Featured Women's health

All about endometriosis

Woman with endometriosis pain
Dr. Leslie Po
Written by Dr. Leslie Po

“I always thought my periods were normal.”

I hear this a lot from my patients with endometriosis, when they’re describing their discomfort (in fact, downright pain) during their menstrual periods.  Often it takes women years to realize how severe their symptoms are, the result being that women often delay seeking help.  Endometriosis often begins during the teenage years, or in your 20s, and women often don’t seek help until in their 30s. It’s estimated that approximately one in ten women in Canada have endometriosis.

What is endometriosis?

Endometriosis is when the tissue that normally lines the inside of the uterus is found outside of the uterus. The tissue can grow in your abdomen, including on your ovaries, fallopian tubes, bladder and rectum. When you have your menstrual cycle, the lining in your uterus thickens and then sheds so that you have bleeding from the vagina (your period). The endometriosis tissue does the same thing. It thickens and then there are small amounts of bleeding. This blood and tissue, however, has no where to go, which can lead to inflammation and scar tissue formation (called adhesions) in the abdomen. This can then cause painful periods and sometimes difficulty getting pregnant.

What are the signs?

  • Painful periods
  • Pain with sex
  • Pain or blood with bowel movements
  • Pain or blood with urination
  • Difficulty getting pregnant

How do I get endometriosis diagnosed?

Sometimes diagnosis can be as simple as a history of your symptoms and a physical examination.  In this case, you can start treatment without doing any other tests.  Your doctor may also request an ultrasound to see if there are cysts on your ovaries or if there are signs of endometriosis.  Endometriosis is often not seen on ultrasound unless you have severe disease.

The only way to know, 100 per cent, if you have endometriosis, is with a surgery called laparoscopy.  Laparoscopy is sometimes called keyhole surgery. Small incisions are made on your abdomen and a thin telescope with a light is inserted to allow your doctor to see what’s going on.

The tricky part…

Here’s the catch: the severity of your symptoms does not always equal the severity of your disease. Your may have a lot of pain but your doctor might only see what they would classify as “mild disease” in an ultrasound or laparoscopy. On the other hand, you might only have a little pain, but your doctor may see quite severe disease.  Every woman’s situation is different.

What types of treatment are available?

Treatment usually depends on how bad your symptoms are and if you want to have children. In my practice, I find most women need long-term treatment to control symptoms, because symptoms often return if you stop taking your medications.

The first step is to talk to your doctor about the best medication for you, and also ask about side effects. Here are some common medications:

  • Hormone-based medication: These drugs decrease pain and can stop your menstrual period. They include birth control pills, progestin (also a pill) and gonadotropin-releasing hormone agonist (an injection).
  • A progestin-released intrauterine device which is inserted into your uterus for up to five years. It can decrease pain during your periods, and potentially stop or lighten your periods.
  • Non-steroidal anti-inflammatory drugs or NSAIDs which you take only when you’re having pain.

When is surgery the right option?

I recommend considering surgery when:
  • You’ve tried medication and it’s not working
  • You can’t take medication because you want to try to get pregnant
  • You are starting to have serious complications to your bowels, bladder or uterus as a result of having endometriosis

After surgery, you may feel relief from pain. But, for some women, the pain will return. There is a 50 per cent chance for the pain to return to the point where you need repeat surgery within five years after your first surgery. Your doctor may recommend medications to prevent your endometriosis from coming back to extend the length of time after surgery that is pain-free. If you don’t want to have children, and your pain is severe, you can consider a hysterectomy (the removal of your uterus) which may help better control your pain.

I’m having problems getting pregnant – help!

There are many reasons you may be having difficulty getting pregnant. That said, if you have mild endometriosis, surgery to remove your endometriosis may make it easier to get pregnant. If you have severe endometriosis, you may need in-vitro fertilization. Speak to your health care team and ask about your options, including if you should see a fertility specialist.

Is there anything else I can do to control the pain?

Some practitioners believe changing your lifestyle can help treat your endometriosis. There is no scientific evidence to support this but there are also no known harms.

  • Diet: A macrobiotic diet, such as eating whole grains, vegetables, beans and lentils, can help control endometriosis. With this approach, you’re encouraged to eat fish, seafood, seeds and nuts, but try to stay away from processed foods, milk, cheese, red meat and refined sugar.
  • Qigong: This is a traditional Chinese practice of body movement, meditation, deep breathing and a calm state of mind. Yoga, mindfulness techniques or meditation can also be helpful to manage pain.
For extra resources, check out yourperiod.ca/endometriosis and The Endometriosis Network for patient support.

About the author

Dr. Leslie Po

Dr. Leslie Po

Dr. Leslie Po is a obstetrician and gynecologist at Sunnybrook.