What You Need to Know About Endometriosis

Endometriosis affects as many as 1 in 10 women in the United States, causing uncomfortable symptoms and sometimes infertility. Unfortunately, many women suffer from the condition in silence and aren’t taken seriously by their primary care providers or gynecologists. 


If you are diagnosed with endometriosis or suspect that you have this condition, you must understand your treatment options. Endometriosis is very treatable with the proper care and a team of dedicated doctors on your side. Armed with the correct information and knowledge, you can advocate for your needs, improve your quality of life, and achieve your goals. Read on to learn about endometriosis, its symptoms, how it impacts fertility, and the treatment options available.



What is Endometriosis?


Endometriosis is a reproductive disorder that causes tissue that normally grows within the uterus known as the endometrium to be found outside the uterus. Typically, the tissue grows along the outside of the uterus, in or on the ovaries, in the fallopian tubes, and elsewhere in the pelvis. Acting just like your endometrium, it goes through changes as you move through your menstrual cycle. So, when you get your period, it breaks down and bleeds. However, the tissue is unable to leave the body and causes scarring, adhesions, or other complications. 


Endometriosis may be diagnosed based on symptoms, but surgery is the only true way to diagnose it. Surgery can be done with laparoscopy, meaning the procedure is minimally invasive. During the surgery, doctors can determine the stage of the endometriosis and often provide some treatment that relieves symptoms.


The Stages of Endometriosis

The stages of endometriosis are based on the amount of endometrial tissue. Here is a short explanation of each stage:

  • Stage 1 (Minimal): There is some damage but little or no scar tissue.
  • Stage 2 (Mild): The endometrium damage is more significant, and it has implanted deeper in the tissue in the abdomen. Some scar tissue may be present.
  • Stage 3 (Moderate): Deep implants are present and scar tissue may have formed bands of adhesions. Cysts may have formed on the ovaries.
  • Stage 4 (Severe): This is the most serious and widespread form of endometriosis. Abundant, widespread endometrial tissue, adhesions, and scar tissue are present. Large cysts may have formed on the ovaries.

Unfortunately, many women aren’t able to get a diagnosis of endometriosis until an average of 7.5 years have passed. This means they’ve lost valuable treatment time, especially when it comes to fertility concerns. For many women, getting appropriate treatment for endometriosis is dependent upon advocating for themselves, as the symptoms and condition are often underlooked or dismissed.


What Causes Endometriosis? Is it Preventable?

It’s natural to wonder why endometriosis happens and if there is any way to prevent it. Researchers are still trying to understand how and why endometriosis appears in the body. So far, there are only theories and possible relationships that may explain this reproductive disorder.


Endometriosis may be genetic, as it does tend to run in families. If you have a close family member such as a mother, aunt, or sister with endometriosis, you are more likely to have it as well. Endometriosis can appear at any point after a girl begins menstruating but more commonly appears in women in their 30s and 40s.




One likely cause of endometriosis is a condition called retrograde menstruation. During retrograde menstrual flow, the endometrial tissue doesn’t flow directly down to the cervix and out of the vagina. Instead, some of it enters the fallopian tubes, or leaves the uterus, and gets into other areas of the pelvis. There, the endometrial tissue continues to grow and follow the menstrual cycle.


Hormones may also play a role in endometriosis. Researchers have noticed that estrogen promotes endometriosis. This is why during pregnancy, when progesterone is prevalent, endometriosis temporarily pauses. Also, endometriosis symptoms may lessen or disappear after menopause when the body stops making estrogen. 

Yet another factor may be the immune system. Women with endometriosis are more likely to experience immune disorders. Researchers suspect that the immune system may fail to remove the endometrial tissue from the areas where it shouldn’t be.

What are the Common Symptoms of Endometriosis?

Endometriosis can cause a range of different symptoms. However, endometriosis can also be asymptomatic, meaning that you may not know that you have it. Some women only discover that they have endometriosis when they struggle to get pregnant or have unrelated abdominal surgery. It’s also important to note that the severity of endometriosis isn’t always linked to how severe your symptoms are. Sometimes, symptoms such as pain can be worse when the endometrial tissue grows close to a nerve or when bleeding causes irritation. 


Some of the most common symptoms of endometriosis are:

  • Painful menstrual cramps
  • Lower back and abdominal pain, especially during menstruation
  • Pain while using the bathroom
  • Long or heavy menstrual periods
  • Pain during or after sexual intercourse
  • Spotting between periods
  • Infertility
  • Digestive issues including constipation, diarrhea, bloating, nausea, etc.

Because symptoms of endometriosis mimic other conditions such as PCOS and even digestive conditions like IBS, it can be extremely difficult to diagnose. It is also complicated by the fact that endometriosis is not always detectable on ultrasounds or other imaging tests. Some doctors go as far as to dismiss symptoms as related to anxiety, stress, or just a painful menstrual period.



