Understanding Endometriosis: Symptoms, Causes, and Treatment Options

Living with unexplained pelvic pain can feel isolating. For many women searching for answers, endometriosis may provide the explanation. Affecting approximately 190 million women worldwide, according to the World Health Organization, endometriosis is a chronic condition that deserves greater medical attention and public awareness.

What Is Endometriosis?

Endometriosis occurs when tissue similar to the uterine lining grows outside the uterus. This tissue can appear on the ovaries, fallopian tubes, outer surface of the uterus, bowel, bladder, and other pelvic organs.

During the menstrual cycle, hormonal changes cause this tissue to thicken, break down, and bleed, responding to the same signals as tissue inside the uterus. Unlike menstrual blood that exits through the cervix, the displaced tissue has nowhere to go. The trapped blood triggers inflammation and, over time, leads to scarring, adhesions that bind organs together, and endometriomas (blood-filled cysts on the ovaries).

Endometriosis affects roughly 1 in 10 reproductive-age women globally. Despite its prevalence, many women wait an average of 7-10 years before receiving a diagnosis, a delay that allows the condition to progress and affects fertility, mental health, and overall quality of life.

Recognizing the Signs of Endometriosis

Symptoms vary significantly among individuals. Some women experience severe symptoms while others have minimal discomfort despite extensive disease.

Common symptoms include:

• Pelvic pain often occurs before and during menstruation
• Dysmenorrhea (painful periods) extending beyond typical discomfort
• Deep dyspareunia (pain during intercourse)
• Dyschezia (pain with bowel movements), particularly during menstruation
• Dysuria (pain with urination)
• Heavy or irregular menstrual bleeding
• Chronic fatigue affects daily functioning
• Gastrointestinal symptoms like bloating, nausea, or constipation

Many women dismiss symptoms as "just bad periods" or are told by healthcare providers that severe pain is normal. However, pain interfering with daily life, work, or relationships warrants a thorough medical evaluation. Using tools like the Samphire App to track symptoms provides objective documentation supporting medical consultations. The app personalizes suggested symptoms to track based on health history and offers meditation and breathwork practices tailored to symptom needs.

What Causes Endometriosis?

The exact cause remains unknown despite decades of research. Several theories attempt to explain how endometriosis might develop:

Retrograde menstruation: Menstrual blood containing endometrial cells flows backward through the fallopian tubes into the pelvic cavity. While this occurs in up to 90% of women, only about 10% develop endometriosis, indicating that additional factors determine disease development.

Cellular metaplasia: Hormones or environmental triggers may transform peritoneal cells into endometrial-like tissue, explaining how endometriosis occasionally appears in distant locations.

Immune system dysfunction: Women with endometriosis have altered immune function. A compromised immune response may fail to destroy endometrial tissue growing outside the uterus.

Genetic factors: Having a first-degree relative with endometriosis increases risk 7-10 fold. Genome-wide studies have identified genetic variations associated with endometriosis susceptibility.

The Brain-Pain Connection in Endometriosis

Research has documented that endometriosis affects not only pelvic organs but also how the brain processes pain signals. Women with endometriosis show altered brain activity in regions governing pain perception, emotional regulation, and stress response.

Studies demonstrate that prolonged pain exposure creates neuroplastic changes; the brain literally rewires itself in response to persistent pain signals. The dorsolateral prefrontal cortex and regions of the limbic system show altered activity patterns, explaining why pain often extends beyond what physical findings alone would predict. Understanding the neuroscience of endometriosis reveals why addressing the brain's role becomes crucial for comprehensive management.

Diagnosing Endometriosis

Getting a definitive diagnosis typically requires persistence.

• Medical history and physical examination include detailed questions about pain patterns, menstrual history, and symptom impact. Pelvic exams detect nodules or tenderness, though small areas of endometriosis aren't detectable through examination alone.
• Imaging studies like transvaginal ultrasound identify endometriomas and deep infiltrating endometriosis. MRI provides detailed visualization for surgical planning. However, imaging cannot detect all lesions.
• Laparoscopy remains the diagnostic gold standard. During this minimally invasive surgery, a surgeon visualizes the pelvic cavity through a small abdominal incision. Suspicious tissue can be biopsied or removed for pathological confirmation.

Comprehensive Treatment Approaches for Endometriosis

Treatment depends on symptom severity, fertility goals, disease extent, and personal preferences. A multimodal approach addressing physical, neurological, and emotional dimensions often provides optimal results.

Pain Management

NSAIDs like ibuprofen reduce prostaglandin production and manage mild to moderate pain. Prescription medications or nerve pain medications like gabapentin address more severe symptoms. Heat therapy, TENS units, and pelvic floor physical therapy provide non-pharmacological relief.

Hormonal Therapies

Hormonal treatments suppress estrogen production or stabilize fluctuations that stimulate endometrial tissue growth. Options include combined oral contraceptives, progestin-only therapies, GnRH agonists or antagonists, and aromatase inhibitors.

Surgical Interventions

Conservative surgery removes implants, adhesions, and endometriomas while preserving reproductive organs. Excision surgery generally provides longer-lasting results than ablation. Hysterectomy may be considered in severe cases when other treatments have failed.

Brain-Based Approaches

Many endometriosis symptoms, including pain perception, fatigue, and mood disturbances, connect through the brain's response to chronic inflammation. Research on neuroplasticity demonstrates that the brain can adapt, potentially reducing hypersensitivity to pain signals.

For women in the United States, Canada, and international markets, Lutea™ offers gentle neurostimulation supporting emotional regulation without adding hormones. For those in the UK and EU, Nettle™, a Class IIa medical device, is clinically proven to reduce menstrual pain and relieve low mood.

Research registered with ClinicalTrials.gov (NCT06974773) and funded through SBRI Healthcare investigates neurostimulation's efficacy for endometriosis-related symptoms. The technology works by boosting neuroplasticity in brain regions involved in pain modulation and emotional regulation. Learn about how neurostimulation devices work and the science behind this approach.

Complementary Approaches

Regular low-impact exercise like swimming or yoga reduces inflammation and improves mood. Anti-inflammatory dietary patterns emphasizing whole foods and omega-3 fatty acids may help manage symptoms. Stress reduction techniques, including meditation and breathwork, support overall well-being.

Living with endometriosis requires ongoing attention to physical, emotional, and neurological well-being. While no single solution works for everyone, understanding the condition empowers informed decision-making. Support addressing the whole experience, not just isolated symptoms, matters most. Whether through medical treatment, surgical intervention, or brain-based approaches like those offered by Samphire Neuroscience, relief and improved quality of life are achievable.