Endometriosis is a disease that affects women due to tissue that usually lines inside the uterus developing outside the uterus. The abnormal tissue can grow under the ovaries, on the fallopian tubes, behind the uterus, on the tissues that hold the uterus in place, and on the bowels or bladder. According to the National Institutes of Health (NIH), 6% to 10% of women of reproductive age have endometriosis, the equivalent to about five million women in the United States alone. The main symptoms of the disease, for which there is currently no cure, are pain and infertility.

Additional endometriosis symptoms include painful, even debilitating, menstrual cramps, which may get worse over time, pain during or after sex, pain in the intestine or lower abdomen, painful bowel movements or painful urination during menstrual periods, heavy menstrual periods, premenstrual spotting or bleeding between periods, painful bladder syndrome, digestive or gastrointestinal symptoms similar to a bowel disorder, as well as fatigue, tiredness, or lack of energy. The symptoms tend to become milder after menopause, while there are also treatments to address the symptoms of pain and infertility.

Pain Associated with Endometriosis

Pain is the most common symptoms of endometriosis, and endometriosis is the reason for pelvic pain in 75% of the cases. It can even be incapacitating, but researchers are yet to understand the reasons for endometriosis-related pain. The pain may be related to the hormonal similarity between endometriosis tissue and uterus tissue, inflammation and chemicals produced by the endometriosis areas that can cause adherence of the pelvic organs and creation of scar tissue, hormones and chemicals that are released by endometriosis tissue and irritate nearby tissue, nodules or bumps in the endometriosis areas that result in lesions on the surface of pelvic organs, nerves in the endometriosis lesions, or patches of endometriosis pressing  against nearby nerve cells.

“The severity of pain does not correspond with the number, location, or extent of endometriosis lesions. Some women with only a few small lesions experience severe pain; other women may have very large patches of endometriosis, but only experience little pain. (…) Pain from endometriosis can be severe, interfering with day-to-day activities. Understanding how endometriosis is related to pain is a very active area of research because it could allow for more effective treatments for this specific type of pain,” explains the National Institutes of Health (NIH).

Endometriosis-Related Infertility

Infertility is also a very common symptom of endometriosis, and endometriosis is the reason for infertility in 50% of all cases. “The relationship between endometriosis and infertility has been debated for many years. In normal couples, fecundity is in the range of 0.15 to 0.20 per month and decreases with age. Women with endometriosis tend to have a lower monthly fecundity of about 0.02–0.1 per month. In addition, endometriosis is associated with a lower live birth rate,” state Carlo Bulletti, Maria Elisabetta Coccia, Silvia Battistoni, and Andrea Borini, the authors of the study “Endometriosis and infertility.”

Infertility is six to eight times more common among women who suffer from endometriosis than healthy ones, but the reason for it are not understood. However, there is the possibility of infertility in patients with endometriosis to be related to distorted pelvic anatomy, endocrine and ovulatory abnormalities, altered peritoneal function, and altered hormonal and cell-mediated functions in the endometrium. In addition, patients also have a complex network of humoral and cellular immunity, as well as increased volume of peritoneal fluid with a high concentration of activated macrophages, prostaglandins, IL-1, TNF, and proteases, which can cause infertility.

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