Endometriosis: The Painful Toll of a Quiet Condition

Like millions of other women, Jennifer Bozeman thought her debilitating period pain was normal.

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One afternoon in the fall of 2014, Jennifer Bozeman was teaching her elementary Spanish students when crippling pain shot through her pelvis. "I was in the middle of a lesson," she says. "I broke into a cold sweat."

Unfortunately, this wasn't unusual for Bozeman, now 26, who had terrible periods growing up. "I used to have to go home from school on the first day [of] each month," she says. "I had horrible cramps, I'd have trouble with the bathroom, fatigue, cold sweats, and insomnia."

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For her, that was normal. But after years of enduring painful and embarrassing symptoms that regularly kept her from enjoying her life, Bozeman finally went to the ER in January 2015 when the pain struck again — hard. This time it was so intense that she threw up in a restaurant parking lot just before heading to the hospital.

After a CT scan, pelvic exam, and ultrasound didn't provide answers, the doctor ordered an MRI and finally gave Bozeman a diagnosis: endometriosis.

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The Pain of 1 in 10 American Women

Also referred to as endo, endometriosis is a condition that causes tissue similar to the lining of the uterus (aka the endometrium, which is shed during menstruation each month) to grow outside of the uterus and attach to nearby organs, such as the ovaries, fallopian tubes, bladder, and even colon. The buildup of this tissue over time can lead to the development of lesions, cysts, inflammation, and scarring – so it's no wonder Bozeman was in so much pain.

Although many people have never heard of it, endometriosis is not uncommon. It's estimated that up to 10 percent of reproductive-age women suffer from endometriosis in the United States; however, because there's no easy way to diagnose endometriosis and not all women display symptoms, it's possible this number is much higher.

Endometriosis is a very common cause of unexplained pelvic pain, says Mamta M. Mamik, MD, assistant professor in the department of obstetrics, gynecology and reproductive science at the Icahn School of Medicine at Mount Sinai. Symptoms are varied, but whatever symptoms an endometriosis patient experiences, they're likely to be severe.

"She is usually in a lot of pain," Dr. Mamik explains. "The pelvic pain could be just before or during a menstrual period; between menstrual periods, with worsened pain during her period; or pain during or after sexual intercourse, with bowel movements or while urinating."

When 'Deal With It' Is Your Main Option

There is no quick fix for endometriosis, so symptom management is key. Bozeman has had to learn ways to manage and work around the painful symptoms that come with her period. She's become a student of her body, and knows what works for her — including over-the-counter pain meds, heating pads, and rest on her worst days.

She's become a student of her body, and knows what works for her.

She says she tries to exercise as much as possible, even if she has pain, and eat a diet low in sugar. "Both help reduce inflammation in the body," she explains, "and inflammation worsens my symptoms. Cells feed off sugar especially, and since the endometriosis is an overgrowth of cells, reducing the sugar in my diet helps a lot."

But — like any woman who's ever had a chocolate craving during her period knows — making those healthier decisions can be easier said than done. "Sometimes, you really do just want to eat whatever you want," Bozeman says.

Depression, Infertility, and Beyond

If endometriosis is severe or a woman is having difficulty conceiving, surgery to stage and remove the excess tissue can be performed, Mamik says. Doctors typically try to remove as much of the tissue as possible while keeping ovaries and uterus intact.

"A doctor makes small cuts to place instruments inside the abdomen and pelvis," Mamik explains. "One of these instruments has a light and camera, which allows the doctor to see the organs on a screen and remove the endometriosis through the small incisions. Patients usually go home the same day and go back to work within a week or two."

The other side of endometriosis is the emotional one. According to Mamik, patients can experience anxiety and depression as a result of their frequent bouts of pain and other symptoms.

Bozeman knows this firsthand. "It's exhausting," she says. "I have endo, and other issues (ovarian cysts and uterine fibroids), as well. I have to visit my OB often, and sometimes take time off work."

Some endometriosis patients also deal with infertility issues. "I'm single and 26," Bozeman says. "To have to think about possibly having trouble conceiving down the road, or having surgery, it's hard — and then even if you do have the surgery, there's no guarantee the endometriosis won't come back."

For now, Bozeman plans to stick with symptom management, but she may consider surgery later on if she has trouble getting pregnant. It's been a long, painful journey to understanding her own body, but Bozeman knows now that she has the strength to push forward.

"I think I've learned to manage it all pretty well," she says with a satisfied smile.

For more information on endometriosis, visit the Endometriosis Foundation of America's website at www.endofound.org.

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