Understanding Endometriosis - Warfighter Wellness

Areas Impacted

Lesions are found most commonly on the ovaries, fallopian tubes and pelvic lining but can be found on other parts of the body like the lungs.

On or under the ovaries
On the fallopian tubes
Behind the uterus
On the tissues that hold the uterus in place
On the bowels or bladder

Risk Factors

There are certain personal characteristics and experiences that make you more or less at risk for developing endo. Though risk factors may be present, it does not mean you will get the condition.

Lower Risk
Been pregnant
Period started late in adolescence
Breastfeeding
Eating fruits, especially citrus

Higher Risk
Immediate female family members with endo
Period started before age 11
Monthly menstrual cycles less than 27 days
Menstrual cycles are heavy and last more than 7 days

Symptoms

Pelvic pain is the most reported symptom of endo, especially around periods. Though it’s the most common, there are many symptoms that can alert you to see a health care professional. Many endo symptoms are also symptoms of other health conditions, like pelvic inflammatory disease (PID), ovarian cysts and sexually transmitted infections (STIs). This is one of the reasons it’s so hard to correctly diagnose. If you suspect endo, it can be helpful to track your symptoms.

Painful Periods
(Dysmenorrhea)

Pelvic pain, as well as lower back and stomach pain, leading up to and throughout your period is the most common symptom. This pain is considered far worse than normal cramping that comes with menstruating.

Painful Sex

Pain during and/or after sex is common. Learn more here.

Painful Bowel Movements
and Urination

These symptoms are most common before and/or during menstruation.

Excessive Bleeding

Heavy periods, periods lasting longer than 7 days, and spotting between periods is common with endo.

Infertility

Many women aren’t correctly diagnosed until trying to conceive. Left untreated, endo can lead to infertility.

Additional Symptoms

Symptoms often stack with endo, so you may also experience fatigue, diarrhea, constipation, bloating and nausea. These are more common before and/or during periods.

Though various forms of pain are symptoms, the severity of pain is not a sign of the extent of lesions in the body. You could have serious pain and a small number of lesions, or you could have multiple lesions throughout the body and little to no pain. It’s not uncommon to have no symptoms at all. This is another reason it can be hard to diagnose.

Diagnosis

If you are experiencing pain, discomfort or any of the above symptoms, talk to your health care provider. Identifying symptoms and ruling out other health conditions with your care team is one way to identify endo may be present. If testing is recommended, your care team will walk you through the process and explain results and next steps.

What Can I Expect

Your provider will complete a pelvic exam and may take imaging tests, as well. The only way to know with 100% certainty you have endometriosis is through surgery (laparoscopy). In this procedure, they may also take a biopsy to get a tissue sample. If diagnosed, there are four stages of endo: minimal (Stage I), mild (Stage II), moderate (Stage III) and severe (Stage IV). Stages are determined by location, extent and depth of tissue outside of the uterus.

Treatment

Though there is no cure for endo, there are treatments to reduce symptoms. Work with your health care team to find the best treatment for you and your needs.

Pain relievers like ibuprofen and prescription medication.
Hormone therapy including birth control pills, progestin and medication that leads to temporary menopause.
Surgical treatments for severe pain to remove lesions and/or cut impacted nerves.

How Can Endometriosis Impact Military Readiness?

As a Warfighter, endo can lead to significant lost duty time given the prolonged periods of pain and how long it takes to properly diagnose. Depending on your job duties, symptoms may worsen with high stress and physically demanding tasks. It’s important to keep up with routine doctor’s visits and be in-tune with your body to spot signs of the condition early.

Endometriosis can negatively impact your mission readiness. It can also lead to other medical conditions like chronic pain, infertility and mental health issues if left untreated. Endo can be medically disqualifying, though waivers are often granted for minimal and mild stages that are well-managed. TRICARE offers treatment coverage under reproductive health care. If you recognize any symptoms, visit your health care team to identify the source of pain and discomfort as soon as possible. Early detection and treatment are essential to both your health and your career.