manage your symptoms if you are one of those experiencing it. Suppose you are experiencing endo belly. In that case, we recommend speaking with your doctor as soon as possible so they can diagnose your condition correctly and provide an appropriate treatment plan tailored specifically for you.  

9 months ago Endometriosis

Managing Endometriosis: What You Need to Know 

Endometriosis is a common condition that occurs when tissue similar to the interior layer of the uterus grows outside the uterus. These pathologic tissues respond to hormones, nutrition, lifestyle, and stress level. Endometriosis can cause pain, fatigue, other symptoms, and infertility. Fortunately, there are several ways to manage endometriosis and reduce its effects on your life. Let’s look at what you need to know about managing endometriosis. 

Can endometriosis be cured completely?

Hormonal Therapy for Endometriosis Management 

Hormonal therapy is one of the most common treatments for endometriosis management. Hormones like progestins and birth control pills work by suppressing ovulation and reducing estrogen levels in the body, which helps reduce the growth of endometriosis tissue. While this treatment may not be suitable for everyone, it can effectively reduce pain and other symptoms associated with endometriosis. But it is not a cure or a permanent solution. You might feel better if you take hormonal therapy, and endometriosis symptoms most likely come back whenever you stop the medication.

Surgery for Endometriosis Management 

Surgery may sometimes be the best choice to treat endometriosis and alleviate its symptoms. Endometriosis surgeons use laparoscopes or robots to remove most endometriosis and adhesions or cysts. After surgery, your doctor may also prescribe hormonal therapy to help keep the condition under control. Your endometriosis surgeon might also recommend physical therapy before or after surgery to help manage symptoms and regain your functions.

Physical Therapy for the Management of Endometriosis

Physical therapists can have a significant impact on your life with endometriosis. They can help you know your body better and understand your limitations. A physical therapist or occupational therapist might be a great resource if you have any pelvic area spasms or movement limitations because of endometriosis pain.

Physical Therapy Before Excision Surgery for Endometriosis

Physical Therapy after excision surgery

Questions to Ask Your Physical Therapist When you have endometriosis

Dietary Changes for Endometriosis Management    

Making dietary changes can also help manage endometriosis symptoms and reduce inflammation in your body. Eating fruits and vegetables—especially those rich in antioxidants—can help reduce inflammation and improve overall health. Avoiding processed foods and refined sugars can also help lessen symptoms associated with this condition. You need a dietitian to help you with this dietary planning. 

Lifestyle Changes for Endometriosis Management

More body fat can mean higher estrogen and higher inflammation levels. Therefore, some healthy changes in your lifestyle to optimize the fat storage in your body can positively impact endometriosis management and symptoms. These changes can mean more physical activity or less junk food, or else. You are the best person to decide what lifestyle you should pursue. Moreover, a healthy lifestyle can improve your mental health and quality of life.

People with endometriosis should talk to their doctor about treatment options that are right for them to manage their condition effectively. In many cases, combining hormonal therapy, surgery, lifestyle, physical therapy, and dietary changes can help reduce pain and other symptoms associated with this condition. The goal should be for you to live a fuller life free from endometriosis effects. With proper management strategies, people with endometriosis can live healthier lives despite their diagnosis!

Find the best endometriosis specialists around the world!

9 months ago Endometriosis

What You Need to Know About Endometriosis Excision Surgery

Endometriosis is a gynecological condition that affects approximately 10% of women between 15-55. It can cause chronic pain, infertility, and other issues. It happens when a similar tissue to tissue that lines the uterus grows outside of the uterus. One way to manage endometriosis is through endometriosis excision surgery. Let’s take a deeper look into what this surgery involves. 

The Procedure 

Endometriosis excision surgery is a procedure in which a gynecologist uses specialized tools and techniques to remove endometriosis tissue from the pelvis, abdomen, and other regions. Excision means removing the tissue from organs near the uterus, such as the ovaries, fallopian tubes, bladder, rectum, or intestines. The doctor will remove any adhesions (scar tissue) causing pelvic pain or threatening fertility. The surgery requires an outpatient surgery center or a hospital operating room.

Benefits of Endometriosis Excision Surgery 

Endometriosis excision surgery aims to reduce or eliminate the pain caused by endometriosis growths, improve fertility outcomes for those who want children, and prevent new growths from developing. In some cases, patients can experience improved symptoms after just one procedure; however, some patients may need multiple surgeries. This need for repeat surgeries depends on the surgeon’s experience, disease behavior and severity, and some unknown factors.

Precautions to Take Before Surgery 

Before undergoing endometriosis excision surgery, you should speak with your doctor about any concerns about anesthesia or other risks associated with the procedure. Additionally, depending on the severity of your condition and your treatment goals (fertility vs. symptom relief), other treatments may need to be considered before considering surgical intervention. 

Talk with your doctor first to ensure that endometriosis excision surgery is right for your needs. If you have questions about this procedure or any other treatments available for managing endometriosis symptoms, don’t hesitate to reach out to your healthcare provider today! They will help you determine if endo excision surgery is a good option.

Endometriosis Surgery Costs: Everything You Need to Know

Have you considered endometriosis excision surgery? What is your most burning question about endometriosis excision surgery?

9 months ago Endometriosis

Understanding Endometriosis Through Blood Tests

Endometriosis is a condition in which tissue similar to endometrial cells grows outside the uterus and can cause severe pain, discomfort, and infertility. While many women with endometriosis experience physical symptoms such as abdominal pain or cramping, it can be challenging to diagnose without a medical professional. A blood test is one-way doctors can help narrow down the diagnosis. Let’s explore how this works.

What Can Blood Tests Show? 

Blood tests help measure levels of hormones in the body that could indicate endometriosis. The two most common hormones related to the condition are estradiol (an estrogen hormone) and progesterone (a progestin hormone). High estradiol levels can indicate an imbalance in female hormones, which may be associated with endometriosis. Low progesterone levels suggest an underlying issue with the reproductive system.

In addition, some blood tests specifically measure for markers like CA-125, a protein in high concentrations in some women with endometriosis. By measuring these markers alongside other hormonal levels, doctors can build a better picture of your overall health and determine whether or not you may have endometriosis. 

Can endometriosis be cured completely?

It’s important to note that blood tests alone aren’t enough to make a definitive diagnosis. Your doctor will likely need to perform additional tests, such as an ultrasound, MRI, or laparoscopy before they can confirm if you have endometriosis. 

Endometriosis Signs and Symptoms: Everything You Need to Know

How do doctors test for endometriosis?

While blood tests cannot definitively diagnose endometriosis, they can provide valuable information about your overall health that could help guide diagnosis and treatment decisions. If you think you may be suffering from this condition, you must speak with your doctor so they can determine the best approach for testing and treatment options based on your individual needs. Taking proactive care now will help ensure better long-term outcomes for managing your condition effectively and efficiently!

9 months ago Endometriosis

A Guide to Endometriosis Surgery and Its Success Rate

Endometriosis is a condition in which tissue similar to the uterine lining grows outside the uterus. Endometriosis can cause pain, heavy bleeding, and infertility. Women seeking relief from endometriosis symptoms and want to maintain their fertility consider surgery an option. This guide will discuss the types of endometriosis surgery available and their success rates. 

Types of Endometriosis Surgery 

Two types of endometriosis surgery are available: minimally invasive (laparoscopy and robotics) and open abdominal surgery. In a minimally invasive procedure, a thin tube with a camera and tiny surgical instruments are inserted into the abdomen through small incisions in the belly area. During the minimally invasive procedure, surgeons can remove or destroy endometriosis tissue with lasers or other tools. Open abdominal surgery involves making a wide incision in the abdomen to access any affected areas directly and remove them surgically. Most top surgeons with significant experience prefer minimally invasive surgeries with laparoscopy or robotics.

Success Rates 

The success rate of endometriosis surgeries depends on factors such as the severity of symptoms, type of procedure performed, and experience of the surgeon performing the procedure, etc. Patients can achieve complete or partial relief in complaints in up to 93.2% of cases with surgery. And 65% of those wishing for pregnancy but were unsuccessful in the past, could conceive after surgery. Some experts believe success rate increases when additional treatments such as hormone therapy or medications are used following surgery to reduce recurrence risk. But hormonal therapy after surgery is not an option if you plan to conceive right after recovery. Minimally invasive surgery is superior to open surgeries because it results in lower risk of surgical complications, such as bleeding, infection and damage to other abdominal organs. Minimally invasive procedure also offers faster recovery compared to open surgery.

Endometriosis can cause significant physical discomfort and emotional distress for individuals living with it. However, fortunately, some treatments can relieve painful symptoms while still allowing to maintain fertility if desired. Surgery is one such treatment option and provides varying levels of success depending on factors such as experience level, the severity of the disease, and the type of procedure used. Studies have found that up to 93% of patients report partial or complete decreased pain after undergoing endometriosis surgery. And 65% of patients achieved pregnancy after surgery. Talk with your doctor if you think you are suffering from this condition. Discuss testing options and treatment plans, including surgical interventions, so that you can take control of your health today!

Find the best endometriosis specialists around the world!

Featured specialists:

9 months ago Endometriosis

Can endometriosis be cured completely?

Endometriosis is a common condition that affects 1 in 10 women between 15 and 55 years old. It occurs when tissue similar to the lining of the uterus grows outside the uterus. Endometriosis can cause painful periods and sex, abdominal pain, and fertility issues. But what exactly is endometriosis, and can it be cured? Let’s take a closer look.

Table of contents:

What causes endometriosis?

Can Endometriosis Be Cured Completely?

What Causes Endometriosis? 

The exact cause of endometriosis is unknown, but several theories exist about how it develops. One theory suggests that during menstruation, some of the uterine linings flow back through the fallopian tubes and into the abdomen, where it implants and begins to grow. Another theory suggests that stem cells present in the body can transform into endometriosis tissue. 

Managing Endometriosis: What You Need to Know 

Can Endometriosis Be Cured Completely? 

Unfortunately, no—endometriosis cannot be cured entirely at this time. However, there are treatments available to alleviate symptoms. These treatments include hormonal medications or surgery, depending on your condition’s severity and preferences. Hormonal medications such as birth control pills or hormone-releasing IUDs may help reduce pain and stop endometriosis growth from progressing further by stopping ovulation and changing hormone levels in your body. Surgery may also be a choice, especially if you have severe symptoms that are not responding to routine treatments. Surgery is also more desirable with deeply infiltrated lesions or cysts on your organs, such as your ovaries or intestines. 

How do doctors test for endometriosis?

Endometriosis affects millions of women worldwide. Although not curable, you can manage this disease with proper surgery, medical care, and lifestyle plans. Lifestyle steps such as maintaining a healthy diet, exercising regularly, reducing stress levels, and avoiding certain foods known to worsen your symptoms can be helpful. Although there is currently no cure for endometriosis, many treatment options exist that can help minimize symptoms. These treatment options can help you lead a near-normal life and improve pain or fertility issues. If you suspect you have endometriosis, talk to your doctor about available treatments for managing your condition today!

9 months ago Endometriosis

Laparoscopy: A Common Treatment for Endometriosis

Endometriosis is a common condition that mainly affects women of reproductive age. It occurs when tissue similar to the uterine lining grows outside the uterus, typically on other organs in the pelvic area. One of the most common treatments for endometriosis is laparoscopy, a minimally invasive surgical procedure used to diagnose and treat the disorder. Let’s take a closer look at what this procedure entails.

How Laparoscopy Works 

During a laparoscopy, your doctor will insert a thin, lighted tube called a laparoscope through small incisions in your belly. The laparoscope allows your doctor to see inside your abdomen and pelvis and identify areas of endometriosis tissue growth. In some cases, they may also use laparoscopic tools to remove any abnormal tissue growth they find during this process. 

This procedure can be performed in several ways. Your doctor may perform it under general anesthesia, where you are completely asleep during the operation. Depending on what your doctor finds during the laparoscopy, they may perform additional procedures, such as removing cysts or scarring caused by endometriosis. 

Recovery from Laparoscopy 

The recovery time after a laparoscopic surgery depends on several factors, including how extensive the procedure was and how long it took to complete. Most people return home within 24 hours after having this done and can expect to recover fully within two to six weeks with minimal pain or discomfort afterward. You should follow all your doctor’s post-operative instructions, including taking medications as prescribed and avoiding strenuous activities like heavy lifting until your healthcare provider clears you to resume normal activities.

Can You Get Pregnant with Endometriosis?

Laparoscopies can be an effective way to diagnose and treat endometriosis in women of reproductive age. This minimally invasive surgical procedure involves inserting thin, lighted tubes into incisions on your belly to identify areas of endometrial tissue growth that could be causing pain and other symptoms. While recovery time varies depending on the procedure’s extent, most people can return home within 24 hours and resume their normal activities within two weeks or so with minimal pain or discomfort afterward. If you think you may have endometriosis, talk to your healthcare provider about whether laparoscopy works for you!
Does Endometriosis Cause Infertility?


10 months ago Endometriosis

The Different Tests Used to Diagnose Endometriosis 

Endometriosis is a common condition affecting an estimated 10% of women in the United States. Unfortunately, it can be tricky to diagnose, and no single test can definitively confirm it. To diagnose endometriosis, doctors must use a combination of tests. This blog post will discuss the different tests used for diagnosing endometriosis. 

History and Physical Exam 

The first step in diagnosing endometriosis is taking a history and a physical exam. During this exam, your doctor will assess your abdomen and pelvis for any signs of swelling or tenderness. They may also order blood work to check hormone levels and screen for other conditions with similar symptoms. 

Can you see endometriosis on blood test?

Imaging Tests 

Your doctor may also order imaging tests such as an ultrasound or MRI (magnetic resonance imaging) scan to better look at your reproductive organs and rule out any other possible causes of your symptoms. Ultrasounds use sound waves to create images of internal organs. MRIs use magnetic fields to produce detailed images of soft tissue structures like the uterus and ovaries. 


Finally, if all other tests come back inconclusive or your doctor suspects endometriosis due to its similarity with other conditions, they may recommend a laparoscopy. This procedure involves inserting a tiny camera into the abdomen through small incisions near the navel area. This tiny camera allows them to look at the pelvic area better and take samples for further testing if necessary. Laparoscopies are usually done under general anesthesia, so you will not feel anything during the procedure. 

Endometriosis can be hard to diagnose because its symptoms are often very similar to other conditions, such as period discomfort, ovarian cysts, or pelvic inflammatory disease. If you think you have endometriosis, you must talk to your doctor as soon as possible so they can determine what type of testing is right for you and how best to treat it. Working with the right healthcare provider ensures you receive the best care possible for managing your condition and improving your overall quality of life.

10 months ago Endometriosis

Endometriosis Surgery Risks

Endometriosis is a condition that affects millions of women around the world. Endometriosis occurs when tissue similar to the tissue found in the uterus grows outside the uterus. This can create intense pain and other health complications, such as infertility. While surgery may be an option for some, it is essential to understand the risks associated with endometriosis surgery before making a decision.

Types of Surgery for Endometriosis 

Several types of surgeries exist to treat endometriosis, including minimally invasive (laparoscopy or robotics) and open surgery (laparotomy.) Minimally invasive surgery typically involves making small incisions in the abdomen so that a camera can be inserted into the body to view abnormal endometriosis growths or lesions. Laparotomy involves a larger incision and allows for more extensive examination and treatment. Almost all top endometriosis surgeons worldwide prefer minimally invasive surgery vs. open surgery.

Endometriosis surgery costs

Risks Associated With Endometriosis Surgery 

As with any surgery, there are risks associated with endometriosis surgery. These include bleeding, infection, and nerve damage due to surgery or anesthesia during the procedure. During surgical procedures, there is also a risk of harm to surrounding organs such as the bladder or bowels. Additionally, there is a risk that a surgeon will not remove all of the endometriosis tissue during surgery. This incomplete removal could lead to recurrent symptoms or disease if not appropriately addressed by your doctor post-surgery.

Other Treatment Options for Endometriosis 

Suppose you are concerned about undergoing surgery for your endometriosis. In that case, other treatment options are available such as hormone therapy or medications used to reduce pain and inflammation caused by endometrial growths or lesions. Additionally, lifestyle changes such as exercise and diet might help reduce endometriosis’s associated symptoms without requiring surgery. Speak with your doctor about other options that may work best for you before deciding on any procedure related to your endometriosis diagnosis.

Find the best endometriosis specialists around the world!

Featured specialists:

10 months ago Endometriosis

Endometriosis Surgery Costs: Everything You Need to Know

Endometriosis is a chronic gynecological disorder that affects many women. One of the treatments for endometriosis is surgery, which can be expensive. This post will discuss what endometriosis surgery costs and how you can manage these costs. 

What to Expect Before and After Endometriosis Surgery

Endometriosis surgery costs

Endometriosis surgery needs minimally invasive tools such as laparoscopy and robotics. The surgery usually includes a general anesthetic to reduce pain and discomfort during the procedure. Surgery removes endometrial tissue, scar tissue, and other growths from around the uterus and other organs in the pelvic region. This type of surgery can cost anywhere from $2,500 to $7,500. The cost depends on where you perform the surgery, how severe your endometriosis is, and how long it takes to complete the procedure. 

How you can manage endometriosis surgery costs?

Other options are available if you don’t have insurance coverage or if your insurance does not cover the cost of endometriosis surgery. Some hospitals offer payment plans or discounts if you pay all or part of your bill upfront. You may also qualify for financial aid programs or grants provided by local organizations or charities that help cover medical expenses for those with limited incomes. Additionally, some states assist with Medicaid programs that can help cover some or all of your medical costs related to endometriosis treatment. 

Endometriosis surgery risks

It would be best if you spoke with your doctor about your options before deciding which route to take in terms of paying for endometriosis surgery. Your doctor can recommend a hospital that offers discounted rates or a payment plan that makes it easier for you to manage costs associated with treatment. Many healthcare providers also offer free consultations so you can discuss possible treatment options without any additional cost upfront.

Taking care of your body should never come at a heavy price tag — but unfortunately, endometriosis surgery can be costly. That doesn’t mean there aren’t ways to manage those costs, though! From payment plans to financial aid programs and even grants from local organizations, plenty of resources are available if you need help paying for endometriosis-related medical expenses. Talk with your doctor about your options before making any decisions. With the right resources, getting the care you need shouldn’t feel out of reach!

What is your experience about dealing with surgery costs and finding resources?

Find the best endometriosis specialists around the world!

