What Is Endometriosis? Symptoms, Causes, Treatment, and Medications
Endometriosis is a chronic condition in which tissue similar to the lining of the uterus grows outside the uterus, often on the ovaries, fallopian tubes, and pelvic tissues. It can cause pelvic pain, painful periods, and infertility. There is no cure, but medications and surgery can help manage symptoms.
Key Highlights
- Endometriosis is a disease in which tissue similar to the uterine lining grows outside the uterus, most often on the ovaries, fallopian tubes, and pelvic lining.
- Common symptoms include pelvic pain, painful periods (dysmenorrhea), pain during or after sex, heavy bleeding, and infertility.
- First-line medications include NSAIDs for pain and hormonal therapies such as birth control pills and progestins to slow tissue growth.
- GnRH medicines - the agonist leuprolide and oral antagonists elagolix (Orilissa) and relugolix combination (Myfembree) - are FDA-approved options for moderate-to-severe endometriosis pain.
- Laparoscopy is the standard way to confirm the diagnosis and can also be used to remove endometriosis tissue.
- PriceMyMeds discount coupons can help reduce the cost of endometriosis medications at participating pharmacies, with no insurance required.
What Is Endometriosis?
Endometriosis is a chronic, estrogen-dependent condition in which tissue similar to the endometrium (the lining of the uterus) grows in other places in the body. These patches, sometimes called implants, nodules, or lesions, are most often found on or under the ovaries, on the fallopian tubes, behind the uterus, on the tissues that hold the uterus in place, and on the bowel or bladder. Like the uterine lining, this tissue responds to monthly hormone changes, thickening and breaking down with each cycle, which can trigger inflammation, scar tissue, and pain.
Endometriosis is one of the most common gynecological conditions, affecting an estimated 10 percent of women and girls of reproductive age. Its two main effects are pain and infertility.
Key Facts:
- Generic names: ibuprofen, naproxen, norethindrone acetate, leuprolide, elagolix, relugolix (in combination)
- Drug classes: NSAIDs, combined hormonal contraceptives, progestins, GnRH agonists, GnRH antagonists
- FDA approvals: Leuprolide (1990s) for endometriosis; elagolix (Orilissa, 2018); relugolix combination (Myfembree) for endometriosis pain (2022)
- Typical cost: OTC NSAIDs $4-$15; hormonal therapies range widely, from about $10 for generics to $900 or more per month for brand-name GnRH drugs
- Common uses: relief of endometriosis-associated pelvic pain and management of heavy or painful periods
Endometriosis vs. Adenomyosis: Understanding the Difference
Endometriosis and adenomyosis are related but distinct conditions. In endometriosis, tissue similar to the uterine lining grows outside the uterus. In adenomyosis, that tissue grows into the muscular wall of the uterus itself, which can make the uterus enlarged and tender. The two conditions can occur together and share symptoms such as heavy, painful periods, so a healthcare provider is needed to tell them apart and guide treatment.
What You Need to Know
Understanding Endometriosis: Causes, Symptoms, Diagnosis, Treatment, and Prevention
1.What Are the Causes of Endometriosis?
Researchers do not know exactly what causes endometriosis, but several theories and contributing factors have been identified.
Leading Theories
- Retrograde menstruation - menstrual blood containing endometrial cells flows backward through the fallopian tubes into the pelvis, where the cells attach and grow
- Immune system differences - the body may fail to recognize and clear tissue growing outside the uterus
- Hormonal and cellular changes - estrogen may transform other cells into endometrial-like cells
- Surgical spread - endometrial cells may attach to a surgical incision after procedures such as a cesarean section
Risk Factors
- A mother, sister, or daughter with endometriosis
- Starting your period before age 11
- Short monthly cycles (less than 27 days)
- Heavy menstrual periods that last more than 7 days
- Never having given birth
Factors that may lower risk include having been pregnant, starting periods later in adolescence, and breastfeeding.
2.What Are the Symptoms of Endometriosis?
