Endometriosis is a painful disorder in which the tissue that normally lines the inside of the uterus grows outside of it, most commonly on the ovaries, fallopian tubes, and tissue around the uterus. If left untreated, endometriosis can cause chronic pelvic pain, scar tissue, infertility, and other complications.
What is endometriosis?
Endometriosis occurs when endometrial tissue, which normally grows inside the uterus, grows outside of it. Each month, this tissue thickens and breaks down like the normal uterine lining, but unlike the tissue inside the uterus, it has no way to leave the body. This leads to inflammation, scarring, and the formation of cysts or adhesions.
The exact cause of endometriosis is unknown, but possible factors include:
- Retrograde menstruation – menstrual blood flows back into the pelvis
- Transformation of peritoneal cells – cells lining the pelvis turn into endometrial cells
- Embryonic cell transformation – cells from the embryo turn into endometrial cells
- Surgical scar implantation – endometrial cells implant in surgical scars
- Genetics – certain genes make a woman more susceptible
- Immune system dysfunction – the body fails to recognize and destroy endometrial tissue outside the uterus
Endometriosis most commonly affects the:
- Ovaries
- Fallopian tubes
- Ligaments that support the uterus
- Outer surface of the uterus
- Bowel or bladder
- Peritoneum (lining of the pelvic cavity)
What are the symptoms of endometriosis?
Common symptoms of endometriosis include:
- Painful periods (dysmenorrhea)
- Chronic pelvic pain
- Pain during or after sex
- Painful bowel movements or urination during menstruation
- Heavy or irregular menstrual bleeding
- Fatigue and nausea
- Infertility or difficulty getting pregnant
Some women with endometriosis have no symptoms at all, while others have severe pain and fertility problems.
How is endometriosis diagnosed?
If endometriosis is suspected, diagnostic tests may include:
- Medical history – discussing symptoms and menstrual history
- Physical exam – feeling for abnormalities in the pelvic area
- Ultrasound – using sound waves to create images of the pelvis
- MRI – detailed images using strong magnets and radio waves
- Laparoscopy – minor surgery to view the pelvic area and take biopsies
Laparoscopy is considered the gold standard for definitively diagnosing endometriosis.
What complications can occur if endometriosis is left untreated?
Some of the possible complications of untreated endometriosis include:
- Infertility – around 30-50% of women with endometriosis have difficulty getting pregnant. Endometrial cysts can distort pelvic anatomy, scar tissue can block the fallopian tubes, and inflammation can negatively impact fertility.
- Ovarian cancer – women with endometriosis, especially endometriomas or deep infiltrating endometriosis, have a slightly higher risk of certain types of ovarian cancer such as clear cell and endometrioid carcinoma.
- Chronic pelvic pain – pain may persist and even worsen over time without treatment as inflammation and scarring increases.
- Painful sexual intercourse – deep pelvic lesions can make sex painful.
- Bowel or bladder issues – endometrial lesions on bowels or bladder cause painful cramps, constipation, diarrhea, and urinary issues.
- Repeated surgeries – without treatment, endometriosis may require multiple repeat surgeries to treat adhesions and cysts.
- Emotional distress – coping with severe chronic pain and fertility problems takes an emotional toll.
The risks and complications above highlight why it’s important to seek treatment for suspected endometriosis.
How is endometriosis treated?
Treatment options for endometriosis include:
- Pain medication – over-the-counter NSAIDs or prescription opioids provide relief during menstrual periods.
- Hormone therapy – hormones like birth control pills, progestins, GnRH agonists can relieve endometriosis pain by thinning the endometrial tissue and preventing ovulation.
- Surgery – laparoscopic surgery removes endometrial lesions and scar tissue. A hysterectomy may be an option if other treatments fail.
- Complementary approaches – acupuncture, dietary changes, and nutritional supplements may help manage pain.
The treatment approach depends on symptom severity, impact on fertility, age, and the woman’s preferences. A combination of medications, surgery, and complementary therapies provides the best results for most women.
What happens if endometriosis goes untreated?
Here is a summary of the potential complications if endometriosis is left untreated long-term:
- Chronic debilitating pelvic pain leading to poor quality of life
- Increased inflammation and scarring in the pelvis
- High likelihood of infertility and inability to conceive naturally
- Higher risk of ectopic pregnancy if pregnant
- Damage to reproductive organs like the ovaries and fallopian tubes
- Repeated ovarian cysts
- Adhesions forming around pelvic organs
- Bowel dysfunction including constipation, diarrhea, and painful cramping
- Bladder pain, inflammation, and urgency
- Painful sexual intercourse
- Emotional distress from coping with severe and worsening symptoms
- Increased risk of certain gynecologic cancers
- Recurring need for surgery to remove adhesions
Leaving endometriosis completely untreated allows it to progress and lead to long-term consequences. However, some mild cases can potentially be monitored expectantly without treatment if symptoms are tolerable.
When should someone with endometriosis see a doctor?
It’s recommended to see a doctor if you experience any of the following:
- Pelvic pain lasting longer than usual menstrual cramps
- Painful periods that disrupt your normal activities
- Pelvic pain during or after sexual intercourse
- Bleeding or spotting between periods
- Painful urination or bowel movements during your period
- Infertility or difficulty getting pregnant
Early diagnosis and treatment of endometriosis provides the best outcomes. Anyone with symptoms suggestive of endometriosis should be evaluated by a gynecologist.
Conclusion
Left completely untreated, endometriosis can severely impact quality of life and fertility. Some of the long-term risks include chronic pelvic pain, recurrent cysts, scarring, adhesions, bowel and bladder dysfunction, painful sex, infertility, and certain cancers. While mild cases may potentially be monitored without treatment, most women require medications, surgery, or both to manage their symptoms and optimize fertility. Early diagnosis and treatment prevents progression of the disease. Women experiencing any symptoms of endometriosis should be evaluated by their gynecologist.