Endometriosis is an often serious disorder in which tissue, similar to the lining of the uterus, grows outside of the uterus. While the cause of endometriosis is unknown, the impact on patients’ health can be severe. The pH balance of the tissues can be disrupted and the muscles and nerves can be put into disarray. Neurotransmitters begin stimulating an inflammatory cascade that can cause chronic pain.

Endometrial lesions are typically located in the pelvis, but they can occur at other locations, including the bowel and diaphragm. Endometriosis is fairly common and can cause a number of serious conditions as well as chronic pain and infertility. Symptoms range from minor to severely debilitating.



  1. Endometriosis plaques can directly invade nerves
  2. Endometriosis can cause pelvic floor muscle spasms
  3. The presence of endometriosis can stimulate the inflammatory cascade which can lead to peripheral nerve neurogenic inflammation and pain as well as contribute to the process of central sensitization

What Are The Causes Of Endometriosis?

There are several theories of the etiology of endometriosis. While the exact cause is unknown, some explanations are:

  • “Induction Theory” or Transformation of Peritoneal Cells: This is where factors, such as hormones or the immune system transforms the peritoneal cells (which are cells that line the inside of your abdomen and pelvis) into endometrial-like cells.
  • Embryonic cell transformation. This theory suggests that embryonic cells, which are present during development in the womb, are transformed by hormones such as estrogen intro endometrial-like cells during puberty.
  • Surgical scar implantation. After uterine surgery, such as a cesarean section or hysterectomy, the endometrial cells may be exposed to the pelvic cavity and implant either to the pelvic sidewalls or to the surgical incision.
  • Endometrial cell transport. Endometrial cells may be transported to other organs or parts of the body (such as the lung) through blood vessels or tissue fluid (lymphatic) system.
  • Immune system disorder. Endometrial tissue or cells is supposed to be inside the uterus, not outside of the body. A problem with the immune system may compromise the body’s ability to recognize and destroy this abnormal tissue.

What Are The Signs And Symptoms Of Endometriosis?

The primary symptom of endometriosis is pelvic pain, particularly associated with menses. Other symptoms which usually increase in intensity during the menstrual cycle include pain with or after sexual intercourse, constipation, diarrhea, and/or painful bowel movements, nausea and/or vomiting, leg and/or back pain, shortness of breath, and unexplained infertility.

The severity of disease does not necessarily correlate with severity of symptoms. For example, many woman may have severe symptoms with mild disease and other women may have no symptoms at all, but have severe disease.

What Are The Risk Factors Of Endometriosis?

Several risk factors place you at an increased risk of developing endometriosis, such as starting your period at an early age, heavy menstrual cycles, having one or two more female relatives with endometriosis, reproductive tract abnormalities, and nulliparity (never having given birth).

How Is Endometriosis Diagnosed?

Endometriosis is definitively diagnosed by histologic evaluation of the diseased tissue. This requires a surgery, most often laparoscopy.

What Are The Possible Treatments For Endometriosis?

Unfortunately, endometriosis is a chronic disease and requires a combination of both treatment and management of the disease. The only way to treat endometriosis is by surgical excision with histopathological confirmation. Once the disease has been excised, management of the disease usually entails medication therapies, such as anti-inflammatories, hormonal suppression, and lifestyle modifications.

Are There Preventative Steps To Avoid Endometriosis?

While there is no known prevention of endometriosis, early diagnosis and surgical treatment is key to managing the disease and preventing it from advancing.

What Are The Risks If Endometriosis Is Left Untreated?

If left untreated, endometriosis can lead to several complications, such as debilitating and chronic pelvic pain, infertility, ovarian cysts, and adhesions (scar tissue from the disease). With advanced disease, endometriosis can infiltrate surrounding structures or organs, such as the bowel, ureters (the tubes that carry urine from the kidneys to the bladder), and/or bladder. Left untreated, women with advanced disease may develop a bowel obstruction or even lose their kidney. Women can also have distant endometriosis invade their diaphragm and lungs, causing the lung to collapse. Moreover, endometriosis is associated with an increased risk of certain types of ovarian cancers.

Are There Other Related Conditions To Endometriosis?

Adenomyosis, which is endometrial glands and stroma which invade the muscle of the uterus, often occurs with endometriosis. Women with endometriosis may have a higher risk of having infertility, autoimmune diseases and developing certain types of ovarian cancers.

Whole Body Approach To The Complications Of Endometriosis

Unfortunately, endometriosis may also be an indicator of a larger issue. Medical experts consider it likely that the disease involves an abnormality in the immune response. The inflammatory nature of the disease was noted more than a decade ago and a study published in the journal Human Reproduction in 2007 explored endometriosis’ inflammatory aspects. The results of this study suggest that endometriosis is a disease involving complex inflammatory behavior, possibly including an auto-immune component.

When dealing with an auto-immune condition – in which the body seems to be attacking itself – we believe our “whole body” approach stands a great chance of success. And, we’re pleased to say that our results often bear out this conclusion.

Meet Pelvic Rehabilitation Medicine

Meet Our Co-Founder & Chief Medical Officer: Dr. Allyson Shrikhande Dr. Allyson Shrikhande is a board certified Physical Medicine and Rehabilitation specialist, Chief Medical Officer of Pelvic Rehabilitation Medicine, and an expert in women’s and men’s health and sexual health.  A leading expert on pelvic... Learn More »