The two main symptoms of endometriosis are pelvic pain and infertility. The amount of pain is not always related to how much endometriosis tissue is present - some people with severe disease have little pain, while others with minimal disease have severe pain.
Common symptoms include:
- Pelvic pain, often worst during your period
- Painful menstrual cramps (dysmenorrhea) that may worsen over time
- Pain during or after sex (dyspareunia)
- Pain with bowel movements or urination, usually during your period
- Heavy menstrual periods
- Spotting or bleeding between periods
- Digestive or gastrointestinal symptoms such as bloating, constipation, or diarrhea
- Fatigue or lack of energy
- Difficulty getting pregnant
How Long Do Endometriosis Symptoms Last?
Endometriosis is a chronic condition, and symptoms often continue throughout the reproductive years unless treated. Pain frequently follows the menstrual cycle, peaking around the period, but some people have pain all month long. Symptoms typically ease during pregnancy and after menopause, when estrogen levels fall, though they can persist in some cases.
3.How Is Endometriosis Diagnosed?
Diagnosing endometriosis begins with a discussion of your symptoms and medical history, followed by an exam and, when needed, imaging or surgery. On average there can be a delay of several years between the start of symptoms and diagnosis, so it helps to describe your pain and cycle clearly.
A healthcare provider may ask:
- When did your symptoms start and where is the pain?
- Is the pain linked to your menstrual cycle?
- Do you have pain during sex, bowel movements, or urination?
- How heavy and how long are your periods?
- Are you having trouble getting pregnant?
- Does anyone in your family have endometriosis?
Diagnostic steps may include:
- Pelvic exam to feel for cysts or scar tissue behind the uterus
- Ultrasound (transvaginal or abdominal) to look for endometriomas (ovarian cysts)
- MRI to map the location and extent of tissue before surgery
- Laparoscopy - a minimally invasive surgery that lets the surgeon see and, if needed, biopsy endometriosis tissue; this is the only way to confirm the diagnosis with certainty
4.How Is Endometriosis Treated?
There is no cure for endometriosis, but treatment can relieve pain, slow tissue growth, and help with fertility. The choice depends on your symptoms, age, and whether you want to become pregnant. Treatment usually combines medication and, in some cases, surgery.
Pain Relievers (NSAIDs)
Nonsteroidal anti-inflammatory drugs such as ibuprofen and naproxen are often the first step for menstrual and pelvic pain. They work best when started at the first sign of pain.
Hormonal Therapy
Hormone treatments lower or steady estrogen so endometriosis tissue grows more slowly. Options include:
- Combined hormonal contraceptives (birth control pills, patch, or ring) to reduce pain and lighten periods
- Progestins such as norethindrone acetate, which suppress endometrial tissue growth; dienogest is a progestin used for endometriosis in some countries and is available in the United States within a combination product
- GnRH agonists such as leuprolide, which lower estrogen to create a temporary, menopause-like state; often given with low-dose add-back hormones to limit side effects
- GnRH antagonists such as oral elagolix (Orilissa) and relugolix combination therapy (Myfembree), both FDA-approved for moderate-to-severe endometriosis pain
3. Surgery
Laparoscopic surgery can remove or destroy endometriosis implants and scar tissue while preserving the uterus and ovaries, which may reduce pain and improve fertility. In severe cases that do not respond to other treatments, more extensive surgery may be considered.
Fertility Treatment
For those trying to conceive, options include laparoscopy to remove tissue and assisted reproductive technology such as in vitro fertilization (IVF).
5.What Are the Complications of Endometriosis?
Endometriosis is not cancer, but it can cause lasting effects when inflammation and scar tissue build up over time.
Possible complications include:
- Infertility or reduced fertility
- Chronic pelvic pain that affects daily life, work, and sleep
- Ovarian cysts (endometriomas), sometimes called chocolate cysts
- Adhesions and scar tissue that can cause organs to stick together
- Bowel or bladder problems when implants involve those organs
- Emotional effects such as anxiety or depression related to chronic pain
Rarely, endometriosis can grow in distant sites such as the lungs. Prompt evaluation and ongoing care help reduce the risk of long-term complications.
