THE MAJORITY OF chronic pelvic pain is caused by endometriosis. Endometriosis is a disease affecting women in their reproductive years. It was widely undiagnosed until the 1980s. The name, as you've probably guessed, comes from the word endometrium. The clinical definition of endometriosis is an "abnormal growth of endometrial cells." Between 2 and 22 percent of women with endometriosis don't have any symptoms and may not know they have it; 40 to 60 percent of women with painful periods have endometriosis, while 20 to 30 percent of women who are having difficulty conceiving have endometriosis.

Roughly 5.5 million women throughout North America have endometriosis. Endometriosis was at one time coined "husbanditis" because the pain that characterizes endometriosis was seen as a woman's excuse to get out of her marital duties. In the past, treating women who complained of pelvic pain ranged from tranquilizers to hysterectomies. Unfortunately, many women today are still being told that their symptoms are "in their heads" when, in fact, endometriosis is a physical disease causing real physical symptoms. What happens is that endometrial tissue forms outside the uterus in other areas of the body. This tissue then develops into small growths, or tumors. (Doctors may also refer to these growths as nodules, lesions, or implants.) These growths are usually benign (noncancerous) and are simply a normal type of tissue in an abnormal location. Cancers that arise in conjunction with endometriosis appear to be very rare. Endometriosis is sometimes referred to in the medical literature as a pseudocyst endometrioma.

The most common location of these endometrial growths is in the pelvic region, which affects the ovaries, the fallopian tubes, the ligaments supporting the uterus, the outer surface of the uterus, and the lining of the pelvic cavity. Some 40 to 50 percent of the growths are in the ovaries and fallopian tubes. Sometimes the growths are found in abdominal surgery scars, on the intestines, in the rectum, and on the bladder, vagina, cervix, and vulva. Other locations include the lung, arm, thigh, and other places outside the abdomen, but these are rare.

Since these growths are in fact pieces of uterine lining, they behave like uterine lining, responding to the hormonal cycle and trying to shed every month. These growths are blind - they can't see where they are and think they're in the uterus. This is a huge problem during menstruation; when the growths start shedding, there's no vagina for them to pass through, so they have nowhere to go. The result is internal bleeding, degeneration of the blood and tissue shed from the growths, inflammation of the surrounding areas, and formation of scar tissue. Depending on where these growths are located, they can rupture and spread to new areas, cause intestinal bleeding or obstruction (if they're in or near the intestines), or interfere with bladder function (if they're on or near the bladder). Infertility affects about 30 to 40 percent of endometriosis sufferers, and as the disease progresses, infertility is often inevitable.

The most common symptoms of endometriosis are pain before and during periods (much worse than normal menstrual cramps), pain during or after intercourse, and heavy or irregular bleeding. Other symptoms may include fatigue, painful bowel movements with periods, lower back pain with periods, diarrhea and/or constipation with periods, and intestinal upset with periods. If the bladder is involved, there may be painful urination and blood in the urine with periods. Irregular menstrual cycles and heavier flows are also associated with endometriosis, but women with severe endometriosis usually continue to have regular, albeit painful, periods. Some women with endometriosis may have no symptoms at all.

It's important to note that the amount of pain is not necessarily related to the extent or size of the growths. Tiny growths, called petechiae, have been found to be more active in producing prostaglandins, which may explain the significant symptoms that seem to occur with smaller growths.

Endometriosis can vary in terms of severity. Like other diseases, it is categorized into four stages—the higher the number, the more severe the endometriosis. Stage I is when your endometriosis is minimal and still very thin and "filmy," hence easier to treat. Stage II is mild endometriosis; the endometriosis is still on the thin side but is situated more deeply into your surrounding tissues. Stage III is moderate endometriosis; here, your endometriosis is denser, mixed with some stage I or stage II symptoms. Stage IV means severe endometriosis. In this case, the endometriosis is dense and deep, a bad combination.

Signs and Symptoms

Since endometriosis includes so many seemingly unrelated symptoms, it's often missed or simply misdiagnosed. The following is a list of symptoms to watch for. If you have at least two of these symptoms during your period or experience them chronically, you may want to get checked out for endometriosis.

