Endometriosis is a chronic gynaecological disease that affects millions of women of reproductive age. Despite being relatively common, many patients live for years with symptoms before receiving a correct diagnosis. This happens because intense period pain and menstrual cramps are still frequently considered "normal", when, in fact, they may indicate a condition that warrants medical investigation.
In this article, you will understand what endometriosis is, what its symptoms are, risk factors, how diagnosis is made, what treatment options are available and when to seek medical advice.
What is endometriosis?
Endometriosis is a chronic inflammatory disease characterised by the growth of tissue similar to the endometrium — the lining that covers the inside of the uterus — in locations outside the uterine cavity.
This tissue can develop in the ovaries, fallopian tubes, bladder, bowel, uterine ligaments, peritoneum and, in rarer cases, in other parts of the body.
Like normal endometrium, this tissue responds to hormonal changes in the menstrual cycle. Each month it can become inflamed, bleed and cause pain, scarring and adhesions.
Endometriosis is not an infection, it is not contagious and it is not cancer.
What are the symptoms of endometriosis?
Symptoms vary from woman to woman. Some experience few symptoms, whilst others live with intense pain that significantly compromises their quality of life.
The main symptoms include:
- Intense period pain.
- Chronic pelvic pain.
- Pain during sexual intercourse.
- Pain during bowel movements during menstruation.
- Pain when urinating during menstruation.
- Bowel changes during the menstrual period.
- Urinary or bowel bleeding during menstruation, in some cases.
- Difficulty becoming pregnant.
- Abdominal bloating.
- Lower back pain.
- Frequent fatigue.
Not all period pain means endometriosis, but intense, debilitating pain or pain that worsens over the years should be evaluated by a doctor.
What are the classic signs of endometriosis?
Although symptoms can vary, some signs are considered quite suggestive of the disease:
Intense period pain
The pain typically becomes progressively worse over the years, and can prevent daily activities, work or studies.
Pain during sexual intercourse
The pain usually occurs during deep penetration and can persist even after intercourse ends.
Pelvic pain
Some women experience pain almost every day, even outside the menstrual period.
Bowel changes
These may include:
- Constipation.
- Diarrhoea.
- Pain during bowel movements.
- Sensation of incomplete evacuation.
These symptoms tend to worsen during menstruation.
Urinary changes
When the disease affects the bladder, pain on passing urine, increased urinary frequency and, in some cases, blood in the urine during the menstrual period may occur.
Infertility
In some women, difficulty becoming pregnant is the first sign of the disease.
What are the causes of endometriosis?
The exact cause of endometriosis is still not fully understood.
Studies suggest that the disease results from a combination of various factors, such as:
- Genetic predisposition.
- Retrograde menstruation.
- Hormonal changes.
- Immune system alterations.
- Environmental factors.
There is still no proven way to prevent the development of the disease.
Who is at greater risk of developing endometriosis?
Some factors increase the risk, including:
- Family history of endometriosis.
- Early first menstruation.
- Short menstrual cycles.
- Prolonged menstruations.
- Never having been pregnant.
- Hormonal changes.
Having risk factors does not mean that a woman will necessarily develop the disease.
Where can endometriosis occur?
The most frequently affected locations are:
- Ovaries.
- Fallopian tubes.
- Uterine ligaments.
- Peritoneum.
- Bowel.
- Bladder.
- Ureters.
In less common cases, it can also affect the diaphragm, lungs and other regions of the body.
How is endometriosis diagnosed?
Diagnosis begins with a detailed clinical evaluation.
During the consultation, the doctor investigates:
- Characteristics of the pain.
- Menstrual cycle.
- Family history.
- Bowel symptoms.
- Urinary symptoms.
- Desire to become pregnant.
When necessary, tests such as the following may be requested:
- Transvaginal ultrasound with bowel preparation.
- Pelvic magnetic resonance imaging.
In some cases, definitive diagnosis occurs during surgery.
The earlier the disease is identified, the greater the chances of controlling symptoms and preventing complications.
What are the risks of endometriosis?
Without appropriate treatment, the disease can progress and cause:
- Chronic pain.
- Adhesion formation.
- Bowel compromise.
- Urinary compromise.
- Ureteral obstruction.
- Reduced fertility.
- Infertility in some cases.
In addition to physical complications, endometriosis can also impact emotional wellbeing, professional life, relationships and quality of life.
How can endometriosis affect daily life?
The disease can interfere with different aspects of life.
Professional life
Intense pain can cause absences from work, reduced productivity and difficulty performing daily activities.
Social life
Many women avoid participating in commitments due to pain episodes.
Sexual life
Pain during intercourse can affect intimacy and create insecurity.
Fertility
Not every woman with endometriosis will be infertile, but the disease can make pregnancy more difficult in some cases.
Emotional health
Living with chronic pain can increase the risk of anxiety, stress and depressive symptoms.
How is endometriosis treated?
Treatment depends on the patient's age, the intensity of symptoms, the location of the disease, the extent of lesions and the desire to become pregnant.
The main options include:
- Medications to control pain.
- Hormonal treatment.
- Surgery to remove endometriosis lesions, when indicated.
- Lifestyle changes, such as regular physical activity, balanced diet, stress management and multidisciplinary support.
Each patient should be evaluated individually to define the best therapeutic strategy.
Is there a cure for endometriosis?
Endometriosis is considered a chronic disease.
Although there is currently no definitive cure for all cases, treatment can control symptoms, reduce disease progression, preserve fertility when possible and provide excellent quality of life.
When to seek medical advice
It is recommended to seek medical care if you experience:
- Very intense period pain.
- Pain that prevents daily activities.
- Pain during sexual intercourse.
- Pain during bowel movements or urination during menstruation.
- Bowel changes related to the menstrual cycle.
- Difficulty becoming pregnant.
- Frequent pelvic pain.
The earlier the diagnosis, the greater the chances of preventing complications and improving quality of life.
Frequently asked questions about endometriosis
Is all severe period pain endometriosis?
No. There are several causes of intense period pain. Only a medical evaluation can identify the source of the pain.
Does everyone with endometriosis become infertile?
No. Many women with endometriosis can become pregnant naturally. However, the disease can reduce fertility in some cases.
Does pregnancy cure endometriosis?
No. During pregnancy symptoms may improve due to hormonal changes, but this does not mean the disease has been cured.
Can endometriosis return after treatment?
Yes. Even after surgery or medication treatment, the disease can reappear, making medical follow-up important.
Can endometriosis turn into cancer?
In the vast majority of cases, no. Malignant transformation is rare.
Conclusion
Endometriosis is a common disease that can significantly compromise quality of life when not diagnosed and treated appropriately. Debilitating period pain, pain during sexual intercourse, bowel or urinary changes related to the menstrual cycle and difficulty becoming pregnant should not be ignored.
Early diagnosis and individualised treatment are essential to control symptoms, reduce complications and preserve women's health. If you show signs suggestive of endometriosis, seek medical evaluation to receive appropriate guidance and follow-up.
This content is exclusively informative and educational and does not replace evaluation, diagnosis, treatment or consultation with a qualified healthcare professional.
Dr Rebeca Soares Andrade CRM - GO 39335