We all know that that time of the month is uncomfortable and stressful. Periods, even light ones, can wreak havoc on your summer plans and interrupt a perfect day with discomfort and frequent trips to the bathroom. But those with endometriosis have it much, much worse. From indescribable pain to infertility issues, this disease is one that is commonly misunderstood and hard for doctors to diagnose. Thankfully, Dr. Kaley Bourgeois walks us through everything from symptoms to causes to natural remedies.

MY: What is endometriosis?

Dr. Kaley Bourgeois: Normally a woman’s endometrial tissue is only inside of her uterus. It thickens between her periods and she sheds it when she bleeds. When a woman’s endometrial tissue grows outside of her uterus, she has endometriosis. These patches of misplaced tissue can be on the ovaries, in the pelvis and abdomen, and even in the colon. They swell and shrink as her hormones fluctuate, causing pain and scarring.

MY: What causes endometriosis?

KB: While the exact cause of endometriosis is elusive, we do know that it’s an inflammatory disorder and that women may have a genetic predisposition to developing the condition. Meaning, having one or more close relatives with endometriosis increases a woman’s risk. Even if you do have a genetic predisposition, there are risk factors you can try to limit in order to avoid “turning on” those genes. These include diets and lifestyles that increase inflammation, alcohol, stress, and exposure to endocrine disruptors (think plastics, toxic makeup products).

MY: Recently we have seen more attention being brought to this condition. How common is it?

KB: Right now the estimated portion of reproductive age women with endometriosis is about 10 percent, however the true number is likely higher because the diagnosis is often missed.

MY: Why is endometriosis commonly overlooked?

KB: Trust me when I say that your doctors want to get your diagnosis right, but sadly this one often takes years due to several factors. First, you cannot always diagnose endometriosis via imaging or symptoms alone unless the disease is very advanced. Pelvic ultrasounds are excellent for finding ovarian cysts and uterine fibroids, but early endometriosis is harder to detect. Often when a doctor sees a normal pelvic ultrasound, further workup (such as MRI, biopsy, or laparoscopic surgery) is not recommended. Diagnosing endometriosis based on symptoms can also be tricky because every woman’s symptoms are unique. Some women will have debilitating pain, others will only have heavier than usual periods.

MY: How can it be treated?

KB: Like most inflammatory conditions, making the right diet and lifestyle choices can have a substantial impact. I recommend diets low in sugar, alcohol, and processed foods and rich in high fiber vegetables to every patient with endometriosis.

MY: How can you tell the difference between severe menstrual pain and endometriosis?

KB: Since one of the symptoms of endometriosis is severe menstrual pain, it’s hard to tell the difference between that and so-called normal menstrual pain (“primary dysmenorrhea”) based on symptoms alone. Women suffering severe pain with their periods deserve an extensive medical evaluation, including hormone testing, pelvic imaging, and further diagnostic workup if desired. There are additional symptoms to look for, though, which may point to more than normal menstrual pain: infertility, irregular bleeding, and painful bowel movements and urination during periods.

MY: What is it like to live with endometriosis?

KB: Living with endometriosis is challenging both physically and emotionally. The pain can be debilitating, leading to absences from work and difficulty participating in social activities. Unlike typical menstrual pain, endometriosis-related pain can occur during and between periods. It often causes abdominal bloat, back pain, painful intercourse, and IBS-like symptoms. Like any form of chronic pain, it can contribute to depression and anxiety. For many women it will impact their fertility, which is a complicated and emotional journey.

MY: Is there anything women can do to avoid endometriosis?

KB: Prevention is always more effective than treatment, so I recommend all women limit inflammatory foods, incorporate exercise, limit alcohol, and track their menstrual cycles so they can catch hormone imbalances and irregular periods early. Severity of endometriosis varies greatly, and catching it early provides greater opportunity for preventing progression. High levels of estrogen are linked to endometriosis, so balancing hormones is key in mild, moderate, and severe disease.

MY: Do natural remedies work?

KB: They can make a significant difference when used correctly! Optimizing the diet (including more greens no matter which diet you follow), reducing stress, and increasing exercise must happen at the same time, because no single intervention is enough when treating an inflammatory disease. Once those changes are in place, nutritional supplements, herbs, and certain bio-identical hormones can accelerate the healing process. I’m particularly fond of DIM (Diindolylmethane) and bio-identical progesterone for patients when lab results suggest estrogen dominance, but I don’t recommend starting either without lab work and diagnosis first.

Understanding the stage of your endometriosis is essential to knowing how and when to incorporate natural remedies. With mild disease, you may see dramatic improvements in the first few months. With severe disease, improvements will take longer and a combination of conventional and natural treatments works best.