March is Endometriosis Awareness Month, and it is a time to bring attention to a condition that affects millions of women, yet is often misunderstood, overlooked, or dismissed.
We sat down with Dr. Bronwyn Richards, an OGA physician who joined our team in 2018, to talk through what endometriosis really is, why it can be so difficult to diagnose, and what patients should know if they are navigating symptoms or seeking answers.
What is Endometriosis?
Endometriosis is a chronic condition in which tissue similar to the lining of the uterus grows outside of the uterus.
These cells can be found in areas on or around the:
- Uterus
- Ovaries
- Fallopian tubes
- Bladder or bowel
- Peritoneum (inner lining of the abdominal cavity)
In some rare cases, endometriosis can even appear in more distant areas of the body.
Because this tissue responds to hormones, it can become inflamed, painful, and lead to a wide range of symptoms over time.
“This is not something that just goes away,” Dr. Richards explains. “Once you have the diagnosis, it is something we continue to manage over time.”
Why is Endometriosis So Hard to Diagnose?
One of the most frustrating aspects of endometriosis is that there is no simple test to confirm it.
- There is no blood test
- Imaging does not always show it
- Symptoms can vary widely from person to person
The gold standard for diagnosis is a minimally invasive surgery called laparoscopy, where providers can directly see and treat the lesions.
However, treatment can often begin based on symptoms alone.
“You do not need a formal diagnosis to start addressing what you are experiencing,” Dr. Richards says. “Your symptoms are valid, and we can begin care from there.”
Common Symptoms to Watch For
Endometriosis can look different for everyone, but some of the most common symptoms include:
- Painful periods that interfere with daily life
- Pelvic pain outside of your cycle
- Pain with intercourse
- Pain with bowel movements or urination
- Heavy or irregular bleeding
- Infertility
One key takeaway: severity of symptoms does not always match severity of disease.
Some patients with minimal disease have severe pain, while others with extensive disease may have few symptoms.
Why Do So Many Women Feel Dismissed?
Many patients go years before receiving a diagnosis. Some are told:
- “This is just normal period pain”
- “You should be able to manage this”
That experience can lead to doubt, frustration, and even questioning whether their pain is real. “One of the biggest things I tell patients is this is real,” Dr. Richards says. “It is not in your head.”
What Causes Endometriosis?
The exact cause is still unknown.
There are several potential contributing factors , including:
- Genetics (it can run in families)
- Retrograde menstruation
- Spread through blood or lymphatic systems
But there is no single confirmed cause—and importantly, there is nothing you did to cause it.
Treatment Options
Because endometriosis is hormonally driven, treatment focuses on managing the disease and symptoms over time.
Hormonal therapy
This is the main form of treatment and may include:
- Birth control
- Non contraceptive progesterone-based medications
- Other hormone-regulating therapies
Surgery
A laparoscopy can:
- Confirm diagnosis
- Remove or excise lesions
- Improve symptoms in some patients
Supportive therapies
These can help manage symptoms, including:
- Pelvic floor physical therapy
- Pain management strategies
- Dietary and lifestyle adjustments
“It is not one size fits all,” Dr. Richards explains. “What works for one person may not work for another.”
Is It Curable?
Endometriosis is considered a lifelong condition. Even with surgery or a hysterectomy:
- Symptoms may improve
- Disease may still persist or return
Treatment is focused on long term management, not cure.
How It Can Impact Fertility
Endometriosis can affect fertility in a few ways:
- Scar tissue may block or alter reproductive anatomy
- Inflammation can impact egg and sperm interaction
- The pelvic environment may become less supportive for pregnancy
However, every case is different, and many patients with endometriosis are still able to conceive.
The Emotional Side of Endometriosis
Beyond the physical symptoms, endometriosis can be:
- Mentally exhausting
- Emotionally draining
- Frustrating when answers are not immediate
“It is a journey,” Dr. Richards says. “But you should not have to go through it alone.”
What Patients Should Know
If you are experiencing symptoms:
- You are not overreacting
- You do not need a diagnosis to seek care
- There are options, even if the first one does not work
“It may take time to find what works best for you,” Dr. Richards says. “But that does not mean there is no solution.”
Supporting Someone with Endometriosis
For partners, family members, and friends:
- Believe them
- Encourage them to seek care
- Be patient through the process Support can make a meaningful difference.
Final Thoughts
Endometriosis is complex, and no two experiences look the same.
But one thing is clear:
patients deserve to be heard, supported, and cared for every step of the way.
If you have questions or think you may be experiencing symptoms, starting the conversation is the first step.
