Causes, Signs, and Symptoms of Endometriosis

Causes and Symptoms of Endometriosis

January 29, 2022

The unfortunate storyline of endometriosis is that although it affects nearly 1 in 10 of us, most women who have endometriosis don’t even know it.

For a majority of women it takes 10-12 years of talking to their health care providers before they find someone who knows what the heck they are talking about and actually listens to their symptoms and suggests finding a way to get the diagnosis. And if those numbers aren’t staggering enough for you, endometriosis (most likely undiagnosed) accounts for 40-50% of the infertility issues.1,23

To make a diagnosis of endometriosis this often requires laparoscopic surgery. That’s right—surgery. A small incision is made into your lower abdomen, and then sliding in a camera and taking a look around. If you’re lucky, while they’re in there your surgeon will do their best to remove all of that tissue.

You have done nothing wrong, and it’s not your fault if you have endometriosis. Although excisional surgery, ablative surgery, hysterectomy, and birth control are the most common options for management they are not your only treatment options. Natural treatments for endometriosis target pain reduction, hormone balancing, and holistic treatments that identify and treat any underlying symptoms that may be worsening the pain.

Signs and symptoms of endometriosis? Where is endometriosis pain felt?

So, what is the most common symptom of endometriosis?

It’s chronic pain.

Where is endometriosis pain felt?

Most specifically this chronic pain is felt in the pelvis. Your pelvis is an area of your body consisting of your lower abs, low back, vulvar tissue, and all the muscles/ligaments/tendons surrounding your uterus/bladder/lower intestines/ovaries/fallopian tubes.

You get pelvic pain because as you grow and build endometrial tissue inside your uterus, this is also growing and thickening outside of the uterus as well. This tissue outside of the uterus is NOT supposed to be there and as your body shifts to accommodate for this growth in tissue it also creates adhesions, inflammation, and pain wherever those endometrial lesions are outside of your uterus.

This tissue can in fact be outside of the area of your pelvis as well, for instance one of my patients back in 2014 had this tissue inside her esophagus. So, every time she had her period she would cough up blood. Cough up blood! Say, what? Yes, that endometrial tissue that builds under the influence of estrogen and progesterone it needs to go somewhere and as your hormones drop and your body realizes that you are not pregnant that blood then needs to be reabsorbed from those areas it’s not supposed to be at.

This is why birth control is so commonly used in the management of endometriosis, because it stops you from ovulating which then reduces the amount of endometrial tissue your body will build up and then shed. Therefore, reducing the thickness of the lesions of endometriosis (hopefully). Unfortunately birth control does not get rid of the lesions nor reduce inflammation related to the chronic pain that many women experience prior to, during, and even after their period.

This is where natural medicine, herbs, and lifestyle come in to benefit you.

1 Expert Opinion on Therapeutic Targets 2015;19(11): 1447-1464
23 Fertil Steril 2017;107(3):555-565

Other symptoms of endometriosis:

  • Heavy period or spotting between periods. 
  • Nausea or vomiting
  • Pain with urination
  • IBS and/or pain with bowel movements (especially if this only occurs prior to or with your period)
  • Fatigue
  • Pain with intercourse or masturbation
  • Pain with orgasm

Connection between allergies, asthma, and endometriosis

57% of women with endometriosis have been shown to have allergies and/or asthma, which is a higher percentage than that of the general population.

There is also research showing a connection between effectively reducing allergy symptoms and this correlating between a reduction in endo symptoms!

Why is this?

Well, your allergies are influenced by genes (yes) but they are also influenced by your gut health.

How does this work?

Women with endometriosis have been shown to have a higher production of mast cells, which are the cells that produce histamine37 (the culprit of allergic reactions). So, not only do women have an increased risk in allergies, but also for hives, leaky gut, and eczema. This goes back to treating the gut and reducing toxins in your life to reduce allergies and histamine production.

Diagnosing abnormalities in the balance of bacteria in your GI tract can actually reduce your allergies and also improve your ability to detox and reduce your pain. The concept is complex, but what you need to know about my approach is that I consider all of this when treating you.

37 J Obstet Gynaecol Can 2009;31(12):1159–1171

Adenomyosis vs Endometriosis: difference between endometriosis and adenomyosis

If you are really unlucky you get a special blend of symptoms that not only includes the pain but also tacks on a heavy, long periods as well. Painful and heavy periods do not always mean you have endometriosis, as it can be due to adenomyosis alone or a uterine fibroid. 

Thankfully, an ultrasound is usually capable of diagnosing a uterine fibroid or adenomyosis. Adenomyosis is a thickening of endometrial tissue in the lining of the uterus: which is incorporated into the actual muscle of your uterus, it can be seen about 50% of the time via a pelvic MRI or ultrasound, unlike our foe endometriosis.

Endometriosis vs IBS and SIBO: why endometriosis and gut issues go hand in hand

Women with endometriosis also have a higher rate of IBS than women without endometriosis44. In fact 9 out of 10 women with endometriosis have GI symptoms even though only 7.6% of women have implants of endometriosis on the bowels, so clearly there is more to play than just additional adhesions on the bowels56. Any female receiving a diagnosis of IBS from her PCP or gynecologist, who also has heavy periods, should strongly consider that she has underlying endometriosis. Treating the IBS through functional stool testing (tests done outside of your insurance which look at good and bad bacteria levels + looking for the presence of yeast and parasites), plus treating the source of IBS through these tests can significantly lower the symptoms of pain and GI symptoms throughout the cycle.