Featured specialists:


5 Podcasts about endometriosis to listen to right now

Do you like listening to podcasts and want to learn more about endometriosis? We got you. There are several teams out there trying to make some sense of endometriosis and bring real-world stories as well as education and news to you. Here we are introducing some podcasts that we found interesting. Please keep reading to learn more about these podcasts.

1- In Sixteen Years of Endometriosis

“Laugh, cry, and shout with us as we talk all things endometriosis. We’re 2 witty best friends that pride ourselves on sharing accurate, well-researched information. We delve into all those embarrassing did-that-really-just-happen?! endo stories, talk vulnerably about our personal growth, and share disease facts with a side of humor. We hope our podcast will support and empower you. —Important note on inclusive language: We hadn’t yet been educated about inclusive language when we began our podcast; but after learning, we used this language midway through the show and going forward.”

2- The Cycle

“The Cycle is a podcast about endometriosis stories from patients as well as helpful information about the disease and ways to cope with it. Our goal is to share endo stories from people all over the world to empower you.

Medical disclaimer: THIS PODCAST IS NOT INTENDED FOR THE PURPOSE OF PROVIDING MEDICAL ADVICE. All information, content, and material of this podcast is for informational purposes only and is not intended to serve as a substitute for the consultation, diagnosis, and/or medical treatment of a qualified physician or healthcare provider.”

3- Not Defined by Endo

“Not Defined by Endo Podcast, hosted by Endometriosis Warrior Teniola Ogunro, is created for and dedicated to women who have been diagnosed with endometriosis or who suffer from symptoms that they suspect to be caused by endometriosis. Every week, Teniola shares her own experiences, interviews health professionals and endo specialists who provide their much-needed insight and speaks to fellow endometriosis warriors who know what it feels like to live with and fight an incurable disease.”

4- Endometriosis | Journey to Butterfly

“This podcast is about my journey with endometriosis over the last 15 plus years including my present day. I will talk all things endometriosis-symptoms, surgery, medical appointments, medications, natural methods, products, eating habits and more. Support this podcast:”

5- Peace With Endo

“Peace With Endo encompasses the journey to naturally managing endometriosis through diet, lifestyle and mindful thinking. Endometriosis impacts your body, mind and spirit. (I know this all too well). All three factors need to be addressed if you’re going to heal. I invite you to join the journey.”

Source : Apple podcast

Read more: 4 Endometriosis Books You Must Read

Read more: 6 Movies & documentaries about Endometriosis you need to watch


4 Endometriosis Books You Must Read

Disclaimer: This post is not a paid promotion. iCareBetter does not do affiliate marketing and does not get paid if you decide to purchase any of these books. This post is purely informational, and we do not give any medical advice.

1- Beating Endo

How to Reclaim Your Life from Endometriosis

By Iris Kerin Orbuch MD (Author), Amy Stein DPT (Author)

“Approximately one out of every 10 women has endometriosis, an inflammatory disease that causes chronic pain, limits life’s activities, and may lead to infertility. Despite the disease’s  prevalence, the average woman may suffer for a decade or more before receiving an accurate diagnosis. Once she does, she’s often given little more than a prescription for pain killers and a referral for the wrong kind of surgery. Beating Endo arms women with what has long been missing—even within the medical community—namely, cutting-edge knowledge of how the disease works and what the endo sufferer can do to take charge of her fight against it.”

2- The Endometriosis Health and Diet Program

Get Your Life Back

by Dr. Andrew S. Cook MD FACOG (Author), Danielle Cook MS RD CDE (Author)

“This timely book will dispel the myths surrounding endometriosis and provide scientifically based recommendations that are easy to understand and follow. It offers recommendations on treating root causes rather than just symptoms — it’s a comprehensive, integrative program for treating endometriosis and serves as a starting point for building an individualized program”

3- Know Your Endo

An Empowering Guide to Health and Hope With Endometriosis

by Jessica Murnane  (Author)

“Learn how to navigate your life with endometriosis in this essential and hopeful guide–including tools and strategies to gain a deeper understanding of your body and manage chronic pain through diet, movement, stress management, and more.”

4- The Endo Patient’s Survival Guide

A Patient’s Guide to Endometriosis & Chronic Pelvic Pain

by Andrew S. Cook MD FACOG  (Author), Libby Hopton MS (Author), Danielle Cook MS RD CDE (Author)

“The Endo Survival Guide is the patient’s essential companion to living with and overcoming endometriosis and pelvic pain: from seeking help and getting an initial diagnosis, to navigating treatment options, and achieving optimal relief and wellness.”

Source: Amazon

Read more: 6 Movies & documentaries about Endometriosis you need to watch

Read more: 5 Podcasts about endometriosis to listen to right now


6 Movies & documentaries about Endometriosis you need to watch

Some popular movies and documentaries about endometriosis.
Disclaimer: we don’t necessarily approve of all the content in these shows. But still the impact of these efforts on raising endometriosis awareness is important. We live in a world where most people haven’t even heard the word “endometriosis.” This leads to gaslighting and dismissal of a lot of patients. Therefore, any efforts like these documentaries and movies can change the life of many.

1- All about NINA – Drama, 97 min

“Nina Geld, a brilliant stand-up comedian onstage but an emotional mess offstage, is forced to face her troubled past when she meets Rafe”

2- Endo what? – Documentary

“Women who are suffering from endometriosis and experts discuss treatments for the disease.”

3- The painful truth – Documentary

“a film about endometriosis and adenomyosis”

4- A thousand needles – Short, 29 min

A Thousand Needles Film is a documentary about the effects of women’s sexual and reproductive health issues like endometriosis on a woman’s life”

5- End-o – Short, 15 min

“Jaq is a typical young woman, navigating the foibles of life, love and endometriosis.”

6- The resilience of woman in pain – short, 27 min

“Rose has been suffering in silence from endometriosis and chronic illness for years. But it’s beginning to wear her down. An unexpected act of kindness from a stranger shows her the power of human connection during hardship.”

source: IMDB & Google library

Read more: 4 Endometriosis Books You Must Read

Read more: 5 Podcasts about endometriosis to listen to right now


Endometriosis Dictionary, 15 common words in endometriosis

1- Endometrium


The inside surface of the uterus that thickens and breaks down during menstrual period and leads to menstrual bleeding.

2- Endometriosis


A condition in which cells similar to endometrium grow outside the uterus

3- Endometrioma


Also known as chocolate cyst; a cystic mass arising from endometriosis lesions within the ovary.

4- Endometritis


inflammation of the endometrium

5- Endometrial cancer

/en·do·me·tree·uhl can·cer/

a disease in which malignant (cancer) cells form in the tissues of the endometrium

6- Ovary


a female reproductive organ in which ova or eggs are produced, present in humans and other vertebrates as a pair.

7- Cyst


a thin-walled, hollow organ or cavity containing a liquid secretion

8- Endometrioma


a cystic mass arising from endometriosis lesions within the ovary; it is also known as chocolate cyst and endometrial cyst

9- Chocolate cyst

a cystic mass arising from endometriosis lesions within the ovary; it is also known as endometrioma and endometrial cyst

10- Endometrial cyst


a cystic mass arising from endometriosis lesions within the ovary; it is also known as endometrioma and chocolate cyst



an OB-GYN, or obstetrician-gynecologist, is a doctor who specializes in pregnancy, birth, and diseases affecting women’s reproductive organs.

12- Gynecologist


a doctor skilled in the treatment of women’s diseases, especially those of the reproductive organs. They mostly have similar training to OBGYNs but they focus less on pregnancy in their practices.

13-MIGS surgeon


a MIGS surgeon, or Minimally Invasive Gynecologic Surgeon, is an OB-GYN who has training in using minimally invasinve tools such as laparoscope and robots.

14- endometriosis surgeon

/en·do·me·tri·o·sis s-ER-j-uh-n/

a gynecologist doctor that has vast skills and epxerience in managing and operating on endometriosis patients; it is also know as endometriosis specialist.

15- endometriosis specialist

/en·do·me·tri·o·sis spesh-uh-list/

a gynecologist doctor that has vast skills and epxerience in managing and operating on endometriosis patients; it is also know as endometriosis surgeon.


Why was iCareBetter built?

A message from Dr. Saeid Gholami, the founder and CEO at iCareBetter:

The story behind the movement

When I used to practice as a primary care doctor, I saw patients’ struggles to find doctors that could do proper endometriosis surgery. Endometriosis patients often came back to our clinic month after month without change in their pain and suffering. Many patients had multiple failed surgeries. That was because almost all gynecologists claimed expertise in endometriosis surgery. Unfortunately, patients could not differentiate truly skilled gynecologists from others for treating endometriosis. One specific patient that I still think of after a decade was a thirty-five years old lady with rectal bleeding during her periods. I recall her coming back every month until everyone believed she was seeking attention. And no one could help her. We tried hard to find endometriosis surgeons for the patients, but no doctor would be able to show enough knowledge and expertise to earn our trust. Some of them claimed endometriosis expertise, but after a couple of questions, we realized that they could not manage the complexity of this disease.

Someone needs to stand up and build a solution when there is a problem. That is how the world has improved since the beginning of humanity. And it was our turn to make something to enhance the world of endometriosis patients. We created iCareBetter to help patients find doctors who possess the knowledge and surgical skills needed for endometriosis treatment. iCareBetter makes the search for endometriosis doctors much more effortless and removes the randomness of finding an endometriosis specialist. By having a platform of peer-vetted endometriosis surgeons, patients can focus on finding a doctor that will match their criteria and personal needs. Criteria such as location, cost, team, and areas of expertise can define a patient’s path to recovery. And patients do not have to worry about the doctor’s basic understanding, empathy, and skills of endometriosis care.

Searching for an endometriosis surgeon is very hard. Most of the time, you have no idea about their surgical skills and whether they will be able to treat your case. iCareBetter evaluates gynecology surgeons for their skills in managing different types and locations of endometriosis. Their surgical expertise is peer vetted, so their ability to do safe surgery. We bring endometriosis specialists closer to patients. 

What is iCareBetter’s mission? 

To help endometriosis patients receive efficient care. To educate patients on endometriosis, to better understand endometriosis and patient’s needs. Patients wait years to receive a diagnosis, are sent to various specialties, and undergo multiple surgeries, and very few people take their pain seriously. iCareBetter mission is to improve endometriosis patients’ lives by providing them with what is needed the most; doctors that can handle each individual’s unique case.

Who is behind iCareBetter? 

I, Dr. Saeid Gholami, am the founder of iCareBetter. I have training as an MD, MBA, and MS in Digital Technology. My training is not in OBGYN, and at the moment, I do not provide care to patients. I founded iCareBetter with my financial resources and then had some family and friends invest in the company to support us. None of the investors are related to the current doctors on the website. And none of the doctors on the website have any ownership or leadership position in the company.

Last words

Like every other life-changing initiative, ours started with a personal story and someone who wanted to make a change. My personal goal has been to improve patients’ lives at the minimum cost for them. And we are just at the beginning of the road. There are many patients with endometriosis who need help. And we have several problems to solve for the patients and the community. Nothing will stop us as long as endometriosis patients use iCareBetter to find hope and care for their debilitating pain and suffering.


What Are The Cost Drivers For Running iCareBetter?

From the beginning of iCareBetter, money has always been questioned. Some think iCareBetter should offer services for free to providers because it costs nothing. But there is a high administration cost for running iCareBetter. The charges come from educating patients and providers about endometriosis and quality of care, maintaining and improving the website, and responding to patients’ and providers’ requests and questions. I am going to share our costs with you in this article.

The costs for operating iCareBetter:

Education about endometriosis and the importance of expert provider

It takes an average of 10 years for a person with endometriosis to get a proper diagnosis. Then several years go by, trying various hormones, artificial menopause, and suboptimal surgeries. After many years and multiple failed treatments, a patient might find an expert who understands endometriosis and how to treat it. We at iCareBetter want to cut that time to less than a year and help patients connect with the expert endometriosis provider as soon as possible. Achieving this goal requires extraordinary efforts in educating the public, patients, and providers. Therefore, we are responsible for making educational content and distributing it on the internet. Content creation and distribution are crucial for raising awareness about endometriosis, the importance of skilled surgery, and fighting misinformation. And it costs money and takes significant effort to create and distribute good educational content about endometriosis.

Reviewing doctors’ applications 

iCareBetter takes a significant financial loss on each application; please continue reading for more explanation. After we receive an application with three full surgical videos (mostly between 2-4 hours long), our team has to de-identify all documents and prepare the videos and questionnaire for reviewers. It takes 5-10 hours per application, costing us about $400 on average to prepare the application for review. Then we send the videos and the rest of the applications to reviewers and follow up with them multiple times to submit their reviews. After the reviewers send their reviews, they get compensated for their time. Compensating the reviewers cost us, on average, $350 per application. Therefore on each application, we spend $750 and only charge $400. Consequently, we lose $350 on reviewing each application.

Website maintenance, APIs, and optimization

iCareBetter has an online website core to its services to patients and providers. Providers use the website to apply for vetting. Patients use search engines and many other features on the website to find doctors and learn about endometriosis. Almost all of these features are paid plugins, apps, or APIs. Moreover, there is a sophisticated web developing team behind iCareBetter to deliver the results to our community. Keeping a high-quality website that serves patients and providers with high standards is costly.

Answering questions from patients and providers

Every day our team receives many questions and inquiries from patients, advocates, and providers. It is our responsibility to answer them. Here are some examples:

  • Patients: 

“Do you have a doctor in region X?”

“Does doctor Y accept new patients?”

“I can not get someone from Dr. Y’s office to answer me, has their phone number changed?”

“Why does the link to this article is broken?”

  • Doctors:

“How can I join the platform?”

“I am changing my office location; please update my info.”

“I want to apply for more specialized surgery areas. How can I do that?”

Every question we receive from a patient or a doctor is our top priority. These questions can define the care plan or the surgery outcome for one or more patients. So we are committed to answering these questions. And answering questions needs the time and focus of a reliable person. And this is another layer of costs added.

Final words

The list of costs does not stop here, but I hope you have seen enough information to justify our desire to make money to keep iCareBetter alive. It costs to run a website that aims to be patient-centric, uplifts the community, and brings transparency to the endometriosis community for a better patient outcome.

Please let us know what you think about this matter.


Physical Therapy after excision surgery

Why do you get a referral for Physical Therapy after excision surgery?

  • Endometriosis is a chronic condition and it takes almost 10 years to diagnose the condition in most cases. 
  • The women suffer from severe pain and disability before they are really diagnosed with endometriosis. Pain leads to muscle guarding and spasms which leads to further limitation in mobility and function.
  • Muscle guarding can also affect fascial mobility. Fascia covers our body from head to toe, it covers the muscles and organs and connects muscle to muscle and muscle to organ. Any fascial restrictions can affect the mobility of the organ and body and also function.
  • Decreased mobility can affect the circulation and lymphatic draining. Many women present with blood stasis and swelling of pelvic region- vulva, discoloration and sometimes itching.
  • Some women with endometriosis can present with the descend of a small intestine between uterus and rectum and it pushes the wall of vagina, it is called “enterocele”.
  • Surgery can lead to scar tissue and muscle guarding which can affect the normal biomechanical movement. 
  • Many women have pain and pelvic floor dysfunction after surgery which can affect the function.

Top endometriosis physical therapists

pelvic floor therapy for endometriosis

Table of Contents

How does fascial mobility affect the pelvic floor function?

How can Physical Therapy help?

How does fascial mobility affect the pelvic floor function?

pelvic floor function
  • Facia lines from
  • The abdominal fascial restrictions from guarding can affect the mobility of the fascia of the large and small intestine. Scar tissue after surgery can also affect the abdominal fascial mobility.
endometriosis excision surgery
  • This is image is taken from Grey’s Anatomy
  • The restrictions of the fascia around cecum (ascending colon on right side) and sigmoid colon (descending colon on left side) can affect bowel movement- many women have constipation, diarrhea, pain after bowel movement, bloating, and food intolerance. Constipation is defined as 
  1. Small palates, hard stools, straining
  2. Not able to empty bowels completely
  3. Less than 3 spontaneous bowel movements a week
  4. The patient has to do manual maneuver to pass the stool
  5. Straining with stools can lead to pelvic floor dysfunction and increase the risk of prolapse
  6. Bristol stool scale helps to understand the consistency of stool and relation to constipation. As if you have bowel movement everyday does not mean you are not constipated. Bristol stool scale 1-2 is considered as constipation, 3-4 is considered as normal bowel movement as long as the person is not straining while doing bowel movement, 5-7 is considered as diarrhea
endometriosis excision surgery

The restrictions of fascia around the bladder can cause

pelvic parts

The image is taken from Grey’s Anatomy

  1. Increase in urinary urgency and frequency
  2. Bladder fascia shares the fascia with pelvic floor through urethra and it can cause stress/urge or both urinary incontinence.
  3. Bladder fascia also shares the fascia with obturator foramen where obturator internus muscle attaches. Obturator internus muscle is one of the major rotator muscles of the hip. Restrictions of bladder fascia can affect the mobility/mechanics of the hip and also can cause pain. Many women with hip pain without any pathology might have a connection to the bladder fascia. They always have one of the bladder symptoms such as urgency/frequency/burning of urination or incontinence.
  • Anatomically small intestine sits on the bladder. The small intestine moves up and allows the bladder to fill. If the fascial mobility of the small intestine is limited or if the small intestine has descended, the bladder does not get enough room to fill and that leads to increase in urgency and frequency.
pelvic floor
  • The image is taken from Sloan Kettering Institute – research 
  • The diaphragm and pelvic floor work as a piston during the breathing. When we breathe in, the diaphragm moves down along with the pelvic floor and when we breathe out they both move up. Breathing mechanics is very important for pressure mechanics- that means it provides stability, keeps the organ continence, pelvic floor function, lymphatic draining, and reduces the strain on joints. The factors can affect the breathing mechanics
  1. Abdominal fascial restrictions
  2. Shallow breathing from pain
  3. Decreased mobility of fascia of diaphragm/pelvic floor
  • The image is taken from Grey’s Anatomy
  • The restriction of fascia can affect the circulation and lymphatic drainage. Many women have pelvic congestion and also swelling of vulva and itching.

How can Physical Therapy help?

Goals of Physical Therapy are

  • Reduction of pain
  • Improve posture
  • Improve mobility of muscle/fascia and organ to improve biomechanics and movement of the body
  • Improve circulation and lymphatic drainage

The Physical Therapist have to perform detailed evaluation on fascial mobility, joint mechanics, muscle guarding pattern, posture, any swelling or signs of congestion, bowel and bladder function, sexual function, pelvic floor muscle function, lumbar spine/sacroiliac joint mobility and stability, breathing mechanics, load transfer, and central sensatization. I have found great success with fascia mobilization on abdomen/chest wall/diaphragm, and around the abdominal organ/pelvic floor muscles to reduce pain, improve mobility, circulation, breathing mechanics, bowel/bladder function and overall well being.

