Endometriosis Awareness: Shedding Light on its Impact on Women’s Health

Hi Friend!

March is National Endometriosis Awareness Month, so before the month is over, I wanted to take a few minutes to talk about something that affects so many women.

what is endometriosis?

Endometriosis is a disorder where the endometrial tissue (the inner lining of the uterus) migrates to areas outside the uterus. The endometrial tissue is the same tissue that thickens during the menstrual cycle and is shed along with blood, causing menstruation. With endometriosis, this process occurs outside of the uterus, most commonly on the ovaries and fallopian tubes, where the blood has nowhere to go and causes pain in the pelvic region.

Endometriosis is not a rare condition. In fact, it affects one in ten women of reproductive age, which translates to roughly 190 million people worldwide. The actual number may be even higher, as many cases go undiagnosed due to delayed recognition, misdiagnosis, and limited access to specialized care. This means that for a disease that affects 190 million people worldwide, endometriosis remains one of the most underdiagnosed, underfunded, and misunderstood health conditions.¹

“Diagnostic delay in endometriosis is a well-known phenomenon, with studies consistently reporting prolonged intervals of up to 7–10 years between the symptom onset and confirmed diagnosis,² but “a recent study in the United States noted a mean time from symptom onset to diagnosis of 4.4 years, suggesting a potentially shorter diagnostic journey in contemporary healthcare settings.”³

The delay can have profound implications for patients, contributing to potentially worsened symptoms, impaired quality of life, and increased healthcare costs.⁴ Imagine living with intense and debilitating symptoms for years, not knowing the cause. This is the reality for many women with endometriosis.

what causes endometriosis?

Endometriosis can be difficult to diagnose because the exact cause is unclear. There are also no known ways to prevent endometriosis. While there is not one specific causal factor, there are theories commonly associated with an endometriosis diagnosis.

Retrograde Menstruation

Instead of flowing out of the body, menstrual blood flows back through the fallopian tubes and into the pelvic cavity. The blood contains the endometrial cells, which may stick to the pelvic wall or pelvic organs. Once “stuck,” the cells may continue to thicken and grow throughout each menstrual cycle.

Embryonic Cell Changes

Hormones, like estrogen, may transform embryonic cells (cells in the earliest stages of development) into endometrial-like cell growths during puberty.

Transformed Peritoneal Cells

Research suggests that hormones or immunity factors may help transform cells lining the inner side of the abdomen (peritoneal cells) into cells like those lining the uterus.

Direct Transplantation

The endometrial cells may attach to scar tissue from surgery in the stomach area, like a C-section or hysterectomy.

Endometrial Cell Transport

Blood vessels or tissue fluid systems may move endometrial cells to other body parts.

Immune System Condition

Immune system troubles may make the body unable to recognize and/or destroy endometriosis tissue.

risk factors.

While endometriosis can be diagnosed in any female who has started her period, there are certain factors that appear to increase a woman’s risk.

They include:

• Never giving birth
  
• Starting your period at an early age (11 years old or younger)
  
• Short menstrual cycles (a gap of less than 28 days between the start of periods)
  
• Heavy periods that last longer than 7 days
  
• High estrogen levels
  
• Low BMI
  
• A close relative (mom, sister, aunt, grandmother) with endometriosis
  
• Going through menopause at an older age
  
• Any health condition that prevents blood from flowing out of the body during menstrual periods can be an endometriosis risk factor

symptoms.

Endometriosis symptoms can vary widely from one woman to another. Some women may experience few to no symptoms, while other women may experience intense and debilitating symptoms that affect their overall quality of life.

According to the Mayo Clinic, there are several common symptoms associated with endometriosis:

Painful periods (Dysmenorrhea): pelvic pain and cramping may start before a menstrual period and last for days into it. You may also have lower back and stomach pain.

Pain with Sex (Dyspareunia): Pain during sexual intercourse that occurs at the vaginal opening, gets worse with certain positions, has a burning or stinging sensation, aches or feels sharp, or feels like something is physically blocking intercourse.

Pain with Bowel Movements or Urination: Most likely to occur before or during your menstrual period.