For a minority of women, GI symptoms come directly from adhesions of that endometrial tissue implanting itself onto the intestines and/or appendix and influencing the swift, efficient movement, or lack thereof, of stool and gas through your intestines. This is why pelvic physical therapy plus treatment for IBS should go hand in hand.

Numerous clinical studies are investigating the link between the bacteria in your intestines and the etiology of endometriosis. These studies are showing there is a difference in the bacteria of a woman with endometriosis and ones without. This is central to the care that I provide, as every woman is being treated holistically which includes a thorough discussion about your poops, gas, bloating, and acid reflux symptoms that may be part of your daily or monthly symptom picture. One diagnosis that is coming up more frequently for women with IBS and endometriosis is small intestine bacterial overgrowth (SIBO).

SIBO is now known to be the actual diagnosis for 70% of people who have been previously incorrectly diagnosed with IBS. This means over half the women with digestive issues plus painful periods also have SIBO.

Having SIBO + endometriosis can alter your ability to absorb the nutrients you are getting from your diet and from supplements you are taking to reduce inflammation. So identifying the reason for IBS, treating it naturally, and then restarting supplements for inflammation is the way to improve your absorption of nutrients, reduce the number of things you need to take, and ultimately reduce your symptoms.

If someone with endo also has dysbiosis from abnormal bacteria or yeast in the intestines it often requires 2-3 more rounds of treatment to completely resolve their symptoms. This is because the additional inflammation and adhesions created by endometriosis make it a more difficult path to healing.

44 Arch Gynecol Obstet 2020 Sep 19
56 P. Maroun, et al. “Relevance of gastrointestinal symptoms in endometriosis,” Australian and New Zealand Journal of Obstetrics and Gynecology, vol. 49 (2009): 411-14.

Autoimmune and allergies related to endometriosis

Several studies have shown a link between endometriosis and autoimmune conditions such as rheumatoid arthritis and psoriasis66. There are also studies showing a higher likelihood of celiac disease, sjogrens, hashimoto’ thyroiditis, multiple sclerosis, and lupus.

Autoimmune and allergies related to endometriosis

Several studies have shown a link between endometriosis and autoimmune conditions such as rheumatoid arthritis and psoriasis66. There are also studies showing a higher likelihood of celiac disease, sjogrens, hashimoto’ thyroiditis, multiple sclerosis, and lupus.

66 Eur J of Obstetrics & Gynecology and Reproductive Biology 2017;209: 3–7

Is endometriosis caused by estrogen dominance? How do hormones play a role in endometriosis?

Yes and no. For women with endometriosis it has been found that the lesions outside of the uterus actually INCREASE the production of estrogen through an enzyme being made by that endometrial tissue. Simply put more estrogen=more bleeding=thicker endometrial lesions=more pain. You can think of estrogen like the building blocks or bricks of the endometrial tissue. The more estrogen the thicker the tissue, the thicker the tissue the more you bleed, the more you bleed the more pain and the heavier your periods are. Progesterone can also be screwed up with your hormonal regulation as the endometrial tissue can actually lack receptors for progesterone. This leads to tissue that continues to grow, brick by brick with estrogen. Without a proper balance between progesterone and estrogen you get more pain, spotting before your period, spotting with ovulation, irritability, PMS, depression, acne, and breast tenderness. You see, if estrogen is the bricks on this wall we build and shed every month, well then progesterone is the mortar that holds those bricks up. Too much brick and not enough mortar leads to a relative estrogen dominance, compared to an adequate balance of estrogen to progesterone, and this is where many of the symptoms prior to your period come from. Not enough progesterone relative to estrogen, or just frank estrogen dominance.

In working together I’m going to build you your particular road map to reducing symptoms related to your endometriosis. This is going to include a comprehensive intake, comprehensive labs, additional imaging (if needed), and the time to discuss it all. We will work from this baseline of knowledge to figure out your diet, supplements, medications, and additional medical providers that need to be added to your team. You are not alone, I am here to help guide you. I promise to listen, come up with a comprehensive treatment plan, and to give you one of the best experiences you have ever had at a doctor’s office.

More resources for women with endometriosis:

National resources:

Endometriosis Association. This is a great place to gain more info about Endometriosis and connect with other women with endometriosis and seek out good gynecologists in your area that are skilled excisional surgeons for endometriosis:

Nancy’s Nook: Nancy Peterson is expert and leading advocate for women with endometriosis. This website is an essential for resources and content related to endometriosis diagnosis.

iCare Better. The go to place for finding surgeons specializing in endometriosis.

Pelvic Physical Therapists in the Los Angeles area:

New Beginnings in South Pasadena:

Laura Horn and Associates in Pasadena:

Femina Physical Therapy (4 locations: mid-Wilshire, Claremont, Sherman Oaks, Glendale/Montrose):

Origin Physical Therapy (Locations: Brentwood, West Hollywood, San Francisco, and Virtual visits for people living in California, Texas, and New York):

Books about endometriosis:

Beating Endo: How to Reclaim Your Life From Endometriosis by Iris Kerin Orbuch, MD and Amy Steing, DPT

Nutrition for Relieving Pelvic Pain: Fueling the Patient/Practitioner Healing Partnership by Jessica Drummond