About the author

The author of this article, Neha Golwala, PT, DPT  is a vetted endometriosis physical therapist. With more than 10 years of experience, she works at Zuppa Physical Therapy P.C. in New York. Neha uses manual therapy techniques including myofascial release, joint mobs, and neurominetic energy. She is an expert in the development of posture awareness and connecting mind to body to recover from injuries and prevent injuries and improve performance.


Endometriosis And Menopause: Everything You Need To Know

If you’ve been told that endometriosis goes away after menopause, this may not be the case. So, this may not be a great strategy if you’re trying to “wait out” endo through perimenopause and into menopause. 

It is reasonable to think that chronic conditions of your female reproductive organs, like endo, might also go away when you stop having periods. Here’s a look at how endo may or may not change after menopause, based on what we know about molecular biology and hormonal changes as you get older.

This article will cover:

1- Does menopause cure endometriosis?

2- Endometriosis management after menopause

3- Endometriosis after menopause: The molecular biology

4- Endometriosis Symptoms after menopause

5- Endometriosis-molecular level

6- Estrogen replacement after menopause with endo: is it safe?

7- How about compounded natural or bioidentical hormones?

8- How about plant-based phytoestrogens?

9- When is surgery an option for peri and post-menopause endometriosis?

10- Surgical concerns

Does menopause cure endometriosis?

Natural menopause does not occur overnight and it might take years before estrogen levels from the ovaries become negligible.  Active growth of endo may decrease at this point but, given other estrogen sources discussed in this article and internal molecular factors, it may not stop. So, trying to wait out endometriosis until menopause is final may give it another 5 years or more to grow and cause problems.  An active treatment strategy to address endo that persists into peri-menopausal years might limit the damage and lead to better results.    

Endometriosis management after menopause

After menopause, the management of endometriosis may become more difficult because by this point in life endo may have been present for decades, even if previously removed partially once or twice by surgery.  At this point symptoms may be due to endo as well as scarring and fibrosis, which is part of the body’s normal healing process. The associated problem is that fibrosis and scar does not respond to any medical therapy.  This, in turn, means that surgery is the main, if not the only, option for treatment after menopause in many cases. Of course, everyone is different and pelvic floor therapy and supportive care are also in the mix.   

Endometriosis after menopause: The molecular biology

Endometriosis cells and tissue look very similar to the normal uterine endometrial lining.  Both are stimulated to grow and both try to shed monthly under cycling hormonal influence.  During a menstrual period,  endometrial tissue has the ability to shed and exit via the cervix and vagina.  Unfortunately, the similar-looking endometriosis tissue has no way to exit the body and gets trapped, causing inflammation, scarring, and pain.

Uterine endometrial tissue needs the hormone estrogen to grow, and usually, but not always, so does endometriosis. When you go through menopause naturally, your ovaries produce less estrogen. This causes symptoms such as hot flashes and night sweats. But the commonly held belief is that endometriosis may improve, or even go away, with the reduction in estrogen production by ovaries. We now understand why this does not happen in all women through molecular biology research.   

Endometriosis at a molecular level

While many factors control endo growth, including immunologic ones, exploring the molecular biology of hormones in menopause suggests that hormones can undoubtedly be a big part of the picture. In addition to the usual conversation about external estrogen from ovaries, which decreases towards menopause, intra-cellular production of estrogens also plays a critical role in the pathogenesis of endometriosis. This increases in peri and postmenopausal women who have persistent active endometriosis lesions.  

Without getting lost in the details of hormone enzyme activation and deactivation, which results from genetic switches getting turned on and off, suffice to say that research supports the following. There is local estrogen production in endometriosis cells, which activates other feedback loops at the cellular level. This activation of loops causes even more estrogen production and resistance to progesterone (the balancing hormone). This affects macrophages and pro-inflammatory cytokines (e.g., TNF-α and IL-1β), which sets off another chain reaction. These also create molecular signals (e.g., VEGF) that stimulate microscopic blood vessel formation to feed the endo cells and activate anti-apoptotic genes (e.g., Bcl-2), creating more endo growth. This leads to local tissue trauma, nerve stimulation, fibrosis, and pain. 

Endometriosis Symptoms after menopause

endometriosis and menopause

What happens to your symptoms could depend on the severity of your symptoms before menopause and hormonal and inflammatory balance. If your endometriosis is mild, it may get better with menopause. If your disease is severe, symptoms are more apt to persist. Why? Several reasons: scarring and fibrosis that only gets worse and a molecularly more active endo type that persists and keeps growing after menopause. It is currently impossible to predict what type you may have and what molecular signals are in play in any given individual.   

If your symptoms don’t improve even after you’ve stopped having menstrual cycles, surgery may be the best option for you. Surgery to remove all of your endometriosis and fibrosis will often be more effective than medication. Years of growth and fibrosis can lead to more local nerve noxious stimulation, and the first step is to remove this. Medications, including natural enzyme supplements, will not dissolve scars, and any persistent active endo is also more difficult to control after menopause. Many other molecular signaling paths are operational, making it harder to determine the best target to block abnormal effects. All the various inter and intracellular signaling forms are under intense research. 

Endometriosis causes

Types of Endometriosis Pain & Natural, Medical & Surgical Treatment

Estrogen replacement after menopause with endo: is it safe?

All of the above concerns how, when, and where estrogen is produced. But how this affects cells in your body, including endometriosis cells, depends on the presence or absence of estrogen receptors. You can think of the estrogen molecules as little keys which float through your bloodstream and tissues (or locally produced on or near the endo cells), and the estrogen receptors are like little locks present in and on the cells. The two have to connect, or the key has to fit the lock to produce a molecular signaling event at the cellular level. One of these signaling events is whether or not to stimulate growth. 

There are different estrogen receptors called estrogen receptor alpha (ERα) and beta (ERβ). In some estrogen-sensitive tissues, like the breast or uterus, these two types can be variably pro-growth, and in others, they can be inhibitory. In addition, there is a progesterone receptor (PR) that binds progesterone in the same fashion via a lock and key mechanism. Endometriosis cells have overexpression of mainly ERβ and underexpression of PR. This imbalanced expression of receptors leads to progesterone resistance and amplification of the growth signal provided by estrogen. This only scratches the surface of incredible complexity, but hopefully, you get the idea. 

In general, to alleviate postmenopausal hot flashes, depending on whether you have a uterus or not after menopause, estrogen alone is often prescribed (no uterus) or combined with progesterone (the uterus is in). This is because progesterone balances the effect of estrogen on the uterus and reduces the risk of endometrial cancer due to estrogen-induced overgrowth of the endometrium.   

The exact ratio of alpha (ERα) and beta (ERβ) and the amount of PR present can be variable in endometriosis. It can change over time into menopause or after surgically induced menopause due to early removal of the ovaries. So, theoretically, any hormonal replacement will affect endo cells to some degree and may amplify the degree to which local estrogen is produced, as discussed above. The degree to which this happens and evolves is not predictable from person to person. 

Where does that leave us? It comes down to risk vs. benefit discussion because a reasonable amount of estrogen replacement after menopause can help the quality of life and bone health. Studies have not proven whether or not this can activate or amplify endometriosis growth after menopause

How about compounded natural or bioidentical hormones?

The long answer to this is very complex and depends highly on the quality of these hormones and whether or not the dosages are correctly mixed and, if one were to use combinations that are applied to the skin, degree of absorption, and much more. The problem with synthetic vs. natural arguments notwithstanding, the effect on the very variable and unpredictable receptor signaling described above remains theoretically unchanged. There is also a higher risk of inadvertently taking a higher dose since many are locally prepared and thus subject to less regulation. Get a highly qualified opinion and possibly several opinions and do a lot of due diligence personal research before going this route.  

How about plant-based phytoestrogens?

Plant estrogens, otherwise known as phytoestrogens, uniquely attach to estrogen receptors. They can bind to either type of estrogen receptor but preferentially bind to ERβ. In doing so, they take up space and block the ability of regular estrogen to bind to the receptor. In terms of helping menopausal symptoms, estrogen receptors also exist on blood vessels, and the binding of phytoestrogens helps stabilize the blood vessels, reducing hot flashes. The effect is less than that caused by regular estrogen but is helpful in many women. At the same time, there can be a relative blockade at the endometriosis cell level. Again, given the differences regarding receptors and signaling effects between individuals, this is not 100% predictable but can be a win-win nonetheless.  

Along the natural, integrative line of thought, a couple of corollary strategies is how the estrobolome and seaweed figure into this puzzle. First, the estrobolome is part of your gut microbiome that can metabolize the excess estrogen in your body and eliminate it. This includes the excess estrogen produced by ovaries, local estrogen created at the cell level, and the toxin type of estrogens called xenoestrogens. Keeping your microbiome healthy and happy with probiotic supplements or fermented foods is the action time. Second, we know that seaweed can predictably reduce circulating estrogen. This can retard any hormonal influence on the regrowth of endo, especially if the bulk of any disease is removed surgically. 

Read more: Postmenopausal Malignant Transformation of Endometriosis

When is surgery an option for peri and post-menopause endometriosis?

If symptomatic endo is suspected as one gets closer to menopause, it merits discussion about expert removal of as much as possible via excision surgery. Ideally, a surgeon should remove all visible lesions in this case. Even if undetectable microscopic implants are left behind, removal of pain-producing scars/fibrosis and the bulk of any active endo limits the number of cells that might grow back over time, whether or not hormonal replacement is taken. 

There is one more reason for considering surgical removal. If you have a family history of cancer or have active endo as you enter menopause, given the known molecular abnormality overlap between endo and cancer (e.g., ARID1A), the risk of malignant degeneration may be higher. This is a highly individualized situation, but some can be critical to balancing the surgical risks vs. potential benefits.    

Surgical concerns

So, with all of the above in mind, is there a reason NOT to have surgery to remove endo, especially if you have symptoms as you get close to or enter menopause? Of course! Even minimally invasive surgery is not risk-free, and the risks can increase as you get older. Scarring and fibrosis from advanced endometriosis possibly increased from prior surgeries, leading to complications and damage to organs, including the bowel. For this reason, selecting an über expert surgeon at that point in life is crucial.   

An über expert surgeon can handle pretty much any possible finding in the pelvis and abdomen. Moreover, they can address oncology risk concerns if you are at higher risk with a family history. This means that the right surgery for cancer would be performed if cancer were suspected or found during surgery. But short of cancer, this surgeon needs to be able to handle small bowel, rectal, bladder, ureteral involvement, even disease in the upper abdomen and diaphragm. Deep infiltrating endometriosis implants are more common if they have been allowed to grow over the years. This full-spectrum surgeon might be a gynecologic oncologist who has experience in endo excision. But even they may need a cardiothoracic surgeon if endo involves the chest cavity. Cardiothoracic surgery is an entirely separate specialty of surgery. Alternatively, a minimally invasive surgery team including an endo excision trained GYN surgeon, a urologist, a general surgeon, and possibly more would need to be available. It can be a logistic challenge to gather such a team, but this is usually possible in centers that specialize in endometriosis surgery.

All symptoms of endometriosis

Join endometriosis forum and discover endometriosis stories

Read on endometriosis forum: What are the long term side effects of lupron?

Get in touch with Dr. Steve Vasilev

More articles from Dr. Steve Vasilev:

Understanding the Connection between Endometriosis and Cancer

How to tell the difference between endometriosis and ovarian cancer

What would happen to the signs and symptoms of endometriosis after menopause?

The author of this article, Dr. Steven Vasilev MD is a fellowship-trained, triple board-certified integrative gynecologic oncologist specializing in complex pelvic robotic surgery. He focuses on advanced & reoparative endometriosis excision and molecular integrative healing, especially as it applies to women of older reproductive age and in menopause.


Types of Endometriosis Pain & Natural, Medical & Surgical Treatment

Learn How People Feel Endometriosis Pain in Different Locations

Endometriosis pain is hard to explain to people who have never experienced it. Why? For many reasons. One of them is that each patient with endometriosis (endo) will endure their specific type of pain. Some patients experience pain during sex, while others may have pain after sex. Another example is that some patients have endometriosis pain in the lower back, and others sometimes have it all over the back and even the hips!

Want to know how to deal with endo pain? In this article, we will review the various types of endo pains, their locations, characteristics, and treatments. 

Get the pdf Version of this article

Read more: How Do I Know If I Have Endometriosis? Endometriosis Signs

Endometriosis signs and Symptoms

Table of Contents

1- Where is Endometriosis Pain Felt?

2- What Does Endometriosis Pain Feel Like?

3- Why Do Endometriosis Patients Experience Different Types of Pain?

4- Different Types of Pain and Their Origins

5- How Does Endometriosis Pain Differ From Menstrual Pain?

6- Endometriosis Pain Treatment Options

7- Do You Have Endometriosis Pain?

Where is Endometriosis Pain Felt?

Unfortunately, it can be difficult to distinguish exactly where endo pain is coming from. This difficulty is because endometriosis pain can feel non-specific and may affect various parts of your body at different times. Can endometriosis cause back pain? Yes. Some patients experience endometriosis rectal pain or generalized pelvic pain – while other people with endo might have pain in their chest, back, or even hips. To that end, pain location usually results from where the endometriosis tissues reside inside the body. 

What Does Endometriosis Pain Feel Like?

It can be tough to explain what endometriosis pain feels like. This is especially true when a woman tries to explain this pain to a guy. For one, most women complain that endo pain feels like very excruciating period cramps. However, unlike period cramps, many patients with endometriosis report that this sensation is not limited to just the area surrounding the uterus. Patients with endometriosis often experience:

  • Pelvic pain
  • Abdominal pain
  • Pain during bowel movements
  • Sciatic pain
  • Pain during or after intercourse
  • Leg pain
  • Rectal pain
  • Pain with urination

Menstruation can exaggerate these types of endo pains. But many patients experience these symptoms outside their period. 

Why Do Endometriosis Patients Experience Different Types of Pain?

Endometriosis is a chronic inflammatory condition that affects each patient differently. Why? For the most part, the type of endometriosis pain you experience will depend on the location of the lesions and the progression of the disease. Furthermore, feeling the pain in one part of the body doesn’t mean that it originated from that body part. It is because pain often radiates to other parts of the body.

Endometriosis After Menopause

Different Types of Pain and Their Origins

Pelvic Pain

Endometriosis is when tissue similar to the endometrium grows outside the uterus. In most cases, these tissues grow in areas close to the uterus, i.e., your pelvis, reproductive organs, and abdomen. 

Meg Connolly, diagnosed at the age of 23 with endometriosis, said that:

“Endometriosis causes a pain that’s very difficult to describe. It’s more than just ‘bad cramps’ — it’s the type of pain that even over-the-counter (OTC) medicine won’t resolve.”

Back Pain

Can you have back pain with endometriosis? Absolutely. The endometrial growths can stick to the front of your pelvic cavity or your lower back. Endo back pain presents deep within the body. This condition can result in sciatic pain.

Is the back pain you experience caused by endometriosis? Back pain is a common ailment among patients of all demographics. However, endometriosis back pain stems from deep inside the body. Furthermore, another indication your back pain might be from endometriosis is that it won’t improve by seeing a chiropractor or changing your posture. 

Leg Pain

Leg pain can result from endometriosis when the lesions grow near or on the sciatic nerve. Patients describe endometriosis leg pain as the following:

  • A dull throb
  • A sharp stabbing sensation
  • A sudden spasm that feels similar to a leg cramp

Patients with severe leg pain from endometriosis may have difficulty walking comfortably or standing up quickly. 

Pain During Intercourse

Endometriosis tissue and scars around it can result in a painful nodule to touch. These nodules may occur in several places, including:

  • Cervix
  • Uterus
  • Pelvic cavity
  • Rectovaginal septum

The presence of these nodules may lead to sharp pain felt in the vaginal or abdominal areas during sexual intercourse or immediately after.

Endometriosis Painful Bowel Movements

Endometriosis tissue can grow in the bowel wall or the space between your rectum and vagina. This abnormal growth results in these symptoms:

  • Diarrhea
  • Difficulty passing urine
  • Irritable bowel syndrome (IBS)
  • Painful bowel movements

Bowel pain can be sharp and consistent. Moreover, pain from the bowels can worsen if combined with poor lifestyle habits, such as diets high in greasy processed foods.

Causes of Endometriosis

How Does Endometriosis Pain Differ From Menstrual Pain?

Endo pain is different from normal menstrual pain. But also pain from this disorder typically feels different for each person who experiences it. However, there are a few things that set endo pain apart from menstrual pain, including:

  • Endo pain is typically chronic, lasting for more than six months.
  • The pain happens several times in the month, before and during your menstrual cycle. 
  • Frequently the pain is severe. As a result of this severity, over-the-counter pain relievers typically do not provide relief.
  • Endometriosis pain is often consistent. Therefore patients can usually recognize it when the symptoms come on.

Endometriosis Pain Treatment Options

Pain relief for endometriosis can be natural, medical, or surgical. Learn more about these three types below. But it is important to know that natural and medical solutions are mostly temporary relievers from this list, and surgery is considered the most permanent treatment.

*Note: iCareBetter is not endorsing any of the treatments but instead provides a list of what helps other patients and routinely performed treatments.

Natural Treatment for Endometriosis Pain:

  • Rest
  • Turmeric
  • Light exercise
  • Castor oil 
  • Ginger tea
  • Dietary changes
  • Pelvic massage
  • Herbal supplements
  • A heating pad or hot water bottle

Medical Treatment:

  • OTC pain medications
  • Physical therapy
  • Prescription pain medication
  • Mental health provider that specializes in pain management
  • Some physicians prescribe hormonal therapy, such as contraceptives. However, new research shows this treatment for endometriosis pain is not a one-size-fits-all solution. A recent study out of Yale came to the following conclusion: 
    • “PR (progesterone receptor) status is strongly associated with response to progesterone-based therapy. Receptor status in endometriosis could be used to tailor hormonal-based regimens after surgery and negate trialing progestin-based therapy to determine resistance. Ascertainment of PR status may allow for a novel, targeted, precision-based approach to treating endometriosis.”