• pelvic pain and/or painful intercourse
• infertility (often the only symptom women experience, even with stage IV)
• abnormal cycles or periods
• nausea and/or vomiting
• exhaustion
• bladder problems (there is something called bladder endometriosis, discussed in the next section)
• frequent infections
• dizziness
• painful defecation
• lower backaches
• irritable bowels (loose, watery, and often bloody diarrhea often mistaken for irritable bowel syndrome)
• other stomach problems
• low-grade fever

Bladder Endometriosis

Women who have endometriosis around the bladder can suffer from the urge to urinate, frequent urination, vulvar pain, urge incontinence, and painful urination. In fact, the symptoms of bladder endometriosis mirror interstitial cystitis. Many women with IC probably have bladder endometriosis instead.

Painful Statistics

A questionnaire distributed by the Endometriosis Association revealed that 100 percent of respondents experienced pain one to two days prior to their periods. In addition, 71 percent reported pain midcycle, 40 percent reported pain other times, and 20 percent reported pain throughout their cycles, while 7 percent reported intermittent pain with no particular pattern. The pain reported in this questionnaire was mostly abdominal, but the pain of endometriosis can manifest in emotional symptoms such as mood swings, depression, irritability, anxiety, anger, and feelings of helplessness, fear, powerlessness, and insecurity. Plus the financial consequences of endometriosis can be painful, too. Women in the United States aren't always covered for the various diagnostic tests or treatments.

What Causes Endometriosis?

Environmental estrogens are probably the most logical cause. Environmental scientists have begun to notice that several wildlife species are experiencing hermaphroditic traits. In the Florida swamplands, alligators are simply not breeding. A concerned research team from the University of Florida went into the swamps to find out why. These researchers pulled male alligators out of the water to examine their genitals. The majority of male alligators found were sterile as a result of having either nondeveloped or abnormally shaped penises. A chemical spill in nearby waters was found to be the culprit—it was having an estrogenic effect on the alligators' natural habitat.

Meanwhile, some 1,400 miles north, in a Canadian creek on Lake Superior, scientists found that fish living in waters close to a pulp mill, which contained certain chemicals with estrogenic effects, were now complete hermaphrodites. The male fish in these waters had developed ovaries and were sterile; the female fish had exaggerated ovaries. In other contaminated waters, fish had actually exploded from thyroid hormone overactivity.

Researchers in Sweden and the United Kingdom have been concerned since the late 1980s over a dramatic increase in male infertility in their countries, while there is an increased incidence of male infants being born with cryptorchidism, a condition in which the testicles do not descend into the scrotum, but remain undescended inside the abdomen. One study found that there has indeed been a huge decrease over the last fifty years in the quality of human semen. (A recent study measuring sperm quality in New York City contradicted these findings.) There has also been a huge increase in the incidence of testicular and prostate cancers. In Britain testicular cancer incidence has tripled over the last fifty years; it is now the most common cancer in young men under thirty. In Denmark there has been a 400 percent increase in testicular cancer. As for prostate cancer, its incidence has doubled over the last decade. These male reproductive problems have been linked to environmental estrogens, too.

The scientific literature is slowly becoming saturated with findings linking one organic chemical after another to reproductive cancers and "endocrine disruption" in both wildlife and humans. Every study, from all corners of the world, is reaching the same conclusion: organic chemicals are transforming into environmental estrogens. And they're everywhere. Organic chemicals are found in the air we breathe from numerous air pollutants, in the food preservatives used in numerous canned and packaged goods, and in the pesticides used on fresh produce. These chemicals then contaminate the water and soil, which contaminate the entire human food chain.

Some suggest that environmental estrogens are "feminizing" the planet. Others suggest that women are being overloaded with estrogen, which may be associated with the rise of estrogen-dependent cancers, such as ovarian and breast cancer, as well as estrogen-related conditions, such as endometriosis and fibroids. Estrogen pollutants are also thought to accumulate in fatty tissues (meaning they are stored in fat). Since women generally carry more body fat than men, women may be accumulating more of these toxins. Some studies have already found that women with breast cancer tended to have higher concentrations of the organochlorines DDT and DDE or of PCBs in their fat tissue. In fact, elevated levels of DDE in the blood have been directly linked to a fourfold increase of breast cancer in the United States. We already know that dioxins, also organochlorines, are associated with endometriosis.

Some suggest that the picture is equally dismal for men, many of whom are not only becoming slowly sterilized by this phenomenon, but are also developing reproductive cancers. Several prominent scientists have gone on record to say that this problem is the environmental priority of the twenty-first century!

On the flip side, many doctors point out that in the Western world, there has been a huge increase in the "fatness" of the population. This also increases the level of estrogen produced by our bodies. Estrogen dominance can trigger more estrogen-dependent conditions, such as fibroids, endometriosis, and various estrogen-dependent cancers.