Symptoms for endometriosis may occur at any time during the menstrual cycle. Some women experience mild endometriosis with little or no pain. Pelvic pain that extends down to the legs during the menstrual cycle is common but some women experience a throbbing, gnawing and dragging pain and describe a feeling that their “insides” are being pulled down. This pain can range from mild to severe, sometimes so severe it can be disabling.
Other symptoms include:
- Pain during sexual intercourse.
- Urinary urgency and pain while voiding.
- Lower back or abdominal pain.
- Chronic tiredness.
- Shooting rectal pain and pain during a bowel movement, usually due to bowel endometriosis.
- Pain during ovulation.
- Inflammation of the pelvic cavity.
- Pain while standing or walking.
- Pain from adhesions (scar tissue) that bind the fallopian tubes, ovaries, uterus, bowels and bladder in ways that are painful to women all the time.
Causes and Risk Factors
When a woman goes through her menstrual cycle, shedding the endometrial tissue due to hormonal changes in her body, the endometrial tissue found outside the uterus is also responding to the hormones. Since this tissue cannot be expelled through the vagina, it remains inside the body and may stay there, unnoticed, for many years.
Although the exact reason endometrial tissue is able to grow outside of the womb is unknown, there are theories:
- Retrograde menstruation, when menstrual debris goes backwards out of the fallopian tubes during a period.
- Most women have some degree of retrograde menstruation though their immune system is able to clear the debris and prevent the development of endometriosis. The immune system typically prevents tissue from growing where it doesn’t belong.
- Hormonal changes during ovulation and menstruation.
- In severe cases, masses, lesions and scar tissue may form in the endometrium.
Women with severe endometriosis may have problems with fertility due in part to anatomical distortions and adhesions, similar to what a person would have following an injury.
Having a first-degree relative with endometriosis may increase a woman’s chance of developing the condition.