Endometriosis is a condition where tissue similar to the lining of the uterus grows outside of the uterus, causing pain, irregular bleeding, and potentially leading to infertility. It’s estimated that at least 6-10% of women suffer from endometriosis during their reproductive years. Many women experience symptoms for years before receiving a diagnosis, while others may never know they have it at all. Ignoring endometriosis can allow the condition to progress, leading to potentially serious consequences.
Worsening Symptoms
If endometriosis goes untreated, symptoms will likely continue and often worsen over time. The most common symptoms include:
- Painful periods (dysmenorrhea)
- Pelvic pain between periods
- Pain during or after sex (dyspareunia)
- Painful bowel movements or urination during menstruation
- Excessive bleeding or spotting
- Infertility
- Fatigue
For many women, symptoms are manageable at first. But without treatment, the pain may become chronic and more severe. Periods are often extremely heavy and accompanied by strong cramping pains. Ovulation pain may also increase over time. Pain during sex can become so severe that it prevents intimacy completely. Pelvic pain may persist throughout the month.
Ignoring mild symptoms allows endometrial tissue to continue proliferating. As it spreads and implants more deeply, it causes inflammation and nerve pain. With time, it can develop into complex lesions and cysts. Advanced endometriosis is more difficult to treat.
Infertility Risk
One of the most devastating effects of untreated endometriosis is the potential for infertility. About 30-50% of women with endometriosis will experience fertility problems.
There are several reasons why endometriosis impairs fertility:
- Inflammation and scarring damage the ovaries and fallopian tubes.
- Ovarian cysts form from endometrial tissue implants.
- Lesions distort pelvic anatomy.
- Toxins released by lesions create a hostile environment.
- Painful periods or sex prevents intercourse at optimal fertility times.
The likelihood of infertility increases as endometriosis progresses. Women who put off treatment are less likely to respond to fertility treatments later on.
It’s important to note that endometriosis can impact fertility even in adolescents and young women. Early diagnosis and treatment is key to preserving future childbearing potential.
Other Complications
In addition to infertility risk, leaving endometriosis untreated raises the chance of other complications:
Ovarian Cysts
Ovarian cysts develop when endometrial tissue grows over the ovaries. As they expand with blood, they can rupture or twist the ovaries. This causes severe pain and may require surgery.
Adhesions and Scarring
Endometrial implants can cause internal scarring (fibrosis), especially in the ovaries and fallopian tubes. Band-like adhesions may also form between pelvic organs, causing chronic pain.
Bowel and Bladder Problems
Endometrial lesions can spread into bowel or bladder tissues in some cases. This can cause painful digestive issues or urinary problems. It may lead to obstruction or perforation requiring surgery.
Anemia
Heavy menstrual bleeding from endometriosis can result in anemia over time. Anemia causes fatigue, weakness, dizziness, and other symptoms that disrupt daily life.
Risk of Endometriosis Progression
Endometriosis ranges from minimal to severe based on location and depth of abnormal tissue growth:
Stage 1: Minimal
There are a few shallow endometrial implants. They are usually on the ovaries, fallopian tubes, or peritoneum.
Stage 2: Mild
Lesions are deeper and more widespread in the pelvis. There may be some scarring.
Stage 3: Moderate
Multiple implants are present. There are ovarian cysts and more scarring.
Stage 4: Severe
Lesions are large and very deep. Scars have distorted anatomy extensively. Many cysts are likely.
Without treatment, endometriosis typically progresses from minimal to moderate or severe over 5-10 years. The rate of progression varies between individuals. Catching it early and starting treatment prevents significant progression in most cases.
Diagnosing Endometriosis
Since endometriosis symptoms overlap with other conditions like fibroids or pelvic inflammatory disease, diagnosis requires testing. To diagnose endometriosis, doctors use:
- Pelvic exam – Feels for signs like ovarian cysts or enlarged uterus.
- Transvaginal ultrasound – Provides images of reproductive organs.
- Laparoscopy – Small camera inserted in abdomen views lesions directly.
- Biopsy – Takes sample of tissue to identify under microscope.
Laparoscopy is the gold standard for diagnosis. It allows the doctor to see lesions and scar tissue directly. Biopsy confirms diagnosis by testing for endometrial cells.
Many women suffer symptoms for years before diagnosis. On average, it takes 4-11 years from onset of symptoms to diagnose endometriosis. Moving quickly on testing when symptoms appear gives the best chance to treat endometriosis early.
Treatment Options for Endometriosis
Treatment focuses on relieving pain, preventing progression, and preserving fertility. The main options include:
Pain Medications
Over-the-counter anti-inflammatories and painkillers can help manage cramping and discomfort. Long-term use carries risks.
Hormonal Birth Control
Birth control pills, patches, rings, or shots suppress ovulation and menstruation. This halts endometrial tissue growth.
Gonadotropin-Releasing Hormone (GnRH) Agonists
These injections switch off ovarian function for 6-12 months. They shrink implants and stop menstruation. Add-back therapy with estrogen and progesterone prevents bone loss and menopause symptoms.
Aromatase Inhibitors
Drugs like letrozole block estrogen production to halt tissue growth and reduce pain.
Progestins
Progestin-only therapies help suppress endometrial tissue growth and menstruation. They come as pills, injections, implants, or IUDs.
Surgery
Laparoscopic surgery removes endometrial implants and scar tissue. It provides pain relief and improves fertility. Additional surgery may be required if lesions recur. Conservative surgery preserves organs. Hysterectomy and removal of ovaries is a last resort.
The best approach often combines medication, hormone therapy, and conservative surgery. Treatment needs to be tailored to each patient’s symptoms and goals. With a multi-pronged approach, most women can manage endometriosis successfully. The key is not waiting until it has progressed to an advanced stage.
Outlook for Untreated Endometriosis
If endometriosis remains undiagnosed and untreated, it’s likely to get progressively worse over time. The symptoms and complications will continue to amplify, potentially leading to:
- Chronic pelvic pain
- Inability to have children
- Repeated ovarian cysts
- Bowel or bladder obstruction
- Anemia
- Fatigue and pain preventing normal activity
- Repeated surgeries
- Major impact on work, relationships, mental health
While the prognosis depends on the individual, most studies indicate untreated endometriosis leads to a poor quality of life. It requires major medical and surgical interventions down the road.
Catching and managing endometriosis early is the best way to prevent complications and disability. Unfortunately, women often downplay early symptoms and put off seeing a doctor. Being alert to subtle signs, pushing for testing when needed, and starting treatment brings the best results long-term.
Conclusion
Endometriosis affects up to 10% of women at some point in their lives. Ignoring symptoms and allowing it to progress leads to worsening pain, infertility, GI and urinary issues, anemia, and other problems. Catching it early and using medication, hormone therapy, and conservative surgery helps manage it before major progression.
While endometriosis can’t be cured, early diagnosis and diligent treatment offers the best chance at a healthy, active life. Learning to recognize the symptoms, being assertive about testing, and working with a doctor to develop an effective treatment plan makes all the difference. With proper management, endometriosis doesn’t have to limit life plans or achievements.