Surgical Treatment

  • Minimally Invasive Surgery for endometriosis is a way to remove endometriosis lesions permanently and help with the pain. In this procedure, the surgeon cuts small incisions into the abdomen and inserts a thin tube with a viewing light (a scope) into the body. Then this scope can visualize lesions, take tissues samples, and remove scarring. 
  • A laparotomy is a surgical procedure where the surgeon cuts and opens the abdomen and does not use thin tubes. However, laparotomy is more extensive than minimally invasive surgery and is not often performed in modern medicine due to the risk of complications.

Read more: How to Find an Endometriosis Specialist for Diagnosis, Treatment, & Surgery

Do You Have Endometriosis Pain?

What type of endo pain do you have? And how would you describe it? If you want to find an experienced endometriosis specialist or a different kind of endo provider near you, you can do so on our platform, iCareBetter.


How Do Endo Fertility Issues Impact the Mental Health of a Person?

Endometriosis (endo) can cause many issues. Endometriosis patients may have difficulty becoming pregnant or maintaining a full-term pregnancy. Up to 70% of women with endometriosis get pregnant without medical treatment. However, 30 to 50% of patients with endo experience fertility issues and may need endometriosis fertility treatments or surgery. Up to 50% of all women with infertility have endometriosis. According to the abstract in a study published in the International Journal of Women’s Health:

“The most common clinical signs of endometriosis are menstrual irregularities, chronic pelvic pain (CPP), dysmenorrhea, dyspareunia and infertility. Symptoms of endometriosis often affect psychological and social functioning of patients. For this reason, endometriosis is considered as a disabling condition that may significantly compromise social relationships, sexuality and mental health.”

Read More: How Do Endo Fertility Issues Impact the Mental Health of a Person?

Why Are Women Impacted Emotionally By Reproductive Disorders?

A plethora of reasons exists as to why women can experience deep emotional impact by a diagnosis of a reproductive disorder or a condition that could cause issues with fertility. Some women already worry about getting pregnant anyway, so an endometriosis diagnosis surely doesn’t help. Here’s a shortlist of some reasons reproductive issues can affect the emotional health of women with endometriosis:

  • Pressure to conceive right away
  • Worries about each stage of the pregnancy, from implantation to delivery
  • Pressured to have a child, even if the person is unsure or not ready
  • Possible medical interventions, such as IVF
  • Stress and emotional drainage that can result from endometriosis fertility treatments
  • Possible laparoscopy endometriosis surgery

Multiple studies demonstrate that a woman’s ability to conceive and bear a child plays a big part in her emotional health and self-esteem. While many women don’t want to have children, a large portion does. But, they might not be ready for a baby when they receive their endometriosis diagnosis. According to a study out of the Iranian Journal of Reproductive Medicine:

“While infertility is not a disease, it and its treatment can affect all aspects of people’s lives, which can cause various psychological-emotional disorders or consequences including turmoil, frustration, depression, anxiety, hopelessness, guilt, and feelings of worthlessness in life.”

Read More: How Does Endometriosis Cause Infertility?

Endometriosis Patients with Fertility Issues Need Emotional Support

Most endometriosis patients with fertility issues benefit by having a mental health provider as part of their multidisciplinary team.

Endometriosis impacts many facets of a person’s life. A recent study concluded that:

“Furthermore, there is an urgent need to develop and evaluate interventions for supporting women and partners living with this chronic and often debilitating condition.”

Endometriosis Facts

All Endometriosis Patients Could Benefit From Emotional Support

Many endometriosis patients with fertility issues express no desire to have children. Therefore, some women are unaffected by infertility that might arise from endo. However, it’s essential to keep these women in mind because their feelings matter, too. Perhaps some did not want to have kids now but were hoping to someday in the future? Or maybe they are just not with the right person to have children with them? 

Whatever the case may be, it’s significant that healthcare providers do not overlook a patient’s emotional needs, even if they say it doesn’t bother them if they cannot have kids. Perhaps a person in this situation may not need as intense emotional support, but they should see a mental health provider have a chance to talk about these feelings and think them through. Some interventions can help one conceive or be ready to conceive even with an endometriosis diagnosis. However, it’s significant to remember that the further the disease has progressed, the more complex it is to treat it to regain fertility. Therefore, when you are unsure if you want to have a baby, it’s still wise to have all the lesions removed as soon as you can and conduct proper follow-up.

Seeking a Mental Health Provider Experienced With Endometriosis

Endometriosis is a complex and often misunderstood disease. Therefore, women who battle this condition daily, especially those with fertility issues, require a mental health professional familiar with this inflammatory disorder. 

Endometriosis encompasses many domains of a patient’s life, and fertility issues are not the only things that impact women’s emotional health. When seeking out a professional, it’s critical to find someone familiar with the disease and its emotional impact on patients.

Importance of Friends and Family

In addition to adding a robust mental health provider to your team, it’s also essential that you seek support from your loved ones. Please encourage them to attend appointments with you to have a better understanding of the condition. When the people closest to you can comprehend the emotional roller-coaster accompanying infertility, they will be better prepared to support you emotionally. 

When a patient receives a diagnosis such as endometriosis, pain management, and other care items often become the priority. Therefore, it can be easy to overlook the emotional aspect of this condition, especially in someone with fertility issues. This is why it’s essential to do your research and find an experienced endometriosis expert to head up your team.

Do You Have Fertility Issues Caused By Endometriosis?

We want to hear from you. What are your thoughts on the emotional challenges? Do you have a solid mental health provider on your team? Leave your responses in the comments below.


Endometriosis and Pregnancy: Natural, Medical, & Surgical Options

Natural, Medical & Surgical Treatment of Endometriosis Infertility 

Endometriosis (endo) is a common condition that affects up to 10% of all women globally. But most people do not realize this condition’s impact on a significant proportion of women. Endometriosis and pregnancy complications are a common coincidence. Up to 50% of women with infertility have endo.

Endometriosis and pregnancy can be problematic for patients. And sometimes, endometriosis treatments are needed to conceive. Keep reading to learn more about fertility options for women with endo.

Read More: How Does Endometriosis Cause Infertility?

Lack of Evidence-Based Research Stalls Treatment Options

Endometriosis is sometimes like the elephant in the room that no one wants to discuss or do enough research. However, that needs to change because endometriosis is often a disabling condition, and people should know about it. Not only does this condition impact the patient’s quality of life, but it also affects the potential for some of these patients to have a family. This situation can affect a marriage, other family members, a partner, etc.

Options for treating women with endometriosis and pregnancy issues can be natural, medical, surgical, or surgery-assisted. Let’s review the latest fertility treatments and courses of action for women affected by endometriosis. First, we will briefly discuss how endometriosis and pregnancy are related. 

Can You Get Pregnant with Endometriosis?


Getting pregnant with endometriosis is not always easy, but it’s a reality for most patients who have the condition and want to conceive. It’s important to emphasize that the body can and still does get pregnant. There are things such as an endometriosis diet that might help. Let’s look at the good numbers. Up to 70%, according to some studies, of women with mild to moderate endometriosis will become pregnant without medical intervention.


Statistics show that about 75% of women with severe endometriosis (stage III/IV) will conceive if they desire. Two-thirds of those pregnancies occurred naturally, and one-third with the help of the endometriosis fertility treatment.

If you have endometriosis and are having troubles getting or maintaining a pregnancy, and you wish to carry full-term, here are some medical options that may interest you:

  • Freeze some eggs: Your ovarian reserve of eggs can decline due to endometriosis. Therefore, some endo specialists recommend preserving your eggs in case you wish to conceive later. Just note that this can be an expensive option.
  • Superovulation and intrauterine insemination (SO-IUI): If you have normal fallopian tubes, mild endometriosis, and a partner with healthy sperm, this might be the best choice for you.
  • Fertility medications: Doctors can prescribe medications to produce up to two or three mature eggs. There are also progestin injections that are often used to help fertility issues. 
  • Frequent ultrasounds: If a person is trying to get pregnant, they may go in for frequent ultrasounds to identify when the eggs are most mature. At that time, a doctor can insert the partner’s collected sperm.
  • In-Vitro Fertilization (IVF): This treatment involves the extraction of the egg and sperm. The egg is fertilized outside the body and then implanted into the uterus.

Endometriosis Surgery For Infertility

Many women with endometriosis do become pregnant without medical assistance. However, studies suggest that endometriosis surgery does help a woman to become pregnant without difficulty. 

  • Removal of endometriosis tissue: Evidence shows that pregnancy rates improve if the endometriosis tissues are removed surgically.
  • Removal of tissue or large endometriosis cysts: Large cysts and tissue accumulation can contribute to infertility. Removing these can help the patient conceive.
  • Routine follow-up: Women with endometriosis often have cysts that relapse after treatment. It is crucial to complete follow-up visits and possibly have complementary surgeries down the road.

How Your Stage of Endometriosis Impacts Fertility

A diagnosis of endometriosis is a heavy thing to take in, primarily since it’s known to impact a woman’s reproductive organs. Studies have shown that the extent of endometriosis present during laparoscopy correlates with fertility.

Do You Have Concerns About Endometriosis and Fertility?

We want to hear from you. What is your biggest concern about the fertility impact of endometriosis? Or does it concern you at all? Leave your answers in the comments below. If you need medical attention that is not emergent, be sure to find a vetted endometriosis specialist who is familiar with the disease and modern treatments.


Endometriosis and Fertility: Statistics, Facts, & Fiction

Debunking the Myths Surrounding Endometriosis and Reproduction

Disinformation about endometriosis and how it can impact reproduction is thick. As a matter of fact, not just endometriosis and fertility, the entire disorder is shrouded in junk information, and so it often goes misunderstood and mistreated. To learn more on this topic, read our previous article, titled: “Endometriosis Facts and Myths: Dispelling the Misconceptions.”

Does endometriosis cause infertility? In some cases, yes. However, in most cases, women with endometriosis can and do get pregnant without any medical assistance or intervention of any kind. There is still a myth that if you become pregnant, that can manage the endometriosis (endo) symptoms and even help resolve disease progression. 

This statement couldn’t be further from the truth, and it’s an example of a widespread myth about endometriosis and fertility. Furthermore, this school of thought can put additional pressure on women with endometriosis to get pregnant as quickly as possible once they get a diagnosis. As you can imagine, this dangerous misinformation can alter their expectations in terms of treatment for fertility and their outlook on endometriosis in general.

So, Can You Get Pregnant If You Have Endometriosis?

The real truth is that the connection between endometriosis and reproduction is complex. Can you get pregnant if you have endometriosis? Yes, many people can and do. However, having the right endometriosis specialist to help you along the way can make all the difference in your journey. Click here to learn more about finding vetted endo specialists near you. In this article, we will review the disease and lay out the facts regarding endometriosis and fertility.

What is Endometriosis?

Endometriosis is an inflammatory disorder in which tissue similar to the uterus lining grows in places outside the uterus. Often these growths happen on the surface of the uterus, ovaries, fallopian tubes, or other organs within the pelvic cavity – such as the bladder or bowel. In some cases, these endometriosis growths have occurred in distant organs.

Endo growths can cause pain, scarring, and sometimes infertility. Because this tissue is similar to the uterine lining, it also bleeds and sheds once a month during hormonal changes. Typically in the uterus, this period tissue and blood have a means of escaping through the vagina. However, this blood and tissue often accumulate inside the body with endometriosis and causes inflammation and pain. As one can imagine, over time, scar tissue growths with subsequent menstrual cycles develop. Eventually, this scar tissue can fuse organs, immobilize organs, and even damage the fallopian tubes.

Alarming Statistics About Endometriosis & Fertility 

  1. Endometriosis is widespread, affecting between six and ten percent of the general female population. That’s more than 170 million worldwide.
  2. In patients with pelvic pain, infertility, or both, endometriosis frequency is higher – between 35 percent to 50 percent.
  3. Between 25 percent to 50 percent of infertile women have endometriosis.
  4. Between 30 percent to 50 percent of women with endometriosis are infertile.
  5. Endometriosis affects approximately the same number of women around the world that have diabetes.
  6. The cost of endometriosis in the US is between $86 Bn – $116 Bn. 
  7. It takes, on average, eight years from the onset of symptoms for a patient to get a diagnosis. This can impact all patients, but especially those of who wish to keep their fertility intact.

Endometriosis Facts About Fertility and Reproduction

  1. There are ways to get pregnant with endometriosis.
  2. Hormonal therapy does not cure endo. 
  3. Endometriosis is related to your menstrual cycle and hormonal changes within your body. 
  4. Endometriosis tissue can be removed during laparoscopy. Depending on the location of the growths and the extent of damage, this can sometimes restore fertility.
  5. There is a type of endometriosis that can cause cancerous lesions, typically dark chocolate brown. 
  6. The causes are uncertain, and there is no “cure” for endometriosis.
  7. Genes seem to play a role in the occurrence of endo. 

Myths About Endometriosis and Fertility 

  1. Pregnancy is not a cure or a way to relieve symptoms of endometriosis. Women should not be pressured or encouraged to get pregnant to help with endometriosis and fertility or alleviate pain or other symptoms. While some women experience less endo pain and symptoms during their period, that does not mean it works the same for all women.
  2. Do not believe any physician that tells you a hysterectomy is the “gold standard” treatment for endometriosis. As mentioned above, there is no “cure” for endometriosis. Until a specialist is inside the body and can view the number and the placement of the endometriosis lesions, they cannot decide whether a hysterectomy would even solve the problems. Also, some women might make themselves infertile (whether they mind or not, it is an emotional part of this disorder) by having a hysterectomy done that was never needed. 
  3. You do not need to have a major medical procedure to get an endometriosis diagnosis or remove some growths and lesions. With modern equipment, skilled specialists, and advanced technology (often robotic surgical equipment), you can have endometriosis diagnosis and treatment with laparoscopy. This type of procedure is minimally invasive and only leaves behind a few puncture wounds. 
  4. Abortion does not cause endometriosis. 
  5. Endometriosis does not cause ovarian cancer. Although a type of endo involves cancerous tumors, this does not mean that having endometriosis makes you more likely to develop cancer.
  6. The most important myth to bust is that there is no treatment for endometriosis. Just because there is no “cure” for this pelvic inflammatory disorder does not mean there are no treatment options, even when it comes to endometriosis and infertility.

If you have endometriosis, what is the most common thing you have heard regarding endo and reproduction?


Does Endometriosis Cause Infertility? Covering the Basics

Learn More About the Connections Between Endometriosis and Infertility

Endometriosis (endo) diagnosis can be a frightening thing. Very frightening. While this inflammatory condition can be binary or non-binary, women of child-bearing age are prone to issues with reproduction due to endo. So does endometriosis cause infertility? Keep reading as I break down the basics on this topic. I will also discuss the emotional impact on patients.

What is Endometriosis?

Endometriosis is a chronic inflammatory condition. In this disease, endometrium-like lesions (the tissue that lines the uterine walls) grow outside the uterus. These glands or stroma cause chronic inflammatory reactions. Endometriosis tissue can occur on the surface of other body parts in the pelvic cavity and distant organs such as the diaphragm, lung, and heart. 

Because these endometrial-like lesions shed blood and tissue, many problems result. Pain is a common symptom because the blood and tissue have no way to leave the body. This pressure can result in unbearable pain and other symptoms. If you would like to learn more about what endometriosis is, check out our previous article.

What Happens When Endometriosis Does Cause Infertility

It can. 25 to 50% of women with infertility have endometriosis, and 30 to 50% of women with endometriosis have infertility. However, it is very encouraging to know that most women with endometriosis can become pregnant

This statistic is significant. Many younger women with this disorder feel psychological effects due to the possibility of not being able to have kids. Not all patients carry this same sentiment. Growing numbers of people do not want to have children. However, for those who do, these thoughts and emotions about fertility can be devastating. Then, endometriosis patients who do conceive often worry about the pregnancy and subsequent delivery of the baby.

How Endometriosis and Fertility are Connected

The association between endometriosis and infertility is well-established. However, there may be multifactorial reasons why it occurs, including molecular, mechanical, environmental, and genetic causes. 

There are some theories to explain infertility in endometriosis. The following are just a few:

  • Inflammation leads to the production of chemicals known as cytokines. These cytokines can inhibit the egg and sperm from meeting each other, which makes fertilization more difficult.
  • Endometriosis-related scarring and adhesions can block the fallopian tubes or uterus space. This blockage makes it difficult for the sperm to meet the egg and implant in the endometrium.
  • Endometriosis lesions on the ovaries can inhibit ovulation and block the release of an egg.

Read More: How Does Endometriosis Cause Infertility?

Other Data on Endometriosis and Reproduction

Studies have also demonstrated that the enzyme, Aromatase may also play a role in endometriosis infertility. There is an abnormally high level of this enzyme in the endometrium and endometriosis lesions in patients with endometriosis. In the uterus, this enzyme may affect both natural endometrial development and its receptivity for the implantation of the fetus. 

Progesterone is another hormone that may play a role in implantation failure. Resistance to this enzyme can affect reproduction, as it is necessary for a normal pregnancy. In some studies, progesterone receptors displayed abnormalities and caused dysregulation in the endometrial layer of the uterus in patients with endometriosis. Levels of progesterone should increase with pregnancy, but with endometriosis, this process is delayed and can cause an unopposed estrogen state that cannot sustain fertility.

Endometriosis Infertility Treatment Options

Patients with endometriosis do have a substantial risk of infertility or problems getting pregnant. According to studies, the amount of endometrial-like tissue visible during a laparoscopy correlates with the possibility of future fertility. For this reason, if you have endometriosis and would like to become pregnant, early treatments for endo and fertility are crucial. This is because the stage of endo might progress within time, which increases the risk of infertility.

Laparoscopy: A Common Treatment for Endometriosis

Can endometriosis cause infertility? Yes, in some patients. However, in most cases, endo does not entirely prevent conception. Traditional treatments for endometriosis approached most cases of endo with total hysterectomies. But these approaches are now outdated. New science-based evidence shows that hysterectomies and oophorectomies are not always needed. That is because these surgeries do not often work to remove all the endometriosis tissue. 

A skilled endometriosis specialist goes in the pelvic and abdomen with thin tubes and excises the endometrial-like tissue for best surgery results. This surgery often requires OB-GYN surgeons with advanced training in endometriosis treatment. It typically involves advanced surgical equipment, such as laparoscopy, robotics, and AI technology. 

Now let’s review the endometriosis treatment options in the context of pregnancy and fertility.

