During menstruation, the uterine lining—or endometrial tissue—sheds from the uterus and regrows. When the endometrial tissue grows outside the uterus, in other parts of the body, it is a condition known as endometriosis.
Endometriosis affects an estimated 1 in 10 women during their reproductive years, approximately 190 million worldwide according to the Endometriosis Foundation of America yet can be hard to diagnose because it shares symptoms with many other conditions.
Conditions that Endometriosis Symptoms are Often Mistaken for
1. Urinary Tract Infection (UTI)
Can endometriosis cause UTI symptoms? Yes. Because endometriosis and urinary tract infection symptoms can be similar, such as painful urination and pain during sex, medical professionals may mistake one for the other. A simple test for infection will show whether a UTI is present and antibiotics are necessary. If symptoms persist but an infection is not present, further testing and analysis should be done by a medical professional.
2. Pelvic Inflammatory Disease (PID)
PID is a serious diagnosis involving an infection of the reproductive organs that can cause severe pelvic pain similar to endometriosis. Scarring in the pelvis as a result of PID or endometriosis can also cause pain at any time, not just during the menstrual cycle. PID is confirmed based on a review of symptoms, physical exam and testing suggesting an infection.
3. Irritable Bowel Syndrome (IBS)
Like endometriosis, IBS causes pelvic pain, bloating, and changes in bowel function leading to constipation and/or diarrhea. IBS and endometriosis, may both be impacted by the menstrual cycle, but can occur anytime of the month, making a diagnosis more difficult to pinpoint. A colonoscopy can evaluate the health of the bowels and may assist in the diagnosis of IBS. Patients can also try medication and make dietary changes to see if symptoms improve.
4. Sciatica
With endometriosis, endometrial tissue grows outside of the uterus rather than only within the uterine cavity. This can lead to endometrial implants growing on nerves in the pelvis, causing back and leg pain, which can be confused with sciatica, which occurs when a disc herniates on top of spinal nerves. An x-ray or MRI will help determine whether structural abnormalities along the spine are causing pain, which will allow a physician to better assess the etiology.
5. Uterine fibroids
Fibroids are common non-cancerous tumors of the uterine muscle. They may sometimes cause symptoms similar to endometriosis such as pelvic pain, painful periods, heavy menstrual bleeding and back pain. A pelvic exam and ultrasound are used to assess the uterus and determine the number, size and location of fibroids.
6. Pelvic floor dysfunction
When a woman cannot control the muscles of the pelvic floor as result of pelvic floor dysfunction, this can cause pelvic muscle tenderness, pain during sex, and can even make sitting or standing painful. Symptoms of pelvic floor dysfunction may overlap with symptoms of endometriosis, making a diagnosis more challenging. Symptoms suggesting pelvic floor dysfunction include having multiple bowel movements within a short amount of time and difficulty maintaining a urinary stream.
7. Interstital cystitis
This is a condition that is characterized by pain and pressure in the region of the bladder. Although symptoms may mimic a urinary tract infection, an infection is not present and symptoms are of a chronic nature. Other complaints include pain in the pelvis, abdomen, lower back and painful intercourse. Many of these symptoms overlap those found in individuals with endometriosis and can present a challenge in establishing a proper diagnosis. A diagnosis of interstitial cystitis is made based on a thorough review of symptoms, physical exam and additional testing to rule out other conditions. Urine culture, cystoscopy and assessment of bladder capacity are often helpful in reaching a diagnosis.
Endometriosis diagnosis and treatment
Who is at risk for endometriosis?
Several factors are associated with an increased risk of having endometriosis, including infertility, early onset of menstruation, late menopause, shorter menstrual cycles, elevated estrogen levels, smoking, low body mass index, and certain uterine abnormalities. Genetics also play a role—women with a close relative, such as a mother, sister, or aunt, who has endometriosis are at higher risk.
It’s important to note that not all women with endometriosis experience infertility. And for those who do, many are still able to conceive with the right care and treatment.
Diagnosis: How do I know if I have endometriosis?
Endometriosis can be difficult to diagnose, as symptoms often overlap with other conditions. The only way to definitively diagnose endometriosis is through laparoscopy—an outpatient surgical procedure in which a small camera is inserted into the abdominal cavity to directly visualize endometrial implants and scar tissue. A biopsy of the tissue is typically performed to confirm the diagnosis.
In some cases, endometriosis may be suspected based on symptoms, physical exam, or imaging such as ultrasound. However, laparoscopy with biopsy remains the gold standard for diagnosis.
Treatment: Can I live a normal life with endometriosis?
Treatment for endometriosis depends on symptom severity and personal goals, including pain management and fertility. For individuals experiencing significant pelvic pain—during menstruation, between periods, or with intercourse—treatment options may include anti-inflammatory medications, hormonal therapies or surgical management.
Pain associated with endometriosis is often improved with hormonal birth control and nonsteroidal anti-inflammatory medications such as ibuprofen or naproxen. A conversation with your OB/GYN is often the first step toward developing a symptom management plan.
For those hoping to become pregnant, consulting a fertility specialist is key. For many patients with endometriosis, in vitro fertilization (IVF) is one of the most effective treatment options. IVF allows physicians to bypass some effects of endometriosis in the pelvis, modify implantation environments and achieve strong pregnancy success rates. With the right diagnosis, treatment plan, and care team, many people with endometriosis are able to manage symptoms and build the family they envision.
Medical contribution by Arlene A. Go, M.D.
Dr. Arlene Go is dedicated to guiding patients through the complexities of fertility treatment with a blend of cutting-edge medical advancements and compassionate care.
