In normal circumstances, menstruation should not turn itself into a significant health problem. It always involves pelvic discomfort, mood swings, and other symptoms resulting from hormonal changes, but they should not last for a very long time or cause excruciating cramps, as in the case of endometriosis.

Menstruation problems are common and usually appear in young and senior women as their hormonal cycles start to change, adapting to their new stage of life. As such, they are a common reason for consultation in the emergency room and the private practice. In the case of endometriosis, as you will see in this article, it leads to a significant reduction in the quality of life, and patients are often admitted into the emergency room due to a very intense pain that requires intravenous medications to improve.

What you need to know about endometriosis

Endometriosis is a medical condition in which we can find outside of the uterus tissue that belongs to the internal lining of this organ. This is also known as ectopic tissue, or in other words, tissue that is located in a place or surface where it does not belong anatomically. The problem with endometriosis is that the internal lining of the uterus undergoes many changes throughout the menstrual cycle of a woman. The inside of the uterus is capable of sustaining these changes without significant problems, but the same is not true with other areas of the body.

Thus, when the endometrium of the uterus (the normal endometrium) undergoes hormonal changes and grows thick, the same happens with this ectopic tissue. Similarly, when menstruation ensues, this ectopic tissue becomes severely inflamed and triggers a series of painful symptoms that may become unbearable and lead patients into the emergency room.

This ectopic tissue is usually located in the pelvic region, usually in the ovaries, near the bladder, or in the bowel. The majority of women who are diagnosed with endometriosis have undergone previous uterine surgery, and in this situation, the endometrial tissue is likely to migrate to the outside of the uterus as a consequence of the surgery.

Signs and symptoms of endometriosis

The most important symptoms of endometriosis are as follows:

• Chronic pain associated with the menstrual cycle: Patients with endometriosis typically complain from chronic pain associated with the menstrual cycle. This type of pain is usually very intense, and some patients may describe it as excruciating. It is not improved with the usual
  medications and may require intravenous painkillers. Pain is caused by inflammation in the pelvic region, and it is cyclic because during menstruation the endometrial tissue undergoes hormonal changes and aggravates inflammation.
• Pain during or after intercourse: Pain symptoms are not only associated with menstruation.Even outside of the menstrual period, patients usually report feeling pain during or after having sex. This is because, even if they don’t realize, women with endometriosis have a chronic
  inflammatory process in their pelvic cavity, and this affects the integrity of every part of the reproductive tissue, including the vaginal mucosa.
•  Heavy menstrual bleeding: Most women with endometriosis report heavy menstrual periods,either because they have menstrual irregularities and hormonal problems or because the chronic inflammatory process influences the way hormones affect the endometrial tissue. Either way, patients will have very heavy periods and may have significant blood loss.
• Infertility: Besides pain, one of the most concerning symptoms among women with endometriosis is infertility. Similar to what happens in pelvic inflammatory disease, patients with endometriosis have a very severe and sustained source of inflammation that may lead toan irreversible dysfunction of the organs of reproduction. It highly depends on the site of inflammation, and the duration of the disease, and not every woman with endometriosis is meant to become infertile.
•  Fatigue: Extreme tiredness is a common symptom in many diseases and may have different
  explanations. In patients with endometriosis, pain symptoms become a source of intense stress,
  and similar to what happens in chronic pain diseases, these patients may feel fatigued, a type of
  exhaustion that does not improve after a good night’s sleep. Another likely cause of fatigue is
  anemia, a reduction of hemoglobin in the blood that results from abundant loss of blood in
  heavy periods.
  

Medical treatments and home remedies for endometriosis

Medical treatment of endometriosis is complex, and decisions should be made according to each case.
On one side, we have surgical treatment, which is a good way to provide short-term relief in cases of
severe pain. This is usually performed after locating the areas where endometriosis is likely to be
through ultrasound and other imaging techniques. However, surgery might not be the solution for other
patients with mild or moderate symptoms. Instead, there are two types of treatment available for them,
and we can divide them into hormone therapy and pain medications.

Pain medications are essential to control pain symptoms, and even though over-the-counter
medications are typically used, some patients may require intravenous drugs and even opioids, which is
a type of prescribed painkiller that may have severe side effects when misused. On the other hand,
hormonal treatments are meant to stop the production and release of hormones by the ovaries. This
will prevent ovulation and the endometrial changes associated with the menstrual cycle.

However, in a patient who has endometriosis and infertility, additional treatments and in vitro
fertilization may be prescribed to facilitate pregnancy. These cases are often difficult to treat, and a
multidisciplinary team is likely to be involved in your treatment.

Home remedies are also available to alleviate endometriosis symptoms. However, keep in mind that
these are not nearly as effective as medical treatments. Still, you can try a warm bath, warm
compresses, supplements with turmeric or omega 3, a pelvic massage, and maintaining an anti-
inflammatory diet consisting of fruits and vegetables and trying to avoid processed foods, dairy, and
other foods that might trigger allergies or inflammatory reactions.