March is Endometriosis Awareness Month. Fidelis Care sat down with one of the experts in our provider network, Dr. Katherine Cartwright of Albany Obstetrics and Gynecology, to learn and share about this painful condition affecting one in 10 women in their reproductive years.
Q: What is endometriosis?
Dr. Cartwright: Endometriosis is when cells that look and act like the lining of the uterus grow outside the uterus.
Most of the time these cells are in the pelvis — on the ovaries, fallopian tubes, or the outer surface of the uterus. They can also show up on the bladder or bowel. More rarely, they’re found in other parts of the abdomen or elsewhere in the body.
Q: How common is endometriosis?
Dr. Cartwright: It affects about 1 in 10 women of reproductive age. It’s an estimate because some people have mild or no symptoms, and the only way to confirm it definitively is through surgery.
Q: Who is likely to get endometriosis? Is it more common at certain ages?
Dr. Cartwright: We most often diagnose endometriosis in the late 20s to early 30s, but symptoms frequently start earlier. It can affect people throughout the reproductive years. When it’s diagnosed later in life, it’s often that someone has dealt with painful periods for a long time before they’re able to get answers.
And family history matters — if a close relative has had endometriosis, your risk may be higher.
Q: When should someone see a doctor?
Dr. Cartwright: If period or pelvic pain is interfering with your life, it’s worth getting checked out. For example, it pain:
- Prevents you from going to school or work
- Limits social activities or relationships
- Is debilitating rather than manageable with over-the-counter medication
Q: What does the medical workup for endometriosis look like?
Dr. Cartwright: We usually start with a detailed conversation about your symptoms, especially painful periods and/or pelvic pain.
For some people, the pain is mostly during their period at first, and then over time it can turn into pelvic pain that shows up even when they aren’t bleeding.
We’ll also ask about your menstrual cycle, your overall health, and what testing you’ve already had. For example, some people have had GI workups (like colonoscopy or endoscopy) because the pain felt more “stomach-related,” but nothing clearly explained it.
It’s also common to hear, “I’ve been to urgent care or the ER for this, and the scans were normal.” That history helps us decide what to do next.
I’ll often ask about things like:
- Pain with sex
- Pain with bowel movements
- Pain with urination
- Pattern tracking (for example, a menstrual and symptom diary)
From there, a pelvic ultrasound is a common first step to look for other causes of pain, like ovarian cysts or fibroids. Unfortunately, it’s very common for that ultrasound to come back normal, even if someone does have endometriosis.
Then we’ll sometimes use specialized ultrasound techniques or an MRI, but those tests usually need to be ordered and read with endometriosis specifically in mind.
The only way to diagnose endometriosis for sure is with surgery — usually a diagnostic laparoscopy, where we place a small camera through the belly button to look inside the pelvis and abdomen.
This is why it can take time to reach a clear diagnosis.
Q: How is endometriosis treated?
Dr. Cartwright: Many first-line options are hormonal treatments that stop periods and help reduce swelling and pain. They can be effective for symptom relief, but they don’t necessarily make endometriosis go away.
If symptoms keep going, worsen, or medication isn’t working, then we think about surgery.
If we’re going to the operating room and the suspicion is high, many specialists try to diagnose and treat in the same procedure — meaning we look for endometriosis and remove what we find.
Some people want a diagnostic procedure first: “Just tell me if it’s there.” Others would rather do one comprehensive surgery if the likelihood is high, so treatment happens at the same time.
What’s best really depends on your symptoms, what we suspect is going on, your overall health, and what you feel comfortable with.
Q: If someone has pelvic pain, when should they push for answers?
Dr. Cartwright: If endometriosis is even on the list of suspects — because you have painful periods, pelvic pain, or abdominal/GI symptoms that haven’t been explained — bring it up directly with your doctor. You can say, “Could this be endometriosis?” and ask them to walk you through why they think yes or no.
If you feel like you’re not getting a straight answer — or the explanation doesn’t match what you’re experiencing — it’s okay to get a second opinion or ask for a referral to someone who focuses on endometriosis.
Q: What’s the most important thing people should know about endometriosis?
Dr. Cartwright: Your period shouldn’t derail your day-to-day life. If pain is making you miss work, school, or things you enjoy, that isn’t “just normal.” Endometriosis is one possible cause that’s worth considering. You should reach out for help from a healthcare provider.