Endometriosis affects 2 to 10 percent of American women — and for those of us in this percentage, we know its symptoms can be debilitating. Furthermore, according to the American Society for Reproductive Medicine, endometriosis can be found in 24 to 50 percent of women who experience infertility. Not only can endometriosis cause heavy, painful periods, but it can be difficult to treat — especially if you are trying to conceive.
The good news is there are treatment options for you to consider — from natural remedies to hormonal birth control; and some, like excision surgery, may even help increase your chances of getting (and staying) pregnant.
What is endometriosis, and how do I know if I have it?
The endometrium is the tissue that lines the uterus. During a "normal" menstrual cycle, hormones cause this tissue to build up, and then after the cycle ends, the tissue sheds. Women with endometriosis develop tissue that looks and acts just like the endometrium, but it’s located on the outside of the uterus. Endometriosis can present itself in several places including but not limited to the ovaries, fallopian tubes, surface of the uterus, bladder, GI tract, and more. It can also cause ovarian cysts, adhesions, and scar tissue to form within these areas.
Each month during the menstrual cycle, this endometrial-like tissue builds up and then recedes, potentially causing pain as the normal tissues swell and inflame. Symptoms of endometriosis may include:
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Excessive cramping (especially during your cycle typically in your abdomen or lower back)
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Infertility
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Pain during sex
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Painful urinating or bowel movements during periods
Endometriosis can be tricky in that some women might have a severe case and experience very little discomfort, while others might have a mild case and experience much more painful symptoms. The stage and severity of endometriosis is based on the location, quantity, and size of the endometrial tissue. Technically, the only way to diagnose endometriosis is through surgery to obtain a tissue sample. However, if you’re experiencing any of the aforementioned symptoms, the initial treatment plan is typically the same whether you have endometriosis, painful periods, or both.
If you believe you might have endometriosis, it's important to talk to your doctor about your symptoms. While there is no cure for endometriosis, treatment aims to ease symptoms so the condition doesn't interfere with your day-to-day life. Treatment is also dependent on whether or not you are actively trying to get pregnant. To learn more about infertility options if you have an endometriosis diagnosis and are trying to conceive, read this article.
Dealing with endometriosis pain and flare-ups
If you have endometriosis, you know that at certain times throughout the month the pain can be worse than at others. Based on how much discomfort you’re experiencing and where you are in your TTC or pregnancy journey, there are a few things you can do to help with an endometriosis flare-up:
1. At-home remedies
When it comes to endometriosis, there are natural ways to help manage the often debilitating pain that can come with it. Get regular exercise when you can, meditate, or find a stress-relieving activity such as walking or yoga. When flare-ups do happen, a warm bath or heating pad on your abdomen can help reduce discomfort. Acupuncture can also be beneficial. In addition, small changes to your diet and lifestyle can make a big difference in managing your endometriosis and boosting fertility. Above all, listen to your body when it's telling you to slow down and make self-care a priority when you're not feeling 100%.
2. Over-the-counter painkillers
Nonsteroidal anti-inflammatory drugs such as ibuprofen (Advil, Motrin, etc.) are safe and effective treatments for managing endometriosis pain. Naproxen sodium (Aleve) can also help ease your cramping. As always, consult with your doctor before taking any new medications, but NSAIDs are typically safe, and you can take them up to 24 hours before you expect menstrual pain to start.
3. Medical management treatments such as hormonal birth control
Hormonal birth control does not cure endometriosis, but it can help alleviate its symptoms without a permanent effect on your fertility. Hormonal birth control hinders the production of estrogen in the body, thus slowing the growth of that pesky endometrial tissue. So, if you have been diagnosed with endometriosis and are not actively trying to conceive, oral birth control pills can be effective in reducing pain throughout your cycle.
Other hormonal options to discuss with your doctor include progestin therapy, Gonadotropin-releasing hormone agonist, and aromatase inhibitors. Typically, these options are not the first line of treatment, but your doctor can help you determine when it’s time to change your treatment course.
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4. Surgery
If you're struggling to conceive or sustain a pregnancy, or if your endometriosis pain is simply too much to manage, it might be time to talk to your care team about surgical options. Surgery can not only diagnose the severity of the endometriosis, but it can also remove the endometrial-like tissue while keeping the uterus intact.
Through laparoscopic surgery, a surgeon can remove any cysts or adhesions caused by endometriosis, which can, in turn, help decrease pain. In mild to moderate cases, this may even help restore fertility. As a heads up, if you do decide to go this route, your doctor might still recommend hormonal treatment following surgery to help with pain management.
5. Join a support group
Endometriosis pain can be difficult to explain to those who haven't faced it, and it can be all-consuming to those affected. Many people find it helpful to join a support group to discuss and share successes and lessons from attempted treatment plans. If you are experiencing an extreme amount of pain due to endometriosis, it’s likely this can affect you socially and emotionally as well. Sharing what you are going through can help you feel more supported along the way. What works for someone else may not work for you, but sharing your journey with others can help you feel less alone. Endometriosis is not uncommon — especially in the infertility community. As a first step, consider joining Rescripted’s free fertility support community. We’re here to hold your hand every step of the way!
Whitney Welsh is a writer and content creator who is passionate about telling stories that inspire change. She has 12+ years of marketing and communication experience at industry-leading brands including Southwest Airlines, Hilton, and Baylor Scott & White Health. In her personal life, Whitney is inspired by travel, spending time outdoors, and volunteering in her community. She is currently expecting her first baby with her husband (and their dog, Odin).
