Endometriosis and Pelvic Pain – Causes and Treatment

Endometriosis is a painful condition that arises when there is an abnormal growth of tissue that lines the womb, anywhere outside the uterus. Endometriosis and Pelvic Pain are closely linked and pain usually worsens during menstruation and for most people becomes debilitating.

Location of pain and Endometrial tissue growth

Pain is generally felt in Pelvis, lower back and lower abdomen. While the most common location for endometrial tissue to grow outside the uterus is the peritoneum. While it can also grow in fallopian tubes, ovaries. May line the organs such as the bladder, bowel, and others.

Character of pain

Pelvic pain due to endometriosis is very severe and debilitating. Most women refer to this pain as “killer cramps”. The pain increases in intensity as the person grows old.


The main symptom is pain in Pelvis during menstruation. But there are several other symptoms experienced by females who have endometriosis. Some of these are as follows:

  • Pain during micturition
  • Severe lower back pain
  • Pain while having sex- dyspareunia
  • Pain during bowel movements
  • Heavy bleeding during periods
  • Constipation
  • Diarrhea
  • Migraines
  • Bloating and Nausea
  • Trouble in conceiving
  • Blood with urine or through the rectum


There is no proven cause of Endometriosis. However, several pieces of research and patient history have given a few possible causes. Some of the most commonly believed reasons are given below:

  • Retrograde flow of menstrual blood: sometimes heavy bleeding during periods may cause backward flow of the blood which enters fallopian tubes and may also enter peritoneum resulting in endometrial implants.
  • Hormonal causes: Estrogen promotes Endometriosis and may even have been one of the causative factors too. However, there is no validity to this yet.
  • Surgical: Several times endometrial tissue is found in the C-section scar. This has led the doctors to believe that endometrial tissue must have been moved by mistake during cesarean section by the surgeon.
  • Immune conditions: Failure of the Immune system to destroy any abnormally grown endometrial tissue outside the tissue is just another cause.
  • Genetic causes: Most patients have given a family history of endometriosis that makes it a disease that runs in family.

Stages of Endometriosis

Endometriosis is divided into four stages by the American Society of Reproductive Medicine on the basis of the spread of endometrial tissue, its depth, and areas affected by the disorder.

  • Stage 1- Minimal: There is the presence of a few small implants on the organs or pelvic or abdominal lining.
  • Stage 2- Mild: Implants are greater in number and invade deeper in the tissues. Are also accompanied by some scar tissue.
  • Stage 3- Moderate: Along with several deep endometrial implants, ovarian cysts and thick additions are also present.
  • Stage 4- Severe: This is the most widespread form of endometriosis involving deep implants and thick adhesions. Other than that large, blood-filled cysts are also present on both ovaries, known as chocolate cysts.


Along with severe crushing menstrual cramps patients with endometriosis also experience other complications, such as Infertility, Autoimmune disorders, Fibromyalgias, Chronic Fatigue Syndrome, Allergies, Certain cancers like ovarian and breast cancer among others.

Endometriosis and Infertility

Endometrial tissue sometimes causes blockage in the normal uterine tract, resulting in failure for sperm to reach the egg and fertilize it. This may lead to infertility. Other possible causes for endometriosis resulting in infertility attacks on the embryo by a faulty immune system. And failure in implantation of the Zygote.

Risk factors

  • Females with a family history of endometriosis
  • Women in their late 30s and 40s
  • Nulliparous women- who never had children
  • Females with long menstrual periods, lasting more than a week.
  • Women with shorter menstrual cycles- a cycle of 27 days or less than that.


For diagnosis, the doctor will ask the patient for a detailed description of her symptoms, followed by a pelvic examination. Your doctor might also ask you to get a pelvic ultrasound done to spot the cysts associated with the disease.

A definite diagnosis is made by laparoscopy. Which provides exact information regarding the location, size, and depth of implants and also allows your doctor to treat the lesion at the same time.

Another possible option is MRI which is done for surgical planning.


Endometriosis is managed according to the type and stage of the disease. The management plan is devised once a proper diagnosis is made and also based on the symptoms experienced by the patient.


Since there are records of estrogen promoting endometriosis, thus one method of preventing endometriosis, if you are at risk, is to lower your body estrogen levels. 

Medical Treatment:

Up till now, there is no definitive cure for endometriosis but several treatment options are available to decrease the pain and for prevention in worsening of symptoms and related complications. Every patient requires a different mode of treatment depending upon her stage and type of disease. However, some of the common treatment modalities are given below:

  • Painkillers: patients with mild endometriosis may just require an over-the-counter painkiller during periods.
  • Hormonal therapy: is often required to decrease the estrogen levels in the body.

Surgical treatment:

This is the definitive option for people with moderate or severe forms of endometriosis. Most of the abnormal endometrial tissue is surgically removed, allowing the patient to conceive easily. However, pain and other symptoms may still persist as all of the abnormal endometrial implants cannot be excised.

Hysterectomy: Several patients who are old and have completed their families are advised to get a total hysterectomy. This involves complete surgical removal of the Uterus, Cervix, and Ovaries. This is by far the most effective treatment option available.

Home remedies:

  • Several home remedies are also done to relieve the severe abdominal cramps due to endometriosis.
  • Taking warm baths.
  • Use heating pads to give heat.
  • Exercise regularly
  • Acupuncture, yoga, and cupping also help in relieving the pain.
  • Following a healthy diet plan is another great option.


What is the difference between normal menstrual pain and pain due to endometriosis?

Normal menstrual pain is not as intense as the pain due to endometriosis. Also, periods are heavier and longer in patients who suffer from this disease.

Can I get pregnant with endometriosis?

Yes, a lot of women do not even require any sort of medical intervention and conceive naturally while some might require medical treatment to get pregnant.

Does endometriosis go away after menopause?

As estrogen levels in the body drop after menopause most females experience improvement in painful symptoms with time.

How common is this disorder?

Endometriosis is a very common menstrual condition that can affect any female who has menstrual periods but is more common in females in their late thirties and forties.