Understanding Endometriosis: Symptoms, Risk Factors, and Why Early Diagnosis Matters

Endometriosis is a common yet underdiagnosed condition that affects millions of women worldwide. In fact, the true prevalence is likely much higher than reported. Currently, we estimate that 10% of women globally have a diagnosis of endometriosis, but this number does not account for those who remain undiagnosed. The average time to diagnosis is seven to ten years.

So, what are the signs and symptoms of endometriosis? What are the risk factors, and what should you be aware of?

What is Endometriosis?

Endometriosis is an inflammatory condition with an autoimmune component. The body responds abnormally to normal endometrial-like cells, causing them to deposit and grow outside the uterine cavity—most commonly within the peritoneal (abdominal) cavity. These endometrial implants are hormonally responsive, meaning they grow in response to estrogen, and in some cases, may also show resistance to progesterone. This process leads to inflammation, scarring, and pain, which are the hallmark symptoms of endometriosis.

Symptoms of Endometriosis

While some individuals with endometriosis experience no symptoms at all, the following signs may indicate the presence of the disease:

1. Painful Periods (Dysmenorrhea)

• Severe cramping and pelvic pain that interferes with daily activities

• Pain so intense it causes nausea, vomiting, or even fainting

• Pain that requires missing school, work, or social events

2. Chronic Pelvic Pain

• Persistent pain in the pelvis even outside of menstruation

• Pain that may feel like it originates from different areas due to nerve involvement

• Pain localized in the same area month after month

3. Pain During Intercourse (Dyspareunia)

• Deep, internal pain rather than pain at penetration

• Pain worsened in certain positions, especially those that allow deeper penetration

• Discomfort due to implants behind or in front of the uterus, particularly in the cul-de-sac region

4. Pain with Bowel Movements or Urination

• Less common but can indicate endometrial implants on the intestines or bladder

• Pain that coincides with the menstrual cycle

5. Gastrointestinal Symptoms

• Bloating, nausea, diarrhea, or constipation that fluctuates with the menstrual cycle

• Symptoms often misdiagnosed as Irritable Bowel Syndrome (IBS)

• Fatigue and loss of appetite accompanying digestive issues

6. Infertility

• Up to 40-50% of individuals with infertility have endometriosis

• Inflammation can affect egg quality, sperm interaction, and embryo implantation

• Even early-stage disease can contribute to fertility challenges

Diagnosing Endometriosis

Endometriosis is officially diagnosed through surgery, typically via laparoscopy, where implants can be visualized and excised. However, other tools such as physical exams and ultrasounds may suggest its presence. Importantly:

• A normal ultrasound or exam does not rule out endometriosis.

• The condition exists at a microscopic level, making it difficult to detect through imaging alone.

Risk Factors for Endometriosis

Certain factors increase the likelihood of developing endometriosis, including:

• Family history – A first-degree relative (mother, sister) with endometriosis increases the risk six to seven times.

• Early menstruation – Starting periods at a younger age leads to more estrogen exposure.

• Shorter menstrual cycles – More frequent ovulation increases hormonal stimulation.

• Fewer pregnancies or longer breastfeeding – Having more menstrual cycles over a lifetime raises risk.

On the other hand, factors that reduce risk include:

• Later onset of menstruation

• Longer menstrual cycles (fewer periods over time)

• Pregnancy and breastfeeding (fewer ovulatory cycles mean less estrogen exposure)

Why Diagnosis Matters

Endometriosis impacts fertility, daily life, and long-term health. Women with endometriosis:

• Are at risk of developing ovarian failure and early menopause.

• Experience significant disruptions in their quality of life due to pain and inflammation.

• Often face delays in diagnosis, especially if they have been on hormonal contraception, which can mask symptoms.

Treatment and Management

There is no absolute cure for endometriosis, but management strategies can help:

• Hormonal treatments such as birth control pills or progesterone to suppress growth (though they do not eliminate implants).

• Surgical intervention to remove lesions through excision, which can alleviate symptoms and improve fertility.

• Lifestyle modifications including an anti-inflammatory diet, exercise, and stress management to reduce flare-ups.

Endometriosis is a complex and often misunderstood disease that requires greater awareness, research, and earlier diagnosis. Understanding the symptoms and risk factors can empower individuals to seek help sooner. If you suspect you have endometriosis, advocate for yourself—early detection can make all the difference in managing your health and fertility.