6.How Can Endometriosis Be Managed?
Endometriosis cannot be prevented, but lowering long-term exposure to estrogen may reduce risk or ease symptoms for some people, and everyday strategies can help you manage the condition.
Management and risk-reduction steps:
- Talk with your provider about hormonal birth control, which can lighten periods and may lower risk
- Exercise regularly, which may help lower estrogen levels
- Limit alcohol and caffeine, which some people find worsen symptoms
- Use heat, gentle activity, and stress-management techniques for pain
- Track your symptoms and cycle to guide treatment decisions
- Keep regular follow-up visits so treatment can be adjusted over time
Because breastfeeding and pregnancy pause menstrual cycles, they may temporarily reduce symptoms, though they are not treatments for the condition.
7.When to See a Doctor for Endometriosis
See a healthcare provider if you have ongoing pelvic pain, painful periods that interfere with daily life, or trouble getting pregnant. Early evaluation can shorten the time to diagnosis and relief.
Make an appointment if you have:
- Menstrual cramps that keep you from work, school, or normal activities
- Pelvic pain that lasts beyond your period or occurs during sex, bowel movements, or urination
- Very heavy periods or bleeding between periods
- Difficulty becoming pregnant after 6 to 12 months of trying
Seek prompt care for sudden, severe pelvic pain, which could signal a ruptured cyst or other urgent problem. Do not stop or change prescribed hormone therapy without talking to your provider first.
8.OTC vs. Prescription Endometriosis Medications: When Do You Need a Prescription?
Over-the-counter (OTC) nonsteroidal anti-inflammatory drugs such as ibuprofen (Advil, Motrin) and naproxen (Aleve) can help with mild menstrual and pelvic pain and are often the first step. However, OTC medicines only ease symptoms - they do not slow the growth of endometriosis tissue.
You need a prescription for the hormonal therapies that target the disease itself, including:
- Combined hormonal contraceptives (pills, patch, or ring)
- Progestins such as norethindrone acetate
- GnRH agonists such as leuprolide
- GnRH antagonists such as elagolix (Orilissa) and relugolix combination therapy (Myfembree)
See a doctor for a prescription if OTC pain relievers are not enough, if pain interferes with daily life, or if you are trying to become pregnant. A provider can match therapy to your symptoms and goals and monitor for side effects such as bone loss with long-term GnRH use.
Save on Your Medications
Endometriosis medication costs vary widely depending on the drug and pharmacy. Over-the-counter NSAIDs are inexpensive, and many hormonal contraceptives and generic progestins are available at low cost. Brand-name GnRH medicines such as elagolix (Orilissa) and relugolix combination therapy (Myfembree) can cost several hundred dollars or more per month. With PriceMyMeds discount coupons, patients may be able to reduce the cost of endometriosis medications at participating pharmacies across the United States.
Simply search for your medication on PriceMyMeds, compare prices at pharmacies near you, and present your free coupon at the pharmacy counter to save. No insurance required.
Comparing medication prices and using discount coupons may help lower out-of-pocket costs for endometriosis treatment.
The Bottom Line
Endometriosis is a common, chronic condition in which tissue similar to the uterine lining grows outside the uterus, causing pelvic pain, painful periods, and sometimes infertility. While there is no cure, symptoms can often be well controlled.
Treatment is tailored to your symptoms and goals and may include NSAIDs for pain, hormonal therapies such as birth control pills and progestins, GnRH medicines like leuprolide, elagolix (Orilissa), and relugolix combination therapy (Myfembree), and laparoscopic surgery. Working closely with your provider helps you find the right combination and adjust it over time.
If you are prescribed endometriosis medication, use PriceMyMeds to compare prices at nearby pharmacies and potentially save on your prescription costs. No insurance or signup required.