Excessive Bleeding (Menorrhagia): Excessively heavy or long periods.

Infertility: Some women are first diagnosed with endometriosis during tests for infertility treatment.

Other symptoms: additional symptoms can include non-period pelvic pain, chronic lower back pain that worsens during your period, fatigue, diarrhea, constipation, bloating, nausea, migraine or other severe headaches, allergies that get worse around your period, irregular or unpredictable periods, spotting (bleeding between periods, brain fog, and hypersensitivity to pain.

endometriosis and mental health.

Not all symptoms of endometriosis present physically. Research suggests that women living with endometriosis have a higher risk of mental health challenges that can include anxiety, depression, substance abuse, and eating disorders, to name a few.

“Rates of anxiety and depression among endometriosis patients are consistently higher when compared to healthy controls. Women have described feeling miserable, angry, frustrated, helpless, hopeless, and defeated, with some even contemplating suicide. The mental health consequences are in part due to the physical effect of the disease but also by the ways in which patients are treated by others with respect to their condition, including dismissal, diagnostic delay, and ineffective treatment. Many are concerned about their future ability to cope with the disease as the recurrence of symptoms is unpredictable.”⁵

A 2023 Yale School of Medicine study revealed that endometriosis and mental health are more closely aligned than previously suspected. “Endometriosis is not just a condition that affects the pelvis, but a systemic disease that involves the entire body. Now, the largest epidemiological study to date on the psychiatric factors that can accompany endometriosis has demonstrated that depression, anxiety, and eating disorders are not only a result of the chronic pain endometriosis generates but also have their own underlying genetic mechanisms.”

“It’s not surprising that having a genetic predisposition to endometriosis might include genetic alterations that affect other areas of the body as well,” says Hugh Taylor, MD, chair and Anita O’Keeffe Young Professor of Obstetrics, Gynecology & Reproductive Sciences at Yale School of Medicine and a co-author on the study.

“The relationship between endometriosis and mental health is more complicated than we expected,” says Renato Polimanti, PhD, associate professor of psychiatry and the study’s principal investigator. “The biological basis is not just chronic pain, and there is much more that we need to understand.” 

Epidemiological studies have long revealed a correlation between endometriosis and mental health disorders, but researchers’ past explanation of this relationship was “often irresponsible” and shifted the blame onto the patients, Taylor says. “Correlation does not prove cause and effect,” he explains. “The inappropriate, wrong, and hurtful interpretation was often, ‘these are anxious people complaining about pain that all women have.’ They were wrong.” When Taylor treats patients, he says, he makes sure not to view endometriosis in isolation while discounting its other manifestations.

Taylor’s research over the past decade has focused on the systemic manifestations of endometriosis in various organ systems, including the brain. Through animal models, his work has established that mood disorders in endometriosis are a component of the disease’s underlying pathophysiology. “We clearly show that the disease causes changes in the brain that lead to anxiety and depression,” says Taylor.⁶

GETTING A DIAGNOSIS.

Diagnosing endometriosis correctly and as early as possible is essential to ensure you are pursuing appropriate treatment. There are a few different ways to work toward a diagnosis.

Pelvic Exam

Physically feel for something unusual in the pelvis by using a hand to touch the area inside and outside your uterus.

Ultrasound

High-frequency sound waves take pictures of your reproductive organs. During the test, the ultrasound scanning wand (transducer) may be inserted into your vagina or moved across your stomach. Ultrasound won’t always show endometriosis itself, but it is good at finding endometriomas, a type of ovarian cyst, which are commonly related to endometriosis. 

Laparoscopy

The gold standard and only truly reliable method for diagnosis of endometriosis. This minor surgical procedure allows an inside view of your abdomen to collect tissue samples (endometrial biopsy) that will be examined for abnormalities.  

MRI

Detailed images of your organs and other tissues inside of the body can help determine whether any endometrial-like tissue is growing outside of your uterus. MRI is not the most common diagnostic tool used, but it can help get a more detailed viewpoint of the body.

TREATMENT.

