HomeHealthEndometriosis: The Pain Is Not in Your Head

Endometriosis: The Pain Is Not in Your Head

Endometriosis, often dismissed as just painful periods or part of a woman’s active imagination, is a serious condition. It can cause debilitating pain that interferes with daily activities, especially during a woman’s period, and it can lead to infertility.

So what, exactly, is endometriosis? It occurs when the tissue that normally lines the inside of the uterus goes outside the uterus and implants in other parts of the body, most commonly inside the abdominal cavity, explained Kecia Gaither, M.D., director, Perinatal Services/Maternal Fetal Medicine at NYC Health+Hospitals/Lincoln. That stray tissue isn’t limited to the abdomen, however; it can also travel to the lungs, brain, eyes, skin and scar tissue. 

Though the tissue is no longer located in the uterus, it still behaves as if it were, breaking apart and bleeding when a woman’s period ends, causing inflammation, scarring and pain.

About 11 percent of women of childbearing age in this country have endometriosis, with those who have never had children, a history prolonged menstrual periods, family members with the disease, medical conditions that block the flow of menstrual blood and who consume diets high in fatty foods and meats most at risk of developing it.

Still, doctors don’t know exactly what causes endometriosis, Gaither said. Some doctors believe retrograde menstrual flow, when menstrual blood with endometrial cells travels back through the fallopian tubes and passes into the pelvic cavity where the cells stick to the organs, is the culprit. 

Genetics could also play a part, “particularly if multiple members of a family have the condition,” she said. In fact, research shows that when it’s in the family, the disease is worse in the next generation.

Women with abnormal immune systems also tend to develop endometriosis. As do those with a high concentration of estrogen concentration in their body and women who have had procedures that disrupt uterine integrity, including c-section, myomectomy to treat fibroids or abortion.

If a woman experiences symptoms of endometriosis—pain (“the most common presenting symptom,” Gaither said. “It can present itself as excruciating period symptoms, painful sex, chronic pelvic pain that is debilitating and painful bowel movements.”); difficulty getting pregnant; intestinal dysfunction, including constipation, diarrhea, nausea and vomiting; or scarring—she should talk to her doctor. 

Doctors determine if a patient has endometriosis through a variety of ways, including a pelvic exam, an ultrasound, an MRI or hysteroscopy, which Gaither called “the gold standard.”

There is no cure for endometriosis, but treatments typically include surgery or medication to manage symptoms. Some women opt for a holistic option.

“We should try this before we go to other options,” Gaither said, suggesting women cut out red meat and fatty foods, while increasing veggies, flaxseeds and foods rich in omega-3s. Herbal remedies, such as ginseng and ginger tea, as well as vitamins B and C, also might be helpful. 

“The take-home message,” Gaither said, “is a lot of things internally and externally can affect uterine health. Because endometriosis has a multi-systemic presentation, it’s often not diagnosed on the first visit. Often doctors will say the pain is in your head. Finding the right physician who understands you is important.”


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