Understanding Endometriosis: A Journey Through Maria’s Pain
By Dr Pereira
“Doctor, I’ve tried everything. Painkillers, birth control, even changing my diet. But nothing helps. Am I going crazy?”
That was the first thing Maria said to me when she entered my office. Her eyes were tired, but more than that, they held fear. At 28, Maria was a bright, strong woman—until her pain started to take everything from her.
As a gynecologist, I’ve met hundreds of women like Maria. Women who’ve been told it’s normal to suffer during periods. That pain is part of being a woman. That they should stop complaining.
But when I examined Maria and saw her flinch in pain during the pelvic exam, I knew what we were dealing with. Her uterus was retroverted and fixed, and she had tenderness deep in the pelvis. I performed a transvaginal ultrasound in my office that same moment.
And there they were: bilateral endometriomas, both ovaries affected, stuck to the uterus and bowel. It was deep infiltrating endometriosis—and Maria had many classic symptoms: painful periods, pain during sex, and infertility.
Understanding Endometriosis: What Is it?
Understanding endometriosis begins with understanding the body. Endometriosis is a condition where tissue similar to the endometrial lining of the uterus grows outside the uterus. It most often affects the ovaries, fallopian tubes, pelvic lining, and even the bowel. In rare cases, it can reach distant organs like the lungs.
This misplaced tissue acts like uterine lining—it thickens, breaks down, and bleeds during each menstrual cycle. But unlike regular endometrial tissue, it has no way to leave the body. The result? Inflammation, pain, and scar tissue.
Some women experience extreme pain. Others, like Maria, also suffer from infertility. That’s what makes understanding endometriosis so complex—and so important.
Understanding Endometriosis: Common Symptoms
In my practice, I’ve seen symptoms vary dramatically. Here are the most common ones:
- Chronic Pelvic Pain – Pain that persists beyond menstruation.
- Dysmenorrhea – Menstrual cramps so severe that even strong painkillers don’t help. Menstrual cramps that are progressive, lasting through the entire period and often before or after menses. These cramps worsen over the years.
- Dyspareunia – Pain during or after sex. Sometimes, the pain during intercourse is so intense that a woman has to ask her partner to stop. Sadly, many partners struggle to understand this, leading to frustration and emotional distance.
- Gastrointestinal Issues – Bloating, nausea, constipation, or diarrhea, especially during periods. Some patients experience sharp, stabbing pain during bowel movements, as if a knife were passing through the rectum. In severe cases, this can lead to partial or complete intestinal obstruction.
- Urinary Problems – Painful or frequent urination, sometimes with blood.
- Infertility – Up to half of women with infertility have endometriosis.
- Fatigue, Anxiety, and Depression – Living with daily pain takes a toll on both body and mind.
Maria had all three: severe pain, sexual discomfort, and infertility. She had been trying to conceive for three years with no success.
Understanding Endometriosis: What Causes it?
There’s no single cause, but several theories help us in understanding endometriosis:
- Retrograde Menstruation – When menstrual blood flows backward into the pelvis.
- Cell Transformation – Some pelvic cells may turn into endometrial-like cells.
- Immune Dysfunction – A weak immune system may fail to clear the misplaced tissue.
- Genetics – Family history increases your risk.
- Environmental Factors – Exposure to toxins and chronic inflammation may play a role.
Understanding Endometriosis: How Is it Diagnosed?
Maria’s diagnosis came from a physical exam and immediate ultrasound. But for many women, the process takes years.
- History & Symptom Review – We listen. And believe.
- Pelvic Exam – Looking for nodules, masses, or tenderness.
- Transvaginal Ultrasound – Detects ovarian endometriomas.
- MRI – Shows deep lesions and helps surgical planning.
- Laparoscopy – The gold standard. A minimally invasive surgery that confirms diagnosis and allows for treatment.
In Maria’s case, the MRI confirmed what we suspected: endometriomas, bowel adhesions, distorted tubes, and superficial lesions on the intestine.
Understanding Endometriosis: Treatment Plan – A Two-Step Approach
Given the level of pain, infertility, and anatomical distortion, we opted for a proactive approach:
- Egg Retrieval and Freezing – Why did we do it? Because during surgery, we would perform excision of ovarian endometriomas, ovarian lesions, and adhesions that could compromise Maria’s ovarian reserve. So we collected her eggs before surgery to preserve her fertility.