Endometriosis cannot be cured, but there are ways to manage symptoms. The severity of the endometriosis will determine the best course of treatment.

Pain Medication

Over-the-counter pain relievers like Advil or Motrin can be taken to manage discomfort and pain.

Hormones

Hormonal therapy lowers the level of estrogen in your body and can stop your period. Hormones help reduce the bleeding of the lesions, so you don’t experience as much inflammation, scarring, or cyst formation. Common hormones can include birth control pills, patches, and vaginal rings. Gonadotropin-releasing hormone (Gn-RH) like Elagolix Sodium (Orilissa) or Leuprolide (Lupron), progestin-only contraceptives, and Danazol (Danocrine).

Surgery

Laparoscopy (minimally invasive) or Laparotomy (open abdominal) surgical techniques may be used to remove as much affected tissue as possible. In some cases, surgery can help ease symptoms while also increasing the chance of pregnancy. In severe endometriosis cases, a hysterectomy where the uterus, cervix, and/or ovaries are removed may be appropriate.

TO SUM IT ALL UP.

If you are living with endometriosis or suspect you may be living with endometriosis, I want you to know that I am here to support you.

Because endometriosis can look so different for each woman, it can be exceedingly frustrating to try and get the help you so desperately desire and deserve. Many women feel dismissed and gaslit by medical providers, which only compounds the physical and emotional toll the disease takes on them.

March may be endometriosis awareness month, but I am aware of it every month. I have patients come to me time and time again, seemingly at the end of their rope. Frustrated with the lack of empathy, unwillingness to acknowledge symptoms, and exhausted from convincing medical providers to take them seriously.

I am committed to changing that narrative.

Here, you will be seen.

You will be heard.

You will be believed.

You will be validated.

You will matter.

I would love to meet, get to know you, and show you what patient-centered care can look like. Please give me a call at 405-701-6717 to schedule a time to come in and see me.

With love,

Dr. Ronni Farris

---

1. https://www.who.int/news-room/fact-sheets/detail/endometriosis ↩︎
2. B. Swift, B. Taneri, C. M. Becker, et al., “Prevalence, Diagnostic Delay and Economic Burden of Endometriosis and Its Impact on Quality of Life: Results From an Eastern Mediterranean Population,” European Journal of Public Health 34, no. 2 (2024): 244–252 ↩︎
3. A. M. Soliman, M. Fuldeore, and M. C. Snabes, “Factors Associated With Time to Endometriosis Diagnosis in the United States,” Journal of Women’s Health 26, no. 7 (2017): 788–797 ↩︎
4. https://obgyn.onlinelibrary.wiley.com/doi/10.1111/1471-0528.17973 ↩︎
5. https://pmc.ncbi.nlm.nih.gov/articles/PMC10465859/
   ↩︎
6. Koller D, Pathak GA, Wendt FR, et al. Epidemiologic and Genetic Associations of Endometriosis With Depression, Anxiety, and Eating Disorders. JAMA Netw Open. 2023;6(1):e2251214. doi:10.1001/jamanetworkopen.2022.51214 ↩︎

*Medical Disclaimer

The information provided by Ronni E. Farris, MD Gynecology, Wellness & Aesthetics (“we,” “us,” or “our”) on this website www.ronnifarrismd.com/blog (the “Website”) is for general informational purposes only. All content, including text, graphics, images, and information, is presented as an educational resource and is not intended as a substitute for professional medical advice, diagnosis, or treatment.

Please consult with a qualified healthcare provider before making any decisions or taking any action based on the information you find on this Website. Do not disregard, avoid, or delay obtaining medical or health-related advice from your healthcare provider because of something you have read on this Website.

This Website does not recommend or endorse any specific tests, physicians, products, procedures, opinions, or other information that may be mentioned on this website. Reliance on any information provided on the Website, its content creators, or others appearing on the website is solely at your own risk.

If you think you may have a medical emergency, call your doctor, go to the nearest emergency department, or call emergency services immediately. We are not responsible for any adverse effects resulting from your use of or reliance on any information or content on this Website.

By using this Website, you acknowledge and agree to this disclaimer in full.