The Effect of Endometriosis on Fertility

As many as 50% of women who experience infertility have endometriosis. There are several ways that endometriosis can affect fertility. Mainly, endometriosis causes problems in the reproductive organs, resulting in infertility. Endometrial tissue can grow in the ovaries or the fallopian tubes. There, the tissue can block the egg and prevent ovulation or fertilization. In other words, the tissue can prevent the egg from leaving the ovary or keep the sperm from reaching the egg. Another theory is that the normal endometrium may not allow the egg to implant, or scar tissue may prevent this.


A  further complication is that endometriosis is often very painful. This can make intercourse so uncomfortable that it is impossible to conceive. 


Despite these hardships, it is possible for many women with endometriosis to get pregnant. With appropriate treatment, including laparoscopy, medication, and, if necessary, fertility treatments. If you want to learn more about endometriosis treatment options including laparoscopy, get in touch with our team of experts.


Do you recognize some of these symptoms?

Use our helpful Endometriosis Symptoms Quiz to learn more about your reproductive health and whether or not Endometriosis may be a factor for you.

Take the Endometriosis Symptoms Quiz

“I had seen several gynecologists over the years, not one mentioned endometriosis.

Fast forward to the Kofinas Fertility. After meeting with Dr. Narine (who was immensely patient with my numerous questions), it was determined I had endometriosis. I will be honest, after the surgery to correct this, my husband and I decided to try the IUI route which failed a few times (it was expected as I am older). We then attempted the IVF route, began the injections and half way through, Dr. Kofinas informed us we needed to stop IVF as I was only producing 1 strong egg. As I held my head crying, Dr. Kofinas, in the most compassionate manner, comforted me and believed it would happen when I lost hope. Rather than scrapping any attempts for that month, Dr. Kofinas said the egg looked very healthy and attempted IUI (eventhough it failed in the past) and that decision is how I became pregnant. Dr. Kofinas, driven as he is, continued with the IUI attempt, if he did not make that decision, I would not have my beautiful child today. My son is turning 3 and is a sweet, happy, smart, energetic toddler.” Read full review here. 

Angie Z.

How do you Treat Endometriosis?

Unfortunately, there is no definitive cure for endometriosis. Yet, there are viable treatment options that help alleviate symptoms and can help you grow your family in case of infertility. Some treatment options only manage symptoms, while other treatments focus on eliminating the endometriosis altogether.



The only way to definitively diagnose and treat endometriosis is through surgery. Fortunately, advancing technology allows minimally invasive surgery via laparoscopy. With laparoscopy, small incisions, typically smaller than one centimeter in length are made, and laparoscopes are inserted. A fiber optic scope and instruments are inserted through the openings, allowing surgeons to remove the endometrial tissue.


Laparoscopy can be very effective in helping resolve fertility issues related to endometriosis. Through laparoscopy, your doctor can remove scar tissue and adhesions that block fallopian tubes or ovarian cysts caused by endometriosis. During the procedure, the tissue is often sent to the lab to confirm that it is endometrial tissue. Finally, the doctor works to resolve any structural fertility issues caused by the endometrial tissue. If you have severe symptoms, any other tissue will also be removed.




Fortunately, because laparoscopy is not as invasive as traditional surgery methods, the recovery time is shorter. You will be able to return to normal life within about 2 to 4 weeks after surgery. Plus, the outlook is also very good for your fertility. As many as 75% of women who undergo laparoscopy for endometriosis are able to get pregnant after they’ve healed.


In many cases, removing endometriosis can eliminate the disorder, and the symptoms, altogether. However, in 20 to 30% of women, endometriosis returns within five years of the surgery.

One common surgical treatment for endometriosis is a hysterectomy. In this procedure, the entire uterus, and possibly the ovaries, are removed surgically. As a result, women who have a hysterectomy are infertile. The treatment is very invasive and may mean you’ll have to take hormone medications for the rest of your life. For this reason, the treatment should be used only as a last resort. Should it be necessary, the treatment can be very effective at eliminating symptoms related to endometriosis.


Treating Symptoms

The symptoms of endometriosis can be debilitating for some women. In these cases, treating symptoms can improve your quality of life until surgery can be programmed. Unfortunately, treating symptoms doesn’t get rid of endometriosis or resolve related fertility issues.


Some of the commonly used endometriosis medication treatments include:

  • Hormone Therapy: Estrogen is thought to make endometriosis grow and cause more pain. For this reason, birth control pills and other hormone therapies can help stop the production of estrogen. This, in turn, can slow the growth of the endometrium and alleviate symptoms. The first pill approved by the FDA to treat pain caused by endometriosis is a GnRH medication. This medicine puts the body in a state similar to menopause, preventing both menstruation and ovulation. Unfortunately, one side effect is bone thinning, meaning that the medication can’t be used for longer than six to twelve months, depending on the dose. 