- Laparoscopic Surgery – A full excision surgery followed:
- Bilateral endometriomas removed
- Deep infiltrating lesions excised
- Resection of a portion of the rectosigmoid colon
- Adhesiolysis and restoration of pelvic anatomy
- Salpingectomy (both tubes were hydrosalpinges and nonfunctional)
Understanding Endometriosis: How Does It Affect Fertility?
Maria’s story highlights what many women face: the silent effect of endometriosis on fertility.
- Inflammation alters the uterine environment, making implantation difficult.
- Hormonal Resistance, especially to progesterone, disrupts ovulation and endometrial receptivity.
- Scar Tissue can block fallopian tubes or surround the ovaries.
- Ovarian Endometriomas may reduce egg quality.
Despite these challenges, freezing eggs before surgery protected her chances.
Can You Get Pregnant Naturally with Endometriosis?
Yes. But it depends on:
- Severity of the disease.
- Age (fertility declines after 35).
- Condition of the fallopian tubes.
- Duration of trying (more than 6 months after 35, or 12 months before 35, warrants evaluation).
For Maria, with tubal damage and bowel endometriosis, IVF became the next step.
Treatment Options for Endometriosis-Related Infertility
For women like Maria, here’s what we consider:
- Surgery – Laparoscopic excision improves pain and fertility.
- IVF (In Vitro Fertilization) – Especially when tubes are damaged or ovaries are affected.
- Egg Freezing – Before surgery or age-related decline.
- Hormonal Medications – For symptom control, not fertility improvement.
Supporting Fertility Naturally
Some changes may help support fertility (though they’re not a cure):
- Anti-Inflammatory Diet – Leafy greens, omega-3s, whole grains.
- Supplements – Vitamin D, antioxidants, always with medical guidance.
- Stress Management – Yoga, acupuncture, therapy.
- Gentle Exercise – Walking, swimming, stretching. Avoid overtraining.
Understanding Endometriosis: When to See a Doctor
If you suspect endometriosis or are trying to conceive, see a specialist if:
- You’ve tried for over 6-12 months (depending on age).
- You have severe menstrual pain or pain during sex.
- You’ve had pelvic surgeries.
- You suspect cysts or blocked tubes.
Understanding Endometriosis: Conclusion
Maria is still on her journey. After recovering from surgery and completing her fertility preservation, she is now preparing for IVF—with hope in her heart and a body that is finally healing.
Understanding endometriosis isn’t just about science. It’s about listening to women. It’s about shortening the years of silence, misdiagnosis, and suffering. It’s about empowering patients to take control.
If you’re reading this and wondering whether your symptoms are being taken seriously, don’t stop until you find answers. Understanding endometriosis is real. And you deserve to be heard.
Help us spread this message. Share this post. Visit Vittafemme.com. Let’s make understanding endometriosis accessible to every woman—together.
References
- Cano-Herrera, G., et al. Endometriosis: A Comprehensive Analysis of the Pathophysiology, Treatment, and Nutritional Aspects, and Its Repercussions on the Quality of Life of Patients. Biomedicines 2024, 12, 1476.
- Inzoli, A., et al. The Evil Twins of Chronic Pelvic Pain Syndrome: A Systematic Review and Meta-Analysis on Interstitial Cystitis/Painful Bladder Syndrome and Endometriosis. Healthcare 2024, 12, 2403.
- Coxon, L., et al. Current Developments in Endometriosis-Associated Pain. Cell Reports Medicine 2024.
- Tsuei, A., et al. Comprehensive Management of Bowel Endometriosis: Surgical Techniques, Outcomes, and Best Practices. J. Clin. Med. 2025, 14, 977.
- Latif, S., et al. Endometriosis and In Vitro Fertilization. Medicina 2024, 60, 1358.
- Centini, G., et al. Endometriosis-Related Ovarian Cancer: Where Are We Now? J. Clin. Med. 2024, 13, 1933.
- Garvey, M. Endometriosis: Future Biological Perspectives for Diagnosis and Treatment. Int. J. Mol. Sci. 2024, 25, 12242.
- Ochoa Bernal, M.A., et al. The Known, the Unknown, and the Future of the Pathophysiology of Endometriosis. Int. J. Mol. Sci. 2024, 25, 5815.
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