Why is Endometriosis So Painful?
Endometriosis is a disease affecting upwards of 176 million women in the USA alone, or about 1 in 10.
One of the biggest hallmark signs of endometriosis is extreme pelvic pain. The pain isn’t limited to when women with endo are on their periods either- it can often persist daily and throughout the entire menstrual cycle.
Women with endometriosis often experience pain in:
- Menstrual flow, aka cramps
- Sexual intercourse
- Bowel movements
- Daily functional movements like walking up stairs or sitting motions
- The entire pelvic bowl
Oftentimes this pain is so excruciating it causes women with endo to miss work, to decline social invitations and basically spend a lot of time on the couch with a heating pad.
Can you relate?
Well, there’s a few reasons why endometriosis is so painful. The good news is that once you understand why the pain is happening and where it’s coming from, it’s easier to make the necessary natural changes to reduce the crippling pain.
3 Reasons Why Endometriosis is So Painful
#1: Hormonally Responsive Tissue
The basic definition of endometriosis is having endometrial tissue (the tissue that normally lines the uterus) outside of the uterus. It can take up residence in many areas, including the bowel, bladder, ovaries, intestines and even the lungs.
Normally, endometrial tissue inside the uterus builds and swells with blood through the cycle to prepare for a fertilized egg (read: pregnancy). If we don’t get pregnant during any given cycle, we shed this lining, and it starts to rebuild the next cycle. This mechanism is controlled by hormones such as estrogen and progesterone.
Because this type of tissue is so specific, even when it’s outside the uterus in the case of endo, it still builds and swells with blood. When period time comes, after both progesterone and estrogen have dropped, the tissue will bleed just like it does in the uterus.
This reason for endometriosis pain is connected to all other reasons. For example, inflammation in the hormonally-responsive tissue as explained above causes pain.
Additionally, women with endometriosis typically have chronic inflammation throughout the body that can sometimes be noted on lab tests.
The presence of inflammation itself can impair the immune system. There is a developing recognition in scientific research that autoimmune responses (where the body begins to attack itself) is part of the underlying cause of endometriosis. More inflammation = poor immune function.
Secondly, inflammatory markers like prostaglandins (hormone-like substances) present in women with endo cause pain. Their job is to mediate the inflammatory response. Some prostaglandins exacerbate inflammation, and others cool it down. In the case of endo, these prostaglandins act locally (in the areas where endometrial tissue is present), amplifying inflammation and therefore pain.
Even women without endometriosis who experience menstrual cramping and pain are at the mercy of inflammatory prostaglandins.
These prostaglandins can also create inflammation of the bowel, since they’re located so close to that area, create bowel issues like diarrhea, especially during menstruation.
Stress is a major contributor to endometriosis pain. We all experience stress in our lives, and often women with endometriosis experience more than other people, as the daily pain and other endo issues create more feelings of stress, fatigue and mood problems.
In one rat study, prior exposure to stress meant more vesicles and more severe inflammation in these vesicles, equalling more pain. Mast cells (cells involved in the inflammatory response) were also increased, as were bowel issues. So, exposure to stress may increase the development and severity of endometriosis.
Additionally, and definitely worth noting, stress perpetuates the “pregnenolone steal” an issue where the body steals pregnenolone (a hormone precursor) to make more stress hormone (like cortisol) instead of progesterone. Resulting low levels of progesterone create imbalances in estrogen and increase the potential for more endometriosis development.