    Other medications include birth control pills, intrauterine devices, and progesterone injections, among others.

  • Pain Medication: As pain is one of the main symptoms of endometriosis, many women take over-the-counter pain medications such as Tylenol or ibuprofen. However, your doctor may also offer prescription medications.  Although many of the above treatments can be effective at reducing symptoms, they also prevent pregnancy. If you are hoping to get pregnant, laparoscopy is preferred as it can both relieve symptoms and help you achieve your fertility goals. Another disadvantage of treating symptoms is that they largely mask the pain rather than addressing the root problem.

Endometriosis FAQs

Do you still have questions about endometriosis? Browse through our frequently asked questions to learn more.


What are the first symptoms of endometriosis?

There is no way to know what the first symptoms of endometriosis will be for any woman. That said, the most common symptom among women with endometriosis is very painful cramps during menstruation. In fact, as many as 87% of women with chronic pelvic pain have endometriosis. The cramps may get worse as you get older and may even interfere with your ability to live your daily life.

What is the leading cause of endometriosis?

The main cause of endometriosis is currently unknown. A number of factors may cause this disorder, including genetics, age, and your immune system, among other things. Researchers suspect that endometriosis may be caused by retrograde menstruation.

What happens if endometriosis is left untreated?

As long as you aren’t experiencing symptoms or infertility, you may continue your life without a negative impact on your health. However, over time, the endometriosis may grow, change, and cause uncomfortable symptoms or interfere with your fertility. Fortunately, experienced fertility doctors such as Kofinas Fertility Group can manage and treat endometriosis to keep it from advancing into further stages. We can also advise you on your fertility journey so that you can make the best decisions for your family planning.

Does IVF medication get rid of endometriosis?

IVF medications and treatments may be a part of your treatment plan if you are facing infertility as a result of your endometriosis. While many women with endometriosis are able to get pregnant naturally, some need a bit of extra support.

However, IVF medications don’t get rid of endometriosis. Instead, they help resolve some of the issues that endometriosis can sometimes pose when it comes to fertility. For example, if your fallopian tubes are blocked with scar tissue, IVF can make it possible for you to carry a pregnancy. Or, if cysts on your ovaries complicate ovulation, IVF may also help make an embryo that you can carry to term.

Why wasn’t a laparoscopy recommended to me by my doctor?

Now that you’re aware of the benefits of laparoscopy, you may wonder why your doctor didn’t recommend it. Unfortunately, most doctors prefer to only recommend procedures they can perform in their own clinics. If they can’t perform surgery, they may prefer to manage your condition through medicinal routes, rather than explaining and exploring all of your options with you.

Also, women’s health issues are often brushed aside. For instance, women wait longer than men for pain medication in the ER and 26% of women say their symptoms of chronic pain or a chronic condition were dismissed when compared to 18% of men. This all points to the fact that many doctors unfortunately don’t take women’s health issues such as endometriosis seriously enough to talk through the treatment options and work toward a long-term solution to chronic pain. 

Rest assured that at Kofinas Fertility Group, we’ll take your symptoms and fertility goals seriously.

Do I need a hysterectomy if I have endometriosis?

While extreme, hysterectomies are very effective at eliminating the symptoms of endometriosis. However, they should only be used as a very last resort. Once your uterus is removed, you will be infertile and may even need to take hormone replacement medications for the rest of your life. The decision to undergo a hysterectomy should not be taken lightly. Rather, it is a decision you should take only after having discussed all of your treatment options with a doctor you trust.

How do you diagnose endometriosis?

We diagnose endometriosis through a laparoscopy exam.

Kofinas is Here to Help You Understand Your Endometriosis Treatment Options

Endometriosis is a common reproductive order that affects many women. Despite its prevalence, many women still struggle to get the proper treatment and care they deserve.


Here at Kofinas Fertility Group, we have many years of experience working with patients who have endometriosis. Not only will we take your symptoms and concerns seriously, but we are able to offer the best solutions that address the root cause of the issue.


Thanks to our extensive experience with endometriosis, we are able to take on and successfully address even difficult cases such as stage 3 and 4 endometriosis or patients who have already failed with IVF. We truly believe that with careful study of the patient, compassionate care, and teamwork, we can help you achieve your family goals. Whether that is through laparoscopy at our state-of-the-art surgical facility or alternative treatments, we are committed to helping you treat your endometriosis and fertility issues successfully.


Start your path to healing today! Contact us to set up your appointment now.

Request An Appointment

Request An Appointment