Medical Treatment Options for Endometriosis

  • Ovarian suppression, such as hormonal therapies or oral contraceptives, is not recommended for women who wish to conceive. This highly-debated advice gained support from a large study that found no difference in pregnancy rates and live birth rates in patients with endometriosis who took a hormone vs. placebo.
  • An endometriosis diet by nutritionists that work on endo can be helpful. The diet can help increase the patient’s likelihood to conceive with endometriosis and maintain that pregnancy to a full-term birth.
  • The Guideline Development Group (GDG) does not recommend the prescription of adjunctive hormonal treatment before surgery in infertile women with endo.

Surgical Treatment Options for Endometriosis

  • The goals of surgery are to remove all macroscopic endometriosis implants and return the pelvic cavity to normal anatomy. While these are the goals, not all surgical procedures or endometriosis specialists will stop this inflammatory disorder or restore the pelvic cavity to its normal anatomy.
  • It’s crucial to weigh the pros and cons of surgical intervention.
  • Endometriosis minimal invasive surgery by an expert is the preferred surgical procedure because:
    • It causes minimal damage to the tissue.
    • It’s assisted with magnification.
    • There is a relatively fast recovery time.
    • Mostly only a short hospital stay is involved.

How Women with Endometriosis Suffer Emotional Impact

Women who deal with endometriosis reproductive problems may experience a variety of feelings, such as:

  • Stress
  • Worry
  • Grief
  • Confusion
  • Anger
  • Sadness
  • Feelings of inadequacy

As mentioned above, over 30% of women with fertility problems have endometriosis. If a woman is already distressed about becoming pregnant, the shock of an endometriosis diagnosis may amplify those emotions. 

Furthermore, women with endometriosis may feel further pressure to have kids sooner to increase their likelihood of success. But, that’s not always practical. Some do not have a partner or might not even know if they want to have kids. Perhaps they are with someone who does not wish to or is not ready for kids. They might also be with someone they have not been with for very long, so they are unsure if they want children. Many factors can cause stress on women with endo to try to get pregnant right away.

For those ready and trying to get pregnant, fertility issues caused by endometriosis may also create feelings of frustration, hopelessness, and sadness. These feelings are the reasons why it’s crucial to incorporate a mental health expert as part of your holistic endometriosis treatment team.

Psychological Impact of Fertility Treatment for Endo Patients

Furthermore, a whole new slew of emotions comes with those patients who move on to endometriosis fertility treatment. Excitement. Happiness. Disappointment. Sadness. You and your partner can do these things to help prepare for these possible feelings:

  • Prepare and be ready for the emotional journey ahead
  • Cope with grief and loss associated with unsuccessful prior attempts or miscarriages
  • Develop strategies for coping with the news of other people’s births and pregnancies
  • Keep the communication lines between you and your partner open and discuss feelings throughout the entire process

Did endometriosis cause infertility issues for you? How has that impacted your life?


Find Endometriosis Specialists for the Best Possible Outcomes

Why You Need an OB-GYN Who Specializes in Endometriosis

Endometriosis is common (affecting nearly 190 million women worldwide) but poorly understood by many medical professionals. It’s hard to find endometriosis specialists who have completed advanced training. With the proper endo specialist, medical treatment or surgery can lessen your pain, improve your quality of life, and manage complications.

Endometriosis is a chronic pain condition that affects 10-15% of women of reproductive age. It causes painful periods, bleeding between periods, pain during sexual intercourse, and discomfort when passing urine or feces. Despite causing chronic pelvic pain, many medical professionals have a poor understanding of the condition.

In this article, we will look into what endometriosis is and explore how to improve diagnosis, treatment, and outcome factors.

What is Endometriosis?

Endometriosis affects menstruating women and girls and some women post-hysterectomy or post-menopause. The condition also can affect transgender men and non-binary individuals. Endometriosis affects roughly 190 million people worldwide, with immune, genetic and hormonal factors all likely to be at play. 

To understand Endometriosis, we first need to understand the endometrium or lining of the uterus.

The Endometrium

A large proportion of the endometrium is stromal cells. Stromal cells regulate cell growth and change during the menstrual cycle.

Endometrial glands line the endometrium. During the menstrual cycle, they widen in response to greater blood flow.

Each cycle, stromal cells, and endometrial glands slough off as part of menstruation.

Endometriosis Lesions

The presence of endometrium-like cells found outside the uterus causes the classic endometriosis symptoms. Discourse exists, but scientists have concluded a genetic basis to the cells’ presence, with endometrium-like cells migrating inappropriately during embryogenesis.

Endometriotic lesions can be in the ovaries, uterine ligaments, fallopian tubes, and pouch of Douglas (the space between the uterus and rectum). In some, lesions are present outside the pelvic cavity. Locations include the bowel, urinary tract wall, diaphragm, lungs, abdomen, and pericardium (the sack around the heart).

The endometrial-like tissue responds to the natural cycle of hormones and also produces some hormones by itself. This tissue has cycles of growth and bleeding. 

Whereas menstrual blood in the uterus leaves the body via the vagina, the blood and tissues cannot escape from endometriosis lesions. This trapped cells and tissue leads to the painful processes of inflammation, adhesions, and scarring.

What does it feel like to have Endometriosis?

Although pain is the most common complaint, Endometriosis causes a wide range of symptoms, including:

  • Painful periods
  • Heavy periods (menorrhagia)
  • Vaginal bleeding between periods
  • Pain on passing urine or feces
  • Bowel symptoms include bloating, constipation, diarrhea, or bleeding from the bowel
  • Pain during intercourse
  • Tiredness
  • Depression
  • Infertility.
Social and Emotional Effects

Severe pain can interrupt daily life for many patients. This interruption may include missing school, taking days off work, or being unable to socialize. A study in 2020 found that in over half of women, the pain had reduced their professional, physical, and sexual activity. 

Endometriosis is associated with low mood. 15% of women are diagnosed with depression, with an average age at diagnosis of 22. 


Infertility can be the only symptom of Endometriosis for some women. Around 30-50% of patients cannot get pregnant owing to inflammation, pelvic adhesions, blockage of the fallopian tubes, and changes to the pelvic anatomy.

Other Symptoms

Additional symptoms are dependent on the location of endometriosis lesions. For example, an endometriotic lesion in the lung could cause breathlessness or chest pain. A study of over 2000 patients found that endometriotic nodules caused leg and buttock pain, as well as numbness, similar to sciatic pain. 

Misdiagnosis and incorrect management are therefore common for women with symptoms that are not classic to pelvic endometriotic lesions. 

Endometriosis Myths

The average delay in the diagnosis of Endometriosis is more than seven years, leading to “unnecessary suffering and reduced quality of life.” This delay leads many people to the internet to conduct their own research before and during diagnosis. However, the internet is awash with myths.  

The importance of educating yourself via a reputable source such as iCareBetter cannot be understated.  

Find Endometriosis Specialists for Appropriate Diagnosis & Treatment 

The widespread misunderstanding of Endometriosis hinders its diagnosis and treatment. The inappropriate investigation, treatment with analgesics, or hormonal suppression do little to manage the cause while delaying diagnosis. Women who felt they were not listened to nor understood by doctors have described frustration, anger, annoyance, and sadness.

Reassuringly, appropriate diagnosis and treatment can lead to significant improvements in pain. This is precisely why it is crucial to find an endometriosis specialist. Only highly specialized surgeons with a comprehensive team can perform a thorough excision to remove endometriotic lesions, including extra-pelvic locations. Complete removal can significantly improve overall outcomes, including relief from pain and increased quality of life.

iCareBetter Endometriosis Care

iCareBetter is a platform that connects patients with experts in endometriosis care. At iCareBetter, patients have access to surgeons who have completed advanced training. These professionals have shown expertise in the diagnosis and treatment of complex Endometriosis. iCareBetter utilizes a transparent and unbiased system to ensure that only doctors with proven advanced excision skills and a comprehensive care team can be on their surgeons’ list.

Patients can select their surgeon based on their specific symptoms. This empowers patients to consult a doctor who truly understands the complexity of their condition. Patients can access specialists for endometriosis in the pelvis, bowels, bladder, thorax, heart, or diaphragm. They also can find help with infertility issues.

A highly specialized endo surgeon will take a holistic approach to treatment. This holistic approach includes managing secondary comorbidities such as infertility, even in stage III and IV disease patients. 

At iCareBetter, patients can also access expert physical therapists who understand the condition. Working with a physical therapist gives access to myofascial release techniques, visceral mobilization, and the tools to manage a susceptible nervous system for better pain management.

Team-based expert care improves post-operative outcomes. For some iCareBetter doctors, post-treatment reports of satisfactory pain relief could be over 80%, with less than 20% of women requiring subsequent pelvic surgery. Moreover, many patients see reduced pain relief requirements post-recovery.

Standards of excellence, such as those endorsed by iCareBetter, must become a driving force behind treatment protocols for Endometriosis. Women should no longer shoulder the pain and reduced quality of life associated with substandard care.


Endometriosis occurs due to the presence of endometrium-like cells found outside the uterus. The resulting inflammation, adhesions, and scarring can cause severe pain and symptoms related to the location of the lesions. By connecting patients with expert surgeons in endometriosis care, iCareBetter empowers patients to access the care leading to better outcomes. Advanced surgical excision, physical therapy, and an expert team-based approach can reduce pain, as well as skillfully manage secondary complications.
Find endometriosis specialists today.


Impact of Living with Endometriosis on Mental Health

(All research studies mentioned in this article about the impact of endometriosis on mental health enrolled people with assigned female gender at birth. However, to be inclusive to all people with endo, we use people throughout the article.)

Being diagnosed with endometriosis (endo) and living with it can bring up a lot of emotions. It can mean making space for changes that you may never have predicted or accounted for. Endometriosis impacts nearly 200 million people worldwide, but there is pernicious misinformation and a lack of awareness and understanding among the medical community and the larger society. This misinformation and lack of awareness stand in the way of receiving a timely diagnosis.

It takes, on average, over seven years for a person who has endometriosis to get a diagnosis. Essentially, this means experiencing intense pain, feeling unheard over and over, and being gaslit at a systemic level for at least seven years. 

In most countries, managing the pain and heavy periods remain the first line of treatment for endometriosis. If one is lucky, they can access endometriosis excision surgery. However, the impact of endometriosis goes beyond just the physical. The effect of endometriosis on mental health and the emotional wellbeing of the person is enormous.

The mental health struggles of living with endometriosis vary from person to person. The debilitating chronic endometriosis pain, one of the most common symptoms, is a critical factor that impacts the quality of life and mental health. Along with the cyclic pelvic pain, one may also experience other types of pain in varying degrees: 

  • Non-menstrual pelvic pain
  • Pain during ovulation, urination, and/or bowel movements
  • Pain during sex
  • Sciatic pain
  • Pain post and during orgasms
  • Widespread full-body pain. 

Research published in the International Journal of Women’s Health Health looked at the link between common symptoms of endometriosis and mental wellbeing. 

It found that a person experiencing chronic pelvic pain (CPP) is likely to feel higher levels of anxiety and depression, which can further amplify the perception and severity of pain, thus placing them in a vicious circle of physical and psychological distress. 

Living with Endometriosis

Figure 1: The vicious circle of chronic pelvic pain and psychological disease.

Pelvic Pain Causes Further Effects of Endometriosis on Mental Health

A study found that endometriosis patients with pelvic pain had poorer quality of life and mental health than those with asymptomatic endometriosis. It also showed that non-menstrual pelvic pain impacts all the variables of a person’s life. Thus, the study emphasized psychological interventions as an essential aspect of the endometriosis treatment plan and pain management treatments and interventions.  

In another meta-analysis of 99,614 people from 24 different studies, researchers found that chronic pelvic pain was a primary factor contributing to the higher rates of depression in patients with endometriosis. This study emphasized that treating this kind of depression with antidepressants without the efforts towards managing the chronic pain would indeed be ineffective. 

The Emotional Reality of Endometriosis

Studies have tried to understand the impact and management of endometriosis within the medical healthcare system. But still, the health system has largely overlooked the effect of endometriosis on mental health. 

Living with endometriosis can make daily activities a struggle, mainly due to the unpredictability of pain and fatigue. The struggle makes some tasks nearly impossible. These tasks can include planning, working, socializing, exercising, eating, or even basics like cooking, cleaning, and bathing. This inability fuels guilt and anxiety. Furthermore, the debilitating pain being reduced to “just a bad period” or “psychosomatic” often leaves one feeling gaslit, isolated, depressed, and sometimes suicidal.

This distress increases due to the lack of systemic and psychosocial support. When the BBC spoke to 13,500 people (female assigned at birth) with endometriosis, more than 50% of the respondents felt suicidal ideations. 

This is a battle

For someone living with chronic pain every day, even a short-lived moment of low pain brings ease, which allows one to hope for a future not controlled by pain. However, grief sets in quickly as fatigue and flare-ups follow. These changes make life with endometriosis incoherent and an inescapable dance between hope and grief. A Swedish study concluded that people living with painful endometriosis underwent a constant struggle for coherence in their lives. It emphasized that healthcare providers should validate this struggle by understanding the disease-related grief. 

The anxiety around pain and health, the grief related to the future, the loneliness and isolation often bring up the feeling that chronic pain has monopolized one’s life. Endometriosis becomes the central point around which all decisions revolve. It takes away the body’s ability to be reliable and the capacity to feel safe within it. It often changes the way one views themselves and takes the world in. 

One of the ways we feel safe in the world is by feeling safe in our bodies. Then what happens to our sense of safety when the body is a constant source of never-ending pain? 

The Trauma of Endometriosis

Experts define trauma as the experience of being left alone with one’s pain. Endometriosis isn’t different. Having to constantly explain one’s pain to medical doctors, families, and friends and still not being believed is an isolating and traumatizing experience. For some, this experience of being gaslit gets stored in the body and pushes the nervous system into a hypervigilant state (Fight, Flight, Freeze). 

This experience of trauma can bring up various responses, anger being one of them. The anger can be at the world, the state, the body, the systems, other people, or the pain. It becomes our protective mechanism in response to the powerlessness that one feels while coping with endometriosis. 

The Way Forward

In treating endometriosis, it becomes necessary to consider its impact on mental health and provide psychosocial support to people with endometriosis and their families. Unlike the conventional medical belief that solely focuses on the physiological aspects, a multidisciplinary approach integrating the mind and the body is necessary

A trauma-informed psychotherapist specialized in treating endometriosis, and chronic pain can be helpful. A therapist trained in chronic pain management understands endometriosis, related diagnoses, and its trauma. This understanding is an integral part of the healing process. Seeing the light at the end of the tunnel is complicated and sometimes impossible with pain. Verbalizing the pain, having the hardships validated, acknowledged, and believed can be an empowering experience. Just as people seek medical help for their physical symptoms, seeking help for mental health struggles is an integral part of the endometriosis journey. If therapy is hard to access, support groups for endometriosis can be a step forward. You should know that you are not alone in your experience, and you can have support. The supports that you get can be a lifeline to your mental health. 

Author: Anindita Kundu, Trauma Psychotherapist. 

How has endometriosis impacted your mental health? Have you considered working with a mental health specialist to help you?


Questions to Ask Your Physical Therapist When you have endometriosis

Author: Dr. Rebecca Patton, PT, DPT

“I feel like you’re the first physical therapist who understands endo.” It’s a statement I wish I didn’t hear as often as I do. Unfortunately, there has not been a resource specifically made to evaluate pelvic physical therapists’ knowledge about endometriosis before iCareBetter.

Education for physical therapists regarding endometriosis needs more advanced continuing education courses. But it doesn’t typically happen until after completing a doctoral program. For perspective, I self-taught for several years before seeking specific classes related to endometriosis care. Therefore, it wasn’t until years after specializing in pelvic pain treatment that I realized the inefficiency of care for those with endometriosis. We can do better, but we have a long way to go.

Communicating with a pelvic physical therapist before seeking treatment can allow you to ask important questions to ensure you’re finding a provider that is a good fit for you. For achieving this goal, take advantage of time-saving strategies such as a phone consultation before committing to a therapist. Here are a few questions you may want to ask during that phone consultation or the first visit with a pelvic physical therapist for your endometriosis issues.

Endometriosis Care Process with iCareBetter

1- Find an expert based on keyword/ specialty or state
2- choose your doctor from the list
3- Get the contact info
4- First call and consultation.
5- Get info regarding costs and care process
6- Receive care

Top endometriosis physical therapists

Endometriosis Physical Therapy

Table of contents

1. Are you familiar with the disease process and current treatment standards for endometriosis?

2. Do they consider the whole body when treating your symptoms?

3. Do they practice trauma-informed care specifically related to healthcare trauma?

4- How much time will you have for a session?


1. Are you familiar with the disease process and current treatment standards for endometriosis?

It is helpful when your treating therapist is up to date on current treatment standards, as with any diagnosis. Unfortunately, there is no specific physical therapy protocol for treating patients with endometriosis. However, physical therapists should understand who will be involved in your healthcare team and have a multidisciplinary approach (1). I aim to establish what provider, either GYN or expert surgeon, will be a point of contact on that first visit. 

2. Do they consider the whole body when treating your symptoms?

  Endometriosis is known as a pelvic disease, but we know it is much more than that. Your physical therapist needs to tap into their education to evaluate and treat the whole body. The secondary effect of endo is often an upregulated nervous system. On the initial visit, it is typical that your physical therapist will look at movement patterns from your neck to your feet. Internal pelvic floor assessments are common but certainly do not need to happen on the first visit. Pelvic floor function is only one component in a much larger picture of your overall function. Your individual goals and comfort will dictate how much treatment involves pelvic floor treatment. 

Advanced Treatments and education

Treatment involving the abdominal wall fascia, diaphragm, and viscera (organs) require additional advanced coursework compared to treating the pelvic floor. Therefore, you can ask them if they have taken additional coursework to treat the abdomen to get an idea of their experience. There is not one single treatment philosophy for the abdomen, but some courses focus on continuing education in this area. The most common that I am familiar with are The Barral Institute (2), Ramona Horton MPT, DPT (3), and Institute of Physical Art (4). Other courses involve manual nerve techniques such as Lumbar and Sacral Nerve Manual Assessment through the Herman and Wallace Pelvic Rehab Institute (5). These are just a few of the many available resources your physical therapist may use to learn more after graduate school. Some pelvic physical therapists create their treatment tanks to teach one another these skillsets.

Treatment strategies that help regulate an upregulated nervous system may be part of your care. These strategies can look like gentle hands-on treatment, questions to help you process how you relate to your body, and creating mindfulness along with movement. The connection of how our nervous system interprets information from our body is complex. A physical therapist can be a valuable resource to help you better understand the pain response and the nervous system.

