Endometriosis: Big Name for a Big Pain

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Until recently, women rarely talked about it. Pelvic pain, cramps and problems with getting pregnant — results of endometriosis — drew little attention in the public spotlight. Many women struggled quietly to understand their symptoms and find a diagnosis.

Now celebs like Susan Sarandon, Whoopi Goldberg and Lena Dunham have taken up the challenge to reveal their own struggles with endometriosis. These high-profile stories are shining a light on its sometimes debilitating, sometimes heartbreaking effects.

Endometriosis Sufferers: You Are Not Alone

Endometriosis is more common than you might think. As many as one in 10 women of childbearing age have this condition. That’s as many as 5 million women! For them, the tissue that typically lines the uterus begins growing in other areas of the pelvis, often causing significant pain. Women in their 30s and 40s are most likely to be diagnosed, although it can begin much earlier.

Heather Hilkowitz, MD, Hilltop Obstetrics & Gynecology, describes what endometriosis is.

Click play to watch the video or read the transcript.

What is endometriosis?

Endometriosis is a condition limited to women. It involves the cells that grow inside the uterus that typically are released and passed each month with the menstrual cycle. But somehow those cells find their way outside of the uterus and implant in other areas in the abdomen and pelvis. Most commonly these might be either on the surface of the outside of the uterus on the tubes or ovaries or on the front or back surfaces of the pelvis. In more rare situations they actually implant on the surface of the bowel or even the bladder and sometimes and even more remote locations.


Each month, the lining of the uterus, called the endometrium, thickens to prepare for pregnancy and then sheds endometrial tissue when you have your period. If you have endometriosis, this tissue also can grow in other places:

  • Ovaries
  • Fallopian tubes
  • Tissues that hold the uterus in place
  • Outside of the uterus

This abnormal tissue has been found to grow in the bladder, intestine, rectum, vagina, cervix and vulva — and sometimes even in places like the brain or lungs.Endometriosis Big Name for a Big Pain - In Content

When you have your monthly menstrual period, the tissue outside the uterus can become inflamed and may release tiny drops of blood. This bleeding can irritate surrounding tissue and cause pain, cramps and sometimes scarring.

Cysts can form, as small as a pea or larger than a grapefruit. Scar tissue called adhesions can bind the pelvic organs together, cover them entirely, or involve nearby intestines. The adhesions may keep fallopian tubes from picking up the egg from the ovary during ovulation. Endometriosis also may grow into the walls of the intestine or into tissue between the vagina and the rectum.

Endometriosis has strong links to infertility and chronic pelvic pain. Up to 50 percent of women with infertility issues have endometriosis. Twenty percent of women with chronic pelvic pain have the condition.

What Causes Endometriosis?

No one knows for sure what causes endometriosis, but doctors have several theories.

Dr. Hilkowitz reviews current thinking on some possible causes of endometriosis.

Click play to watch the video or read the transcript.

What causes endometriosis?

There's no cure for endometriosis and how it comes about is a little bit of a mystery as well. There are several different theories about it, one of the most popular being that somehow the menstrual blood flow flows backwards perhaps through the tubes and then allows those endometrial or internal uterine cells to then implant on outside surfaces. That's probably the leading cause that we can identify to date but there's several other more complicated ones. Another cause may have something to do with very immature cells that are forming when we're just developing as a fetus in utero and those cells get dropped off at the locations in the pelvis and in the abdomen along the way but don't develop into endometrial cells until much later when a woman is an adult has started her period. So we don't really have a 100 percent answer and how endometriosis comes about, but at least we’ve got some great options on how to treat it.


As Dr. Hilkowitz notes, some experts think the condition may result from tissue shed during a woman’s period flowing backward through the fallopian tubes and into the pelvis. Although it’s not uncommon to have some of this backward flow, not all women develop endometriosis.

Genetics could play a role, as endometriosis seems to run in families. Immune system disorders may contribute by failing to destroy endometrial tissue outside of the uterus.

The hormone estrogen seems to promote endometriosis, so researchers are looking at this as a possible trigger.

Women in their 30s and 40s are most likely to be diagnosed, although it can begin much earlier.

Other theories suggest that endometrial tissue becomes displaced during abdominal surgery or a Cesarean section. Exposure of the uterus to chemicals such as dioxin also may be a contributing factor.

Whatever the cause, it’s important to identify if you have endometriosis, especially if you are planning to have children.

Learn more about the symptoms of endometriosis and who’s at risk.

It's easy to get the care you need.

See a Premier Physician Network provider near you.

Heather L. Hilkowitz, MD

Heather L. Hilkowitz, MD

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