14 Conditions Endometriosis Is Mistaken for the Most
This painful disease hits 1 in 10 women—yet it's tough to diagnose because it shares symptoms with so many other conditions.
Know what endometriosis is
Each month, a woman sheds the endometrial lining in her uterus and regrows a new lining. However, in about 10 percent of reproductive-age women, this endometrial tissue also grows outside the uterus—a condition known as endometriosis. The wayward tissue doesn't break down and shed as it would in the uterus; instead, it triggers inflammation and immense pain. "These endometrial growths have been found on the ovaries, fallopian tubes, bladder, on the outside of the uterus, lining the pelvic cavity, and between the vagina and rectum. In rare occasions, growths have been found in the arm, thigh, and lung," says John Rapisarda, MD, a reproductive endocrinologist with Fertility Centers of Illinois.
Who gets endometriosis?
Though there's no one cause of endometriosis, Dr. Rapisarda explains that risk factors include infertility, starting menstruation earlier, experiencing menopause later, shortened menstrual cycles, elevated levels of estrogen in the body, smoking, having a low body mass index, and uterine abnormalities. "Those with a close relative who has endometriosis, such as a mother, aunt, or sister, are at a higher risk of being diagnosed with endometriosis." Endometriosis doesn't just happen to adult women either; it's been found in girls as young as eight years old. Learn the surprising facts about endometriosis.
Diagnosing the condition
The biggest challenge with endometriosis is how difficult it is to diagnose. In fact, according to the Endometriosis Foundation of America, it takes an average of ten years from the onset of symptoms for women to get an accurate diagnosis. This is partly due to a lack of knowledge about the condition among women and the medical community. Another issue is that the symptoms can be similar to other gastrointestinal and gynecologic diseases. Following are some of the most common conditions that endometriosis may be mistaken for by doctors.
Extremely painful menstrual cramps—dysmenorrhea—are one of the most widely recognized symptoms of endometriosis, according to Ken Sinervo, MD, OBGYN, of the Center for Endometriosis in Atlanta, Georgia. However, it is possible to suffer from menstrual pain without a specific pelvic abnormality. This is called primary dysmenorrhea and it's among the most common of gynecological disorders. "Generally characterized by menstrual cramping, dysmenorrhea may also be accompanied by other symptoms such as sweating, headache, nausea, vomiting, or diarrhea, and they occur just before or during menses in individuals with normal pelvic anatomy," says Dr. Sinervo. "Pain associated with typical or 'primary dysmenorrhea' can typically be treated with over the counter remedies or medications, whereas severe dysmenorrhea failing to respond to medical therapy, or 'secondary dysmenorrhea,' is typically associated with endometriosis and warrants proper diagnosis and treatment." These surprising things happen during your period—besides your period.
This benign uterine disorder shares many symptoms with endometriosis—pelvic pain and infertility along with heavy or lengthy, painful periods that include bloating. However, adenomyosis is quite different in how it presents itself internally, according to Dr. Sinervo. Instead of endometrial tissue growing outside of the womb, he says, with adenomyosis, endometrial glands and fluids are found in the middle lining of the uterus," he says. Diagnosis is also tough with this disease—imaging can help, he says, but often surgery is necessary to establish adenomyosis. Often, hysterectomy is the only cure. Learn about these potential medical reasons for abdominal pain after sex.
These common benign tumors in the uterus are known as leiomyomas or myomas; they can cause abnormally painful periods. In fact, the intensity and character of pain caused by fibroids are quite similar to that of endometriosis. When women have painful menses along with pain during sex and uncomfortable bowel movements, endometriosis may be most likely, explains Aaron Styer, MD, a reproductive endocrinologist, founding partner, and co-medical director of CCRM Boston. "A pelvic ultrasound can be performed to evaluate a woman for fibroids," he says; if fibroids are ruled out, endometriosis may be the most likely cause of the symptoms. Read about silent signs you might have uterine fibroids.
These common, usually benign growths in the ovary come in all different sizes and varieties. While most go away without any medical intervention, some may cause severe pain if they are large or they rupture, explains Anate Brauer, MD, a reproductive endocrinologist at the Greenwich Fertility and IVF Centers and assistant professor of OB/GYN at NYU School of Medicine.
Sometimes cysts on an ultrasound can be mistaken for endometriosis, says Dr. Brauer: "An ovarian cyst can be composed of endometriosis—this specific type of cyst is called an endometrioma—but a simple ovarian cyst tends to go away after four to eight weeks," she says. "Endometriosis, on the other hand, persists, so if you're suffering from what you think is an ovarian cyst that won't quit, consult your doctor about additional imaging such as an MRI." Learn about the symptoms of polycystic ovarian syndrome (PCOS).
Any scarring in the pelvis or abdomen—often due to an infection or prior surgery—can be misdiagnosed as endometriosis itself, according to Dr. Brauer. "Presence of pelvic adhesions can cause significant chronic pelvic pain that is similar to that experienced with endometriosis. However, it's not as closely linked to the timing of your menstrual cycle as is in the case of endometriosis," she says. If you have pelvic pain, here's what it could mean.
This chronic pain disorder is notoriously difficult to diagnose. Patients generally have symptoms like muscle and joint pain as well as pelvic pain—and together, they can be mistaken for endometriosis, explains Dr. Brauer. (Or the other way around: Endometriosis can be diagnosed as fibromyalgia.) "The general treatment for fibromyalgia involves pain medications or neuromodulators," she says. Here are other conditions that are commonly mistaken for fibromyalgia.
This little finger-shaped pouch hangs off your colon on the right of your abdomen. "It may have a function as part of the immune system before the ages of seven or eight," says Dr. Sinervo, "and it may serve as a reservoir for healthy bacteria." But as you get older, the organ is mostly known for becoming infected and inflamed, leading to excruciating pain in your belly. Appendicitis can share many of the same symptoms as endometriosis, including right-sided lower abdominal pain, pain that worsens when you're walking or moving around, nausea, vomiting, constipation or diarrhea, and bloating. Unlike endometriosis, says Dr. Sinervo, appendicitis is usually accompanied by a fever and can be diagnosed by CT scans and elevated white blood cell counts.