Trauma-informed care in physical therapy does not substitute mental health treatment. A trauma-informed approach concerning physical therapy means understanding the entirety of the patient’s experience and the effects of that experience. Medical trauma can have a lasting response on an individual’s well-being (6). We know that those with endo, on average, have a delayed diagnosis. This delay can lead to a complicated relationship with the medical providers. Many patients with endo are seeking out pelvic PT after years of seeing various specialists. These experiences with the medical system can create barriers to a patient feeling comfortable with a new provider. 

For this reason, a trauma-informed approach to treatment is essential. Awareness of how these experiences may have impacted their patient is a critical portion of providing affirming care. You can ask your physical therapist about some processes that they use to create a safe environment. These processes should include consent before any treatment or touching, checking in with your emotions and body reaction during manual therapy, and providing adequate time to provide education throughout the session.

4. How much time will you have for a session?

Asking this question can ensure you have an idea of what to expect when going into your appointment. There is no magic number of minutes that will create a perfect appointment. However, the nature of endo being more complex means I prefer more time to establish a care plan. There are multiple factors to consider during the first evaluation. These factors include sexual health, daily function, bowel and bladder health, and personal goals. Having realistic expectations for each session is helpful to decrease additional medical trauma and find a therapist that fits your needs.

Patient care and human interaction are complex, and sometimes it takes time to establish a level of comfort with your PT. Every session of PT may not equal a breakthrough in pain. Retraining the nervous system takes time, especially when the body has been protecting itself due to chronic pain.

Ultimately, endo care is ideally a multidisciplinary approach. Your physical therapist can work closely with your gynecologist and other healthcare team members to find the best individual plan for you. 

If you have more questions about pelvic physical therapy, reach out for more information. 

Would you mind sharing with us what pleasant or unpleasant experiences you have had with your PT?


1.      Agarwal SK, Foster WG, Groessl EJ. Rethinking endometriosis care: applying the chronic care model via a multidisciplinary program for the care of women with endometriosis. Int J Womens Health. 2019;11:405-410. Published 2019 Jul 23. doi:10.2147/IJWH.S207373

2.      Jean-Pierre Barral, DO, MRO(F), RPT. The Barral Institute.  Accessed September 1st, 2021.

3.      Ramona Horton, MPT, DPT.  Herman and Wallace Pelvic Rehabilitation Institute. Accessed August 27th, 2021.

4.      Institute of Physical Art. 2015-2021. Accessed August 19th, 2021.

5.      Nari Clemmons PT, PRPC.  Herman and Wallace Pelvic Rehabilitation Institute.  Accessed August 20th, 2021.      Michelle Flaum Hall and Scott E. Hall. When Treatment Becomes Trauma: Defining, Preventing, and Transforming Medical Trauma.  American Counseling Association.  March 24th, 2013.  Accessed August 19th, 2021.


Endometrioma 101: Understanding Deep Ovarian Endometriosis

Your Guide to Ovarian Endometrioma: Treatment, Symptoms, Doctors, Etc.

Endometrioma (deep ovarian endometriosis) can be difficult to treat due to controversies and challenges surrounding the best approaches, treatment, and diagnosis. Many of these hurdles result from misunderstandings about the condition and underlying disease process – deep ovarian endometriosis.

If you suffer from these ovarian endometriosis lesions, our sincere thoughts go out to you. Often known as “chocolate cysts,” some consider endometriomas as the most severe threat to a woman’s reproductive system (aside from cancerous tumors found in the reproductive tract). Furthermore, these lesions don’t always respond well to medical treatment and can potentially ruin the health of ovarian tissue. This article will help you understand endometrioma, symptoms, and deep ovarian endometriosis treatment.

Get the pdf Version of this article

Table of contents:

1- What is Endometriomas (Deep Ovarian Endometriosis)? 

2- Recurrence of The Lesions Following Surgery

3- linical Impact of Endometriomas (in Women of Reproductive Age)

4- Major Concerns

5- Treatment and Surgery Options

6- Final Thoughts and Question for Readers

What is Endometriomas (Deep Ovarian Endometriosis)? 

Endometriomas happen when endometrial-like tissue grows inside the ovary or sometimes outside. Endometrioma is very common and affects between 17-44% of endo patients. Endometriomas are typically an advanced form of endometriosis, meaning stage three or four.

Surgery is often necessary to remove the endometriomas. However, eliminating endometrioma cysts and capsules is an advanced procedure and needs excellent skills. This surgery can potentially lead to partial or complete loss of ovarian function, especially if done by less experienced surgeons. These cystic masses can cause extreme challenges for women undergoing fertility treatments, i.e., assisted reproductive technologies (ART).

Endometriomas are dark-fluid-filled cavities, and they can present in a variety of shapes and sizes. An ultrasound can show suspected cases of endometrioma, but confirmation needs surgery and histology. Therefore, getting a diagnosis of endometrioma can be riddled with challenges.

Recurrence of The Lesions Following Surgery

On our social media accounts, we receive many questions about the topic of endometrioma recurrence. We took to Instagram to get the responses from endometriosis specialists about this recurrence. Here are some of their responses:

“It depends on several factors including the age of the patient, method of surgery, the experience of the surgeon, etc. In the literature, recurrence rates of over 30% have been reported, although I have personally not seen that high of recurrence risk.”

“We’ve had ovarian recurrence rates of less than 10 percent in our two years of follow-ups of about 85 patients with ovarian endometriomas.”

“What’s important is to completely free the ovary and excise the peritoneum or uterosacral ligament it was adherent to, apart from excising the cyst. This will truly help reduce recurrence rates compared to just doing a cyst excision and leaving peritoneal disease behind.”

“I share the same opinion, in my center, our recurrence rate is less than 8% a good technique and excision of all zone of endometrioma even peritoneal improve outcomes, also as previously said it depends on many factors like endometrioma size, multiple endometriomas, and post-op treatment.”

“We have a very low recurrence rate. This is because often, during surgery, only the visible endometrioma cysts are removed. Anything under 2 cm is out of our visual field.”

Clinical Impact of Endometriomas (in Women of Reproductive Age)

Endometriomas does not cause infertility in all women it affects. However, studies show that between 25% to 50% of women with infertility have endometriosis, and 30% to 50% of women with endometriosis have infertility. However, that does not mean that endometrioma will necessarily cause infertility in women of reproductive age, especially when diagnosed and treated early with the best-practice treatments that have evolved over the years. 

One of the leading fertility challenges is that ovarian lesions affect the number of eggs in ovarian tissue. Endometrioma can also impair the maturation of the egg and cause the woman to have a lower antral follicle count (AFC) and Anti-Müllerian hormone (AMH). Also, women with endometriomas often have high follicle-stimulating hormone (FSH) levels.

Major Concerns:

  • Intense pelvic pain
  • Possible infertility
  • Decrease ovarian function
  • It can place women of child-bearing age at a higher risk of cancer

Treatment and Surgery Options

Treatment for endometriomas will vary from person to person. The number of lesions and the staging of the disease progress are just a couple of the factors that will influence the right treatment plan for you. 

Treatment for Females of Reproductive Ages

Many OB-GYNS and other healthcare providers still practice old treatments for endometriosis that don’t effectively manage the disorder. It’s a complicated condition. Thus, there are many myths and misconceptions about endometriosis

Women of reproductive ages who wish to maintain fertility should have a fertility specialist in their multidisciplinary endometriosis team. Women with endometriomas may respond to some of the following treatments: 

Non-surgical treatments: These treatment options are temporary choices to manage pain and complications in the short term.

  • Medication therapy 
  • Observation

Surgical treatment: this may include:

  • Drainage
  • Laser ablation
  • Capsule excision (the procedure of choice for most top experts)

Final Thoughts and Question for Readers

Have you had to deal with endometrioma? If so, please share how it has impacted your endo journey.


7 Ways to Prepare For First Endometriosis Specialist Appointment

Diagnosis. Treatment. Surgery. Many Topics May Be Discussed At Your Visit

An endometriosis specialist appointment is not something you do every day (although sometimes it might feel like all day while you’re waiting there). However, the time you get to talk with the doctor may be pretty short. During that moment of consultation with the endometriosis (endo) specialist, you might feel brain fogged or bombarded. Whether it’s the diagnosis, treatment, surgery, pain management, or an endometriosis symptom you want to bring up, it’s easy to forget an essential topic while you’re there.

To make the most out of your initial endometriosis specialist appointment with an endometriosis specialist, we’ve made a list of seven ways you can prepare for the visit. First, we will give a short description of what endometriosis is. 

Table of contents

What’s Endometriosis?

Why You Are Here

7 Ways to Prepare for Endometriosis Specialist Appointment

Endometriosis Care Process with iCareBetter

What’s Endometriosis?

Endometriosis is a female medical disorder in which tissue similar to the endometrium (tissue that lines the walls of the uterus) grows outside the uterus. This endometriosis tissue can grow on the surface of the uterus, ovaries, intestines, fallopian tubes, bladder, or other organs in the body.

During menstruation, this tissue releases blood, and it sloughs off. However, this blood and tissue often remain trapped with no way to escape the body. This increased pressure can result in moderate to severe pain, among other symptoms. If you want to learn more about endometriosis and get a general background on the condition, read our article, “Endometriosis 101: Covering the Basics.”

Why You Are Here

People of various ages and demographics are subject to this often debilitating inflammatory pelvic disorder. Whether you have confirmed the diagnosis of endometriosis or if you need surgery to verify its presence and remove lesions – these suggestions can help you prepare for the endometriosis specialist appointment. There are many stages of endometriosis. Whether you’ve got into a specialist early on your journey or later, the important thing is that you are here now – exploring treatment options.

7 Ways to Prepare for Endometriosis Specialist Appointment

Once you have found an experienced endometriosis specialist, it’s essential to prepare yourself for the doctor’s appointment ahead of time. There is no concrete test to diagnose endometriosis (outside of surgery). Therefore, it’s imperative to have a solid understanding of the signs and symptoms of endo and detailed accounts of your own experience ready. Simple things such as medical records or journals that list all your endometriosis symptoms are a vital arsenal that will help you and your doctor determine your treatment plan. 

1. Gather Your Records. 

Unfortunately, most people with endometriosis have had many doctor appointments before seeing an endometriosis specialist. Therefore, you should have some medical records for them to review during your first appointment with an endo specialist. Gather everything from your regular medical history from your general practitioner to your OB/GYN records, testing, imaging, blood work, etc. Even if you think the particular doctor appointment or medical history is insignificant, you might be surprised by the various conditions linked to endometriosis. Bring it all. This information could play a vital role in your endometriosis treatment. 

2. Keep a Journal of Endometriosis Symptoms/Pain.

Write down all the possible endo signs and symptoms you’ve had leading up to the doctor’s appointment. If you get a visit scheduled, and it’s a couple of weeks out, start the journal at that time, but also include the signs and symptoms you’ve experienced leading up to that point. Then, from that date until your appointment, write down all the different types of symptoms you experience. Include everything, even if you don’t think it’s relevant, like colds, headaches, stomach issues, shortness of breath, chest pain, etc. Also, be sure to include your emotions and feelings because endometriosis can significantly impact mental health and can lead to conditions such as depression and anxiety. Emotions and mental health are essential as you might want to include a counselor as part of your holistic endometriosis treatment team.

3. Bring This Printable Guide.

At, they’ve created a convenient guide that can help you describe your symptoms and know what to ask your endometriosis specialist. Click here for the PDF. Please print it out and answer all the questions. Bring this with you to your doctor’s appointment to help specifically describe your endometriosis pain and other symptoms. 

4. Take All Your Medications With You. 

The importance of this cannot be understated. Even if you have a medication reconciliation (also known as a “med rec” for short) from your doctor, it’s important to realize those are not always up-to-date with everything you take. This inconsistency is especially true if you are on medications from multiple specialists or take supplements as well. The best way for your endo specialist to have a complete picture of all the medicines you are currently taking is by bringing them with you to the doctor’s appointment. You should include any supplements or over-the-counter medications. Bring in the physical bottles along with any medication history records.

5. Prepare Yourself Mentally. 

Go into the appointment with the bold mindset that you will ask every single question you have to gain clarity on your endometriosis diagnosis and treatment options. Endometriosis is an aggressive inflammatory disorder that can have a devastating impact on your quality of life. It would help if you carried an even more aggressive attitude toward trying to stop it dead in its tracks.

6. Bring a List of Questions.

What’s been bothering you the most? Pain? Bowel symptoms? Bring a list of all the important questions that you want answers to. Writing them down will help you not forget during the appointment. Furthermore, when the doctor sees you have a list of questions you want answers to, it makes it harder for them to get up and walk out of the room like the appointment is over. If something like that has ever happened to you, we are sorry you’ve experienced this. That’s why it’s crucial to find a vetted endometriosis expert.

7. Take a Support Person With You.

Finding a good endo expert is no easy task (unless you use iCareBetter to connect you to one). If you are the type of person who is a bit shy or feels intimidated, you should bring your best support person to the appointment with you. Even if you are not nervous about your first endometriosis specialist appointment, having someone you trust by your side can help you process the information and encourage you along your journey. If no one you would like to accompany you, consider bringing a recorder and taping the visit. Because this can help you go back later and make sure you’ve understood all the information. Most doctors will have no qualms about recording your visit.

Endometriosis Care Process with iCareBetter

1- Find an expert based on keyword/ specialty or state
2- choose your doctor from the list
3- Get the contact info
4- First call and consultation.
5- Get info regarding costs and care process
6- Receive care

We Want to Hear From You

Have you been to an endometriosis specialist (OB-GYN experienced in endo)? If so, is there anything you wished you would have done differently? If you’ve not been to an endo specialist yet, what is your biggest concern about the first doctor visit?


Endometriosis Facts & Myths: Dispelling the Misconceptions

Debunking the Myths About Endometriosis & Exploring the Facts

One in ten women worldwide is affected by endometriosis, also known as “endo,” for short. While this number is an estimate, the actual figures may be higher. Not only is the person with this inflammatory disorder affected, so are the family members and people around her due to the often debilitating effects of this disease. Endometriosis facts are important because it is complex and often misunderstood even though it’s a common disorder. Because of this, there are many myths and misconceptions regarding endometriosis prognosis, treatment, causes, symptoms, diagnosis, complications, etc. 

Focusing on the disease itself often ignores the vicious cycles of stress, fatigue, pain, doctor visits, flare-ups, and loss of productivity experienced by the patient. These factors can lead to a decreased quality of life. Worse is that endometriosis facts come behind outdated treatment options, myths, and misconceptions about this disorder. It takes an average of eight to ten years for a patient to be diagnosed with endometriosis. One of the biggest problems with the misconceptions about endo is that they can prevent women from seeking treatment. Keep reading as we review endometriosis facts and debunk the myths. 

Overview of Endometriosis 

Endometriosis is a pelvic disorder characterized by endometriosis tissue similar but not the same as the tissue inside the uterus, growing elsewhere. Typically, the growth occurs outside the uterus, ovaries, fallopian tubes, cervix, the surface of the bladder, bowel, and distant organs.

Endometriosis growths can cause pain, scarring, and sometimes infertility. Pain from endometriosis is usually the result of menstrual bleeding from the tissues. Unlike the endometrium inside your uterus, blood that comes from endo tissue outside this organ has no means of escaping the body. This blood causes increased pressure and inflammation, which can result in pain that’s often debilitating. If you would like to learn more information about endometriosis, please read our introduction article, “Endometriosis 101: Covering the Basics.”

Why is it Difficult to Diagnose endometriosis?

Studies show that it can take an average of seven years or more for a woman to get an endometriosis diagnosis. Why is this? Endometriosis signs and symptoms are often similar to other conditions, such as irritable bowel syndrome or pelvic inflammatory disease (PID). Therefore, it’s often mistaken for another illness. Furthermore, the myths and misconceptions we discuss below also prevent a lot of women from seeking help. For this reason, it’s crucial to get the endometriosis facts clear. Keep reading as we debunk the myths and state the facts.

Myth #1: Severe Period Pain is Normal

Nineteenth-century doctors were often perplexed by “women’s problems.” As a result, women were often discounted as being unstable mentally. While the attitudes and thoughts have improved since, some of those old beliefs persist, including those regarding period pain.

Many patients with endometriosis hear that their severe period pain is “normal.” Pain and cramping are normal during menstruation. However, the pain should not be so intense that it interferes with functioning or impacts the quality of life. If your period pain is so severe that you cannot carry out daily activities, you should seek an endometriosis expert.

Myth #2: A Hysterectomy Cures Endometriosis

Endometriosis growths are tissues “similar” to those inside of the uterus. It is not the same tissue. Simply removing the uterus and/or ovaries without excising any endometriotic implants growing outside the uterus will not cure it. 

Myth #3: Endometriosis Only Affects the Pelvic Area

Locations within the pelvis, such as the surface of the uterus, bladder, or fallopian tubes, are the most common locations where endometriosis growths occur. However, endo can occur elsewhere in the body. In some cases, endometriosis growths have been present in distant organs, such as the lungs

Myth #4: Endometriosis Symptoms are Simply a “Heavy Period”

Bleeding during menstruation can be heavy at times. However, it should not exceed the saturation of a pad or tampon in one hour. If you experience that degree of bleeding, you should bring this up with your healthcare provider. The fact is that many women with endometriosis experience abnormally heavy flow due to the excess tissue.

Myth #5: Douching Causes Endometriosis

No scientific evidence links douching with the development of endometriosis.

Myth #6: Having an Abortion Can Cause Endometriosis

No scientific evidence demonstrates that having an abortion causes endometriosis. Those who claim otherwise might be confusing endometritis and endometriosis.

Myth #7: You’re Too Young to Have Endometriosis

A common misconception is that endometriosis is rare or doesn’t occur in young women and teenagers. As a result, many doctors do not consider an endometriosis diagnosis in young women with typical symptoms. Endometriosis facts demonstrate that teenagers and women in their early 20s can have the disorder. Most people with endometriosis state they experienced endo symptoms during adolescence. 

Myth #8: Endometriosis Can Be Prevented

It’s not clearly understood what causes endometriosis. Therefore, there are no proven ways to prevent this inflammatory condition. Anything else is purely speculation at this point.

Myth #9: Endometriosis is Always Painful

Not all women with endometriosis experience pain. Studies show that some women with advanced stages of endometriosis do not experience pain as a symptom.

Myth #10: Pregnancy is a Cure for Endometriosis

This misconception about endometriosis is slowly beginning to fade. However, not quickly enough! Pregnancy fluctuates hormones in the female body, which can temporarily suppress some symptoms of endometriosis. However, these symptoms usually recur for most patients following the pregnancy. Therefore, it’s not a cure.

Myth #11: Menopause Cures Endometriosis

Endometriosis symptoms often occur during menstruation, but many women experience them long after periods stop. Following menopause, the body still produces small amounts of hormones, and the endometriosis tissue still responds to them, thus causing pain. For many women, the symptoms of endometriosis may improve after menopause, but that does not mean it’s a cure. Depending on the case, it might be necessary to remove endometriosis implants or adhesions even after menopause. 

Myth #12: Hormonal Therapy Cures Endometriosis

Doctors have been treating endometriosis for years using hormonal therapy drugs. However, these medications do not have long-term effects on the disease itself. Hormones can help relieve the symptoms temporarily and even shrink the growths, but they do not cure endometriosis.

Myth #13: Endometriosis is Cancer

Endometriosis growths are not cancerous. To date, there is little evidence that shows endometriosis directly causes cancer. However, some types of cancers are more common in women who have endometriosis. Endometrial cancer is also known as uterine cancer. Many studies have examined the relationship between the two, and one showed that merely 0.7 percent of patients with endometriosis had endometrial cancer at the 10-year follow-up. Therefore, endometriosis does not equal cancer, but it may increase the risk of cancer.

Myth #14: Tubal Endometriosis Always Causes Infertility

Tubal endometriosis is not very common, and it does not always cause infertility. Does endometriosis cause infertility? It can be in many cases, but the mechanisms of infertility in endometriosis remain multifactorial. Can you get pregnant with endometriosis? It is possible, and many women do – especially with proper treatment early on.

Myth #15: Endometriosis Symptoms Are the Results of Emotional Distress (It Is All in Your Head)

Yes. People have heard many times that emotional distress could be the cause of their endometriosis and pain. This statement is false. The fact is, endometriosis is a highly complex disorder with many underpinnings. Those with endometriosis often experience emotional distress as an impact of the symptoms such as pain and infertility. But emotional distress it’s not the cause of endometriosis symptoms.

Endometriosis quick facts:

1- There is no blood test available for the diagnosis of endometriosis.

Mehedintu C, J Med Life, 2014

2- The diagnosis of endometriosis starts by taking a good history from patients, and performing a detailed physical exam including pelvic exam. In some cases, a doctor might ask for MRI and Ultrasound to have a more thorough picture. But the ultimate diagnosis is only possible with laparoscopic /robotic surgery and taking a biopsy for histopathology. There is no blood test that can tell if you have endometriosis.

3- Studies show that those with endometriosis have an increased risk of developing depression and anxiety disorders.

Chen LC, et al, J Affect Disord, 2016

4- Pelvic pain due to endo occurs a day part of an inflammatory cycle which can affect the pelvic organs and functions such as sitting, sex, bowel movements and even urination. Pelvic floor physical therapy can help with restoring balance to the pelvic floor muscles.

Dr. Juan Michelle Martin,  Endometriosis Physical Therapist.

5- “The most common clinical signs of endometriosis are menstrual irregularities, chronic pelvic pain, dysmenorrhea (painful periods), dyspareunia (painful sex), and infertility.”

Lagana AS, et al, Int J Womens Health. 2017

We Want Your Input

Are there any endometriosis myths or misconceptions we did not list here? Let us know in the comments below!


A Multidisciplinary Team for Endometriosis is Key to Positive Outcomes

Why Your Endometriosis Treatment Plan Should be Multidisciplinary

Endometriosis (endo) is a chronic and progressive disorder characterized by the growth of endometriosis tissue outside the uterus. This disorder often affects various organs in the body and results in pain and other issues. In addition to the intense physical and often debilitating symptoms of the disease, it can also take a toll on mental and spiritual health. Therefore, a multidisciplinary team (MDT) approach to endometriosis pain, surgery, and disease management leads to the best outcomes for patients. Keep reading to learn how.

What is Endometriosis?

Pronounced (en-doe-me-tree-O-sis), endometriosis is a chronic inflammatory disorder in which a type of tissue that is similar to the endometrial tissue that normally grows inside the uterus, grows outside this organ. Sometimes, the endometriosis tissue appears on the outer side of the uterus. These lesions can also grow on the ovaries, fallopian tubes, bladder wall, and on the outside of other organs within the pelvic cavity and other regions of the body.

Endometriosis is often a very painful and debilitating disease. During menstruation, these endometriosis growths shed blood into the body which is not able to be released. This causes an increase in pressure throughout the pelvic and sometimes abdominal region. Endo often involves other organs such as the bowels, ovaries, fallopian tubes, vagina, and cervix. In rare cases, it may affect other organs, such as the bladder, lungs, diaphragm, or kidneys. If you would like to learn more information about endometriosis, read our article, “Endometriosis 101: Covering the Basics”.

What is a Multidisciplinary Team Approach in Medicine?

Multidisciplinary care is when multiple members of the healthcare team come together to collaborate to provide optimal care for a patient. When it comes to endometriosis treatment, it’s important to involve various disciplines across the healthcare spectrum to achieve the best possible outcomes for patients.

Benefits of a Multidisciplinary Treatment (MDT) Team for Endometriosis

Draw in endo experts across different care areas to enhance the patient’s prospects and outcomes. Physicians benefit from this approach as they are able to provide a better framework for decision-making on a collaborative level and implementation. These aspects are particularly important when dealing with complex endometriosis cases. When several endo experts work together in unison, the benefits include cross-discipline learning, research, and review.

There is a type of disease, called deep infiltrating endometriosis (DIE). Alarmingly, about 20 percent of endo patients have this type. With DIE, the lesions can penetrate 5 mm deep into the organs affected by the disorder. A multidisciplinary treatment plan is the best approach for better outcomes and improved quality of life for the patient. The resection of DIE lesions requires a surgeon with expertise in endometriosis and a multidisciplinary approach coordinated by the endo specialist.

In fact, in 2019, the Society for Women’s Health Research assembled a team of clinicians, researchers, and patients to deliberate on the barriers in the commonly accepted forms of endometriosis treatment and management. The team underscored the importance of comprehensive and interdisciplinary approaches to disease and pain management for proper treatment and diagnosis.

Who comprises an Endometriosis Multidisciplinary Team?

The following are some of the endometriosis experts that come together and help treat patients holistically:

Endometriosis Surgeon (Gynecologist): 

If you have endometriosis, a regular obstetrics-gynecological surgeon is not going to suffice. It’s important to have an endometriosis specialist, who is an OB surgeon with experience in the treatment of this pelvic disease. An endometriosis laparoscopy is often needed to diagnose and treat the disease. It’s important to choose a surgeon familiar with endo to ensure all lesions are removed. Learn more about endometriosis specialists and how to find a vetted physician in our article here.

Colorectal Surgeon (Bowel Surgeon): 

If the endometriosis affects the bowel, surgical excision may be necessary to remove the lesions. Surgical treatment, such as full-thickness disc excision or a bowel resection should only be performed by an experienced colorectal surgeon. This physician will participate in the care from the diagnostic workup to surgical treatment and follow-up care.

Urologist (Genitourinary Tract Doctor): 

A urologist treats disorders of the urethra, kidneys, urinary bladder, and adrenal glands. Having an experienced urologist as part of your multidisciplinary team can help aid in the treatment of ureter and bladder lesions as well as minimize kidney or bladder complications.

Radiologist Experienced in Endometriosis: 

Endometriosis may have several presentations, which can make diagnostic testing challenging. Because endometriosis lesions can present in other areas of the body away from the reproductive organs, it’s important that the radiologist on your team is familiar with the pelvic nerve anatomy and how to detect signs of neural endometriosis.

Physical Therapist/Pelvic Floor Therapist: 

Physical therapy can be very important in the treatment of endometriosis. While some patients may require physical therapy to help them adapt to pain and stay mobile, others may need highly specific pelvic floor therapy. A pelvic floor physical therapist can work with the patient to help reduce adhesions and scar tissue which can limit pelvic floor extensibility. These exercises are important to help reduce pain sometimes associated with intercourse or the insertion of a tampon.

Pain Management Doctor: 

Endometriosis pain is often the primary complaint and most debilitating symptom of this disease. In fact, it’s not uncommon for the pain associated with endo to become so intense that a person is no longer able to function in daily life. For this reason, a pain management doctor should be a part of the team to improve functioning and overall quality of life.


Anxiety and depression are two of the biggest mental health disorders that often accompany endometriosis. Furthermore, the pain and sometimes infertility that come with this disorder can further aggravate these negative emotions. Therefore, a holistic MDT for endometriosis will include a psychiatrist or psychologist, possibly one who specializes in pain management.


Nutrition plays a key role in the processes and regulation of your digestive and immune systems. A proper endometriosis diet can help to reduce the chronic inflammation that keeps the endometriosis lesions growing and spreading. A nutritionist with experience in treating endo patients is key for successful outcomes


There are different stages and types of endometriosis. Endometriosis with architectural atypia is one type that may be a precursor of ovarian cancer. Therefore, it’s important that a pathologist carefully examines the lesions to discover if they could be indicative of endometriosis-associated ovarian cancer.

Building Your Multidisciplinary Team for Endometriosis

Who’s got your back? If you have or suspect you might have endometriosis, this is a very important question to ask yourself. iCareBetter is a digital platform that connects endo patients to vetted endometriosis experts across a variety of disciplines. If you have endo, we want to hear from you. Do you already have an MDT for endo? If so, who are the members of your personal team?


How Do I Know If I Have Endometriosis? Endometriosis Signs

Learn Endometriosis Signs & Symptoms & What to Tell Your Dr.

Pelvic pain is common for most women during their period. However, for some – this time of the month comes with excruciating pain due to the medical condition – endometriosis (also known as endo for short). Believe it or not, endometriosis signs extend beyond just the debilitating pain, although, that’s the hallmark symptom of this inflammatory disorder.

If you think you might have endometriosis, it’s important to have a solid foundation of information before you see your doctor for a possible endo diagnosis. Keep reading to learn what endometriosis is and what are the most common signs and symptoms of this condition.

What Is Endometriosis?

Pronounced (en-doe-me-tree-O-sis), endometriosis is a chronic inflammatory disorder of the pelvis where tissue similar to that normally grows inside your uterus, grows elsewhere instead, usually on the outside of it. The endometriosis tissue can block fallopian tubes, cover your ovaries, and even line the organs of your pelvis. 

Endometriosis can cause intense pain and fatigue, which makes it a disabling inflammatory condition for many women. Pain from endometriosis can be so intense that sometimes even medication cannot touch it. Other organs commonly involved include the fallopian tubes, bowels, cervix, ovaries, vagina, and pelvic tissue. Rarely, endo may also affect distant organs. Learn more about the disorder in our previous article, “Endometriosis 101: Covering the Basics”.

What Are Endometriosis Signs and Symptoms?

Sadly, endometriosis is an inflammatory disorder that often goes undiagnosed for years because the hallmark symptoms are things that some women take for granted as “normal”: heavy bleeding and pain during periods. If you think you might have endometriosis, it’s important that you know what to look for and when you should notify a doctor. The following are seven common signs of endometriosis:

Dysmenorrhea (painful periods)

Intense pelvic or abdominal pain is one of the most common symptoms of endometriosis. Endometriosis pain is often described as a sharp or stabbing sensation. During menstruation, women with endo may experience very painful periods because the endometrial tissue swells and bleeds every month, just like the uterine lining would. However, because this process is occurring outside the uterus, blood is not easily shed, and this pressure can cause extreme cramping that is much more intense than typical period cramps. Period pain should not disrupt your daily life, so if it does, you need to let your doctor know or find a qualified endo specialist.

Menorrhagia (heavy menstrual bleeding): 

While many women bleed heavily during their period, endometriosis can cause significant blood loss. How do you know if your amount of bleeding is excessive? Watch for these signs:

  1. Passing large clots
  2. Period goes on longer than a week
  3. Bleeding through a pad or tampon in an hour
  4. Too fatigued to carry out daily activities

If you have these symptoms, you may have menorrhagia and should contact a gynecologist. Menorrhagia is sometimes caused by endometriosis, and it can cause anemia and severe fatigue.

Dyspareunia (pain during or after intercourse): 

When endometriosis is the cause of painful intercourse, the woman may not experience the pain upon entry, only upon deep penetration. There can be physical and psychological causes of this condition, and endometriosis may be the culprit, as tissue builds up on the other side of the lower uterus or vagina – and sexual intercourse can stretch the tissue. You should talk to an experienced physician if you have pain during or after intercourse.

Chronic Pelvic Pain: 

While the inflammatory condition usually involves pain during menstruation, endometriosis pain can occur at any time of the month. Endometriosis causes an increase in pressure due to the excessive tissue in the pelvic cavity. This can cause a chronic pain condition that might be felt exclusively in the pelvis or manifest as abdominal or back pain. 

Ovarian Cysts: 

There is a type of endometriosis that causes endometriomas (also known as chocolate cysts) to grow on your ovaries. These cysts are non-cancerous but may become large and painful. Also, women who have these may also have other endometrial growths in the abdominal or pelvic areas. 


Up to about half of women who have problems with fertility also have endometriosis. Furthermore, up to 50 percent of women who have endometriosis are unable to get or stay pregnant. The relationship between these conditions isn’t always clear as many factors can impact fertility. However, in the event that the endometriosis tissue blocks the reproductive organs, there is a clear connection. Treating the condition can increase your odds of having a baby. If these fertility issues are affecting you, contact an endometriosis specialist. 

Bowel/Bladder Problems: 

Bathroom visits may be problematic if you have endometriosis lesions growing near your bladder or bowels. And if you are experiencing difficulty with urination or bowel movements or bleeding in the bowel – these may be signs of endometriosis. Also, if you have painful urination, blood in your stool, nausea, or hyper urgency to urinate – you should tell your medical provider immediately. 

When to Call Your Healthcare Provider

Share with your healthcare provider any of the following endometriosis signs and symptoms:

  • Pain. Pain is the most common sign of endometriosis, and it can be present:
    • During or after sex
    • With bowel movements
    • When urinating during your period
    • As chronic abdominal, lower back, or intestinal pain
    • Similar to menstrual cramps that get worse gradually
  • Bleeding or spotting between periods
  • Difficulty getting pregnant or infertility
  • Digestive issues or stomach problems such as diarrhea, constipation, bloating, or nausea—especially during your periods

Find an Endometriosis Specialist for Diagnosis, Treatment, & Surgery

Why It’s Important Your OB-GYN Specializes in Endometriosis?

When it comes to the treatment and management of endometriosis pain and/or other symptoms, all doctors are not the same. In fact, if you have or suspect you might have endometriosis, you should never just walk into the office of a random obstetrics/gynecology (OB-GYN) surgeon. 

However, it can be a bit tricky to find an endometriosis specialist that is highly skilled and follows the best treatment practices for this disorder. If you want to learn more about endometriosis, read this article that gives an introduction to the condition, signs and symptoms, causes, complications, and treatments.

With so many myths about endometriosis (endo) – it’s important to separate facts from fiction. Arm yourself with research and a solid foundation of knowledge to help you simplify the process and to get in touch with a trusted endometriosis specialist. Keep reading to find out why it’s so important to use an endo expert, red flags that your doctor/surgeon is not the right fit, and how to find an endometriosis specialist near you.

Find an Endometriosis Specialist near me

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This article will cover:

What is an Endometriosis Specialist?

Doctors with extensive experience in treating and caring for patients with this condition are known as endometriosis specialists. They are typically obstetricians and gynecologists (OB/GYNs), which are doctors who treat female pelvic organs, reproductive issues, and deliver babies. Therefore, most endometriosis specialists are also skilled surgeons.

Read more: 7 Ways to Prepare For First Endometriosis Specialist Appointment

How are Endo Specialists Different than Typical Gynecologists?

Practitioners who specialize in endo care mostly for patients with endometriosis. From surgical treatment to medical management, their guidance is unparalleled to that of a gynecologist who serves general patients. You find endometriosis specialists at large teaching hospitals, medical centers, and private practices with gynecological surgeons.

The Role of Endometriosis Specialists in Treatment

The right specialist will have extensive knowledge of this disorder and the additional surgical training and skills it takes to effectively treat endo and the related conditions. Furthermore, the endo doctor should also have experience with modern techniques and access to state-of-the-art equipment – which often includes robotic or laparoscopic surgical tools. Additionally, openness to complementary treatments and a thorough understanding of various treatments are some other advantages of choosing an endometriosis expert and not just a regular OBGYN.

Patients report the most important thing about a surgeon is that they take their time and carefully listen to you. A good surgeon will pay attention when you speak and not challenge your knowledge or experience.

Read more: Common endometriosis symptoms

Uncommon symptoms of endometriosis

Finding the Right Doctor for Endometriosis Treatment

Endometriosis is a painful disorder that affects up to 10% of women. It is caused by cells similar to those in the lining of the uterus growing outside of it, leading to pain and other symptoms such as fatigue, heavy menstrual cycles, and infertility. As endometriosis can be challenging to diagnose and treat, finding the right doctor for your condition is essential for successful treatment. When selecting a doctor for endometriosis treatment, let’s look at what you should consider. 

Types of Doctors 

When looking for a doctor to treat your endometriosis, consider seeing an experienced OB-GYN or a Reproductive Endocrinologist (RE) specializing in treating fertility problems. An expert OB-GYN can provide surgical options, general care for your reproductive health, and address any issues related to your pain. They may also be able to refer you to an RE if they believe further testing or treatments are necessary. 

An RE specializes in diagnosing and treating difficulties with fertility, including endometriosis. They have received specialized training in reproductive medicine, making them uniquely qualified to diagnose and treat endometriosis. Seeing an RE may help you get a more accurate diagnosis and provide access to treatments such as hormone therapy or surgery that can relieve the symptoms of endometriosis and achieve fertility.

Qualities To Look For 

When selecting a doctor for endometriosis treatment, there are certain qualities that you should look for to ensure that you are getting the best care possible. Your doctor should have experience treating endometriosis, understand the physical and psychological aspects of living with this condition, and provide comprehensive care from diagnosis through treatment options and follow-up visits.  

Choosing the right doctor for your endometriosis treatment is essential for successfully managing this chronic disorder. When selecting a physician, make sure they have experience treating this condition and understand both its physical and psychological components so they can provide comprehensive care from diagnosis through follow-up visits. By doing so, you can ensure that you receive appropriate care explicitly tailored to your needs and get relief from your symptoms to lead a healthier life.

Considerations When Looking for an Endometriosis Specialist

Your endometriosis specialist will be a teammate with the common goal of getting you to living your best life. Ask a lot of questions and listen to the answers. Here are some considerations when looking for an endometriosis expert near you: 

  • Does the doctor have experience with various medical conditions related to endometriosis?
  • Does the doctor specialize in the treatment of adult or adolescent endometriosis? Or both?
  • Is the doctor receptive to your information and input? What is their attitude towards your healthcare treatment?
  • Does the doctor rush you through assessments and questions, or do they take their time?
  • Does the doctor speak to you in terms you understand? (This is particularly important during the explanation of tests and/or surgical procedures.)
  • What is the doctor’s belief on the use of hormonal therapies? Do they have medical justifications for prescribing them? Can they tell you the pros and cons of these options?
  • Do you feel comfortable speaking with the doctor? Endometriosis pain and symptoms can be hard to discuss, so it’s important you feel at ease.
  • Does the doctor work in cooperation with other professionals to offer holistic treatment, (i.e. physical therapists, pain specialists, psychotherapists, gastroenterologists, etc.)?

Red Flags About a Potential Endometriosis “Expert”

It’s important that you pick an expert who knows what they’re doing to support you. Unfortunately, there are a lot of myths surrounding surgical best practices when it comes to endo treatment. What’s even worse is that some of these options could result in infertility or other issues, and not even address the underlying endometriosis condition.

The following are red flags that could indicate the doctor you are speaking with is not a trusted endometriosis specialist:

Red Flags

How Can I Find an Endo Specialist Near Me?

Now that you’ve read more about the importance and what to look for in an endometriosis specialist, are you ready to connect with someone in your area? At iCareBetter, our passion is to connect patients with vetted endo specialists. Go to the directory to learn how we can help you get on the road to health and improve your quality of life.

Top Endometriosis Specialists/doctors

Endometriosis specialists New York

Endometriosis specialists California

Endometriosis specialists Virginia

Endometriosis Care Process with iCareBetter

1- Find an expert based on keyword/ specialty or state
2- choose your doctor from the list
3- Get the contact info
4- First call and consultation.
5- Get info regarding costs and care process
6- Receive care


Endometriosis Signs and Symptoms: Everything You Need to Know

Sharp. Stabbing. Burning. Throbbing. Aching. All these adjectives have been used to describe endometriosis pain. Endometriosis is a condition that, for some women, can cause excruciating uterus pain. Some describe it as feeling like their insides are being pulled out of their bodies. Even worse – pain medication doesn’t cut through or provide relief for many patients with this condition. Therefore, an endometriosis diagnosis can be very serious and life-changing news.

Our commitment to our patients runs deep, and our mission is to help patients with endometriosis pain and other complications find the skilled doctors they need.

Read more: How to Find an Endometriosis Specialist for Diagnosis

As our first introduction to the disorder, we will give you a brief overview of the signs and symptoms of endometriosis, its causes, complications, and treatment options (or, as we like to call it – hope). First, we will give you general information on the disease and cover what endometriosis is.

Table of contents

1- What is the Endometrium?

2- What is Endometriosis?

3- Signs and Symptoms of Endometriosis

4- Causes of Endometriosis

5- Complications of Endometriosis

6- Diagnosis of Endometriosis

7- Treatment for Endometriosis

8- Surgical Treatment Options for Endometriosis:

9- Multidisciplinary care

10- Find a Vetted Endometriosis Expert

What is the Endometrium?

The endometrium, also known as the endometrial lining, is the tissue that comprises the “wallpaper”, or lining of the uterus. The uterus is the pear-shaped organ that houses a growing baby. During pregnancy and menstruation, the endometrium plays vital functions.

What is Endometriosis?

Endometriosis is pronounced (en-doe-me-tree-O-sis). Endometriosis is a medical condition in which tissue similar to what normally lines the inner walls of the uterus, also known as the endometrium, grows outside the uterus. It is often a very painful, even debilitating disorder. It may involve the ovaries, fallopian tubes, bowels, vagina, cervix, and the tissues that line the pelvis. In rare cases, it can also affect other organs, such as the bladder, kidneys, or lungs.

Signs and Symptoms of Endometriosis

Signs and Symptoms of Endometriosis
signs of endometriosis
endometriosis symptoms

Not all women will experience the same symptoms of endometriosis or degree of intensity/severity. Some women may not experience any symptoms at all. 

endometriosis does not always have symptoms. It can show itself by complications such as infertility.
signs you have endometriosis

20 Signs and Symptoms of Endometriosis

It is also important to keep in mind that the severity of symptoms is not a solid indicator of the progress of the disease. There are women with advanced stages of endometriosis who experience no symptoms at all and others with mild cases who endure many. Common endometriosis symptoms include: 

  • Painful periods, or dysmenorrhea
  • Infertility
  • Diarrhea during period
  • Pain during intercourse
  • Heavy or abnormal menstrual flow
  • Abdominal or pelvic pain after vaginal sex
  • Painful urination during or between menstrual periods
  • Painful bowel movements during or between menstrual periods
  • Gastrointestinal problems, including bloating, diarrhea, constipation, and/or nausea

Mechanisms of signs and symptoms of endometriosis:

Painful periods (dysmenorrhea)

Cyclic release of multiple inflammatory factors activates nerve fiber growth, leads to cell damage and fibrosis, and exacerbates pain during periods


The overall mechanisms can include tubal blockage, local inflammation, uterine muscle dysfunction, local hormonal alterations, and much more.

Diarrhea during menstrual periods

Diarrhea may result from endometriosis growing directly on the rectal muscle or endometriosis inflammatory substances. Local production of inflammatory molecules can lead to hyper-motility of the sigmoid and rectum muscles, which can manifest as cramping and diarrhea.

Pain during intercourse (dyspareunia)

Endometriosis implants have more nerve endings than usual (hyperinnervated) and can produce pain with pressure. The act of intercourse can apply this pressure on the upper vaginal area and uterosacral ligaments, which are common locations of endo implants. Once this pain occurs and local inflammation further causes tension in the pelvic floor, the muscles surrounding the vagina can contract, which worsens the problem.

Heavy or abnormal menstrual flow

Endometriosis can impact your bleeding by increasing stress from pain or damage to the ovaries, which can change local hormonal function.

Abdominal or pelvic pain after vaginal sex

Uterine and pelvic floor spasms are part of regular orgasms. When these areas are hypersensitive due to endometriosis, spasms lead to continued contractions and pain that lasts for a while. In addition, rectal fusion to the posterior vaginal wall will also cause more direct pain and inflammation by the vaginal area pulling on the rectal wall. Also, as you probably recognize, any event that stirs up the pelvis and causes some trauma leads to increased molecular signaling, further amplifying the problem. 

Painful urination during or between menstrual periods (dysuria)

Painful and frequent urination is a prevalent symptom of endometriosis. Endo cells and responding inflammatory cells produce inflammatory molecular signals that aggregate in the area of injury. These molecular signals affect all pelvic organs, including the bladder, leading to bladder wall spasms. Moreover, interstitial cystitis is common in endometriosis patients and can also be a factor. In the worst-case scenario, endo lesions implant inside the bladder, which can also cause cyclic bleeding from the bladder (hematuria). 

Painful bowel movements during or between menstrual periods (dyschezia)

Endometriosis causes inflammation and fibrosis or scarring as your body attempts to heal. This inflammation and fibrosis can severely alter the anatomy in the pelvis and distort the rectal course, gluing it to the uterus, cervix, and posterior vaginal wall. This angulation can cause constipation and trouble evacuating stool, while the inflammatory signals cause the rectal muscles to hyper-contract. These mechanisms lead to painful bowel movements, which worsen during the cyclic increases in inflammatory molecules. In the worst-case scenario, the endo will grow through the rectum wall over time, causing cyclic rectal bleeding.

Gastrointestinal problems, including bloating, diarrhea, constipation, and nausea

Generally, intestinal symptoms of endometriosis can be direct or indirect or related to conditions like small intestinal bacterial overgrowth (SIBO). Even if there are no direct implants on the bowel, the endo inside the abdomen and pelvis can cause enough inflammation to irritate the intestine and cause symptoms. In addition, endometriosis implants directly on the bowel can worsen the symptoms.

Join the discussion and discover other stories :

What were your uncommon symptoms of endometriosis?

What were your endometriosis symptoms?

Does Endometriosis Go Away After Menopause?

Causes of Endometriosis

One cause of endometriosis is the direct transplantation of endometrial cells into the abdominal wall during a medical procedure, such as a cesarean section. Besides this known cause of endometriosis, other theories exist as to how it develops:

1. One theory is that during the menstrual cycle, a reverse process takes place where the tissue backs up through the fallopian tubes and into the abdominal cavity, where it attaches and grows.

2. Another theory is a genetic link. This is based on studies that show if someone has a family member with endometriosis, they are more likely to have it as well.

3. Some also suggest that the endometrial tissues travel and implant in other body parts via blood or lymphatic channels, like cancer cells spread.

4. A fourth theory suggests that all cells throughout the body have the ability to transform into endometrial cells. 

Complications of Endometriosis

The following are complications of endometriosis if left untreated or in advanced stages of the disorder:

  • Infertility/subfertility
  • Chronic pelvic pain that can result in disability
  • Anatomic disruption of involved organ systems (i.e., adhesions, ruptured cysts, renal failure)

Diagnosis of Endometriosis

The diagnosis starts with assessing signs and symptoms and then performing imaging studies such as MRI and ultrasonography. But the confirmation or exclusion of the endometriosis diagnosis is only possible with surgical biopsy and histopathology. Laparoscopy is the gold-standard surgical modality for diagnosis in all cases.

Treatment for Endometriosis

Endometriosis needs a multidisciplinary team approach for effective and holistic treatment. This team should include the following medical professionals:

  • Nutritionist
  • Physical therapist
  • Endometriosis surgeon
  • Mental health therapist
  • Pain management specialist

Pain is often the biggest complaint from patients with endometriosis. Therefore, many treatment options are aimed at pain control. So first, here are some options for women to help temporarily ease the pain of endometriosis:

  • Exercise
  • Meditation
  • Breath work
  • Heating pads
  • Rest and relaxation
  • Prevention of constipation

These therapies may be used in combination with medical and/or surgical options to lessen the pelvic pain associated with this disorder. Furthermore, alternative therapies exist that may be used in conjunction with other interventions, and those include but are not limited to:

  • Homeopathy
  • Immune therapy
  • Allergy management
  • Nutritional approached
  • Traditional Chinese medicine

*Be sure to discuss any of these treatment options with a physician before implementing them.

The Right Medical Treatment For You:

Options for medical and/or surgical treatments for endometriosis are going to depend on several factors, including: 

  • Desire for pregnancy
  • The extent of the disease
  • Type and severity of symptoms
  • Patient opinions and preferences
  • Overall health and medical history
  • Expectations of the course of the disease
  • Patients’ tolerance level for medications, therapies, and/or procedures

In some cases, management of pain might be the only treatment. In others, medical options may be considered. The following are typical non-surgical, medical treatments for endometriosis:

  • “Watch and Wait” approach, where the course of the disease is monitored and treated accordingly
  • Pain medication (anything from non-steroidal anti-inflammatory drugs [NSAIDs] to other over-the-counter and/or prescription analgesics)
  • Hormonal therapy, such as:
    • Progestins
    • Oral contraceptives with both estrogen and progestin to reduce menstrual flow and block ovulation
    • Danazol (a synthetic derivative of the male hormone testosterone)
  • Gonadotropin-releasing hormone antagonist, which stops ovarian hormone production

Surgical Treatment Options for Endometriosis:

Despite their effectiveness in symptom control, pain medications can have significant side effects. Moreover, these medications do not stop the progression of the disease, and symptoms might return once stopped. But on the other side, surgery can lead to long-term relief and can prevent further damage to tissues. Your treatment plan should be a shared decision based on your desires, goals, and abilities. 

Almost all endometriosis surgical procedures are laparoscopic or robotic. These are minimally invasive surgeries in which small tubes with lights and cameras are inserted into the abdominal wall. It allows the doctor to see the internal organs and remove endometriosis.

Common procedures include: 

Excision of endometriosis:

In this technique, a surgeon cuts out much or all of the endometriosis lesions from the body. Therefore, surgeons avoid leaving any endometriosis lesions behind while preserving normal tissues. This technique is widely adopted by highly skilled endometriosis surgeons who are world leaders.

Ablation of endometriosis:

In this technique, a surgeon burns the surface of the endometriosis lesions and leaves them in the body. Most top experts highly criticize this ablation method. Ablation is most popular with surgeons who have not received enough training to do excision. As a result, these surgeons are not comfortable performing excision, and they do the ablation.


this is a surgery in which surgeons remove the uterus and sometimes ovaries. But, many surgeons consider hysterectomy an outdated and ineffective treatment for endometriosis. Almost all top endometriosis surgeons reject doing it unless there is a clear indication for hysterectomy such as adenomyosis.


this surgical procedure cuts and opens the abdomen and does not use thin tubes. Therefore it is more extensive than a laparoscopy. Very few surgeons still do laparotomy because of its complications. Almost none of the top endometriosis surgeons do laparotomy for endometriosis.

Multidisciplinary care

Along with effective surgical treatment, the patient should start working with endometriosis experts in physical therapy, mental health, nutrition, and pain management to achieve the best possible outcome.

Get in touch with Dr. Steve Vasilev

More articles from Dr. Steve Vasilev:

Endometriosis And Menopause: Everything You Need To Know

Understanding the Connection between Endometriosis and Cancer

What would happen to the signs and symptoms of endometriosis after menopause?

Physical Therapy Before Excision Surgery for Endometriosis

Endometriosis can cause multiple issues for patients. And it can create the need for a multidisciplinary care team to address chronic pelvic pain. Physical therapy is one example of part of a multidisciplinary treatment plan for endometriosis symptoms. Guest writer Rebecca Patton, PT, DPT, discusses considerations for using physical therapy while awaiting excision surgery:

Pelvic physical therapy has gained more following and prompted much-needed discussions in recent years.  However, pelvic physical therapy looks quite different for someone with chronic pelvic pain and endometriosis.

The reality is that pelvic physical therapists may be the first line of defense to refer a patient to a specialist.  First, because we have direct access, meaning a patient can see us for an evaluation before seeing a physician.  Second, because symptoms of endometriosis are often missed or dismissed by referring providers.  In the latter case, someone may be referred to physical therapy before excision surgery or even before seeing an endo specialist.

Physical therapists can optimize care by helping a patient get to a specialist while providing physical therapy treatment.  

If we are seeking to provide the best care available for the treatment of endo, getting a faster diagnosis and referring a patient to an excision specialist is the primary goal.  With a thorough medical history including bowel and bladder habits, menstrual symptoms, pelvic pain symptoms, previous treatment, and understanding the patient’s experience, a pelvic physical therapist can create a differential diagnosis list that may include endometriosis.  If endometriosis is suspected, a referral to an excision specialist should be given to the patient and explained. 

Endo specialists’ wait times vary greatly depending on where you are located. 

In my personal experience in Phoenix, AZ, a large metropolitan area with several specialists, it takes anywhere from 3-12 months.  More time if we are in the middle of a global pandemic.  Decreased access in rural areas may also increase waiting times.  One positive change is the inclusion of virtual appointments which may improve access for those in rural areas. 

During the waiting period, the goal is to manage pain and maintain some regularity with bowel and bladder habits until excision surgery.  Internal pelvic floor retraining may or may not be appropriate during this time. 

As mentioned before, physical therapy before excision surgery is going to look different from treatments for other conditions.  As a patient, you want to ensure the physical therapist you are seeing treats patients with endo regularly.  You may want to consult with them prior about how often they treat patients with endo and what treatments they use specifically.  Additional coursework for visceral and abdominal manual therapy techniques, nerve mobilization, and myofascial therapy techniques will be helpful.  

Most studies research the effectiveness of physical therapy following excision surgery.  What about physical therapy before excision surgery?

Zhao et al. (1) found that 12 weeks of PMR (progressive muscle relaxation) training is effective in improving anxiety, depression, and quality of life of endometriosis patients under GnRH agonist therapy.  These participants had not received excision surgery.

Awad et al. (2) found improvements in posture and pain with an 8-week regular exercise program in those diagnosed with mild to moderate endometriosis.  This exercise program included posture awareness, diaphragm breathing, muscle relaxation techniques, lower back and hip stretches, and walking. Of note, this exercise program was not vigorous exercise.  These participants were also receiving hormonal treatment but not receiving pain medication. 

Both studies did not say that physical exercise or PMR plays a role in the prevention of the occurrence or progression of endometriosis.   Both studies were short-term (8-12 weeks) and did not explore pain management directly before excision or outcomes after excision.

In the time that a patient is waiting for excision surgery, I believe physical therapy treatment can be effective at minimizing overall pain levels and improving quality of life.

A few factors to keep in mind if you are seeking pelvic physical therapy before excision surgery:

1.       Your symptoms after physical therapy should not last more than 1-2 days and should feel manageable. Being bedridden for a week after physical therapy is not a helpful treatment.  If you experience this, be sure to communicate it with your physical therapist to adjust the plan.  Not all pelvic PTs are experienced with this type of treatment and they may create an exercise plan that is too vigorous. 

2.       Internal pelvic floor treatment is not always the most helpful in this situation and may exacerbate symptoms. An individualized plan is important to discuss with your provider.

3.       You are in charge of your body. If you don’t feel like treatment is working then communicate that to your team and discuss other options.  It is always okay to voice your concerns to change the treatment to fit you best.

4.       Treatment before surgery requires a multidisciplinary team.  This may include other pain management options including medication.

iCareBetter is doing the groundwork to vet pelvic physical therapists. 

Rebecca Patton PT, DPT (If you are seeking a pelvic PT, I accept consultations through my website for in person and telehealth appointments:

For more resources on physical therapy for endometriosis see:


Zhao L, Wu H, Zhou X, et al.: Effects of progressive muscular relaxation training on anxiety, depression and quality of life of endometriosis patients under gonadotrophin-releasing hormone agonist therapy. Eur J Obstet Gynecol Reprod Biol, 2012, 162: 211–215. [PubMed] [Google Scholar]

Awad E, Ahmed HAH, Yousef A, Abbas R. Efficacy of exercise on pelvic pain and posture associated with endometriosis: within subject design. J Phys Ther Sci. 2017;29(12):2112-2115. doi:10.1589/jpts.29.2112 [NCBI]