Understanding how endometriosis affects your health and future pregnancy.

What is the deal with painful periods? Some people suffer every month while others never experience cramps. The most common cause of painful periods (dysmenorrhea) is endometriosis.

Endometriosis happens when tissue similar to the lining of the uterus grows outside of the uterus where it does not belong. It causes painful periods and affects more than 11% of American women. It is especially common among women age 25–35, and may impact ones ability to get pregnant. Several different treatment options can help manage the symptoms, improve your life, reduce pain, and improve your chances of getting pregnant.

What is endometriosis?

Endometriosis, sometimes called “endo,” is a common gynecologic health problem. It gets its name from the word endometrium, the tissue present in the lining of the uterus or womb. For women with endometriosis, this tissue begins growing outside of the uterus and on other areas in the body where it doesn’t belong.

Most often, endometriosis is found on the:

  • Ovaries
  • Fallopian tubes
  • Tissues that hold the uterus in place
  • The outer surface of the uterus

Endometriosis implants may also be found in the vagina, cervix, vulva, bowel, bladder, or rectum. Rarely, endometriosis appears in other parts of the body, such as the lungs, brain, and skin.

What are the symptoms of endometriosis?

Symptoms of endometriosis can include:

  • Pain. Pelvic pain and painful periods are the most common symptoms. Women with endometriosis may have many different kinds of pain. These include:
  • Very painful menstrual cramps (dysmenorrhea). The pain may get worse over time.
  • Chronic (long-term) pain in the lower back and pelvis.
  • Pain during or after sex (dyspareunia). Most endometriosis patients describe a “deep” pain distinctly different from discomfort at the entrance to the vagina during penetration.
  • Bleeding or spotting between menstrual periods (metrorrhagia). Abnormal uterine bleeding has many causes and should be evaluated by your doctor.
  • Infertility, or not being able to get pregnant.
  • Stomach (digestive) problems. These include diarrhea, constipation, bloating, or nausea, especially during menstrual periods.

Why does endometriosis cause pain and health problems?

Endometriosis growths are benign (not cancerous), but they can still cause troublesome problems.

Remember, endometriosis implants occur when tissue similar to the lining of the uterus begins to grow outside of your uterus where it doesn’t belong. Endometriosis growths may swell and bleed in the same way the lining inside of the uterus does every month during menstrual cycles. This process causes swelling, pain, and scar tissue because the tissue grows and bleeds in an area where it cannot easily get out of your body.

The endometriosis implants may also continue to expand causing problems such as:

  • Blocking the fallopian tubes.
  • Benign ovarian tumors (endometriomas)
  • Inflammation (swelling)
  • Forming scar tissue and adhesions (a type of tissue that can bind your organs together).
  • Problems in your intestines and bladder

How common is endometriosis?

Endometriosis is a common health problem for women affecting approximately 11% of women, or more than 6 ½ million women in the United States, have endometriosis. The exact number is unknown as many women who have endometriosis suffer no symptoms at all. Obgyns often discover endometriosis during routine surgeries such as tubal ligations.

Who gets endometriosis?

Endometriosis can happen to any woman who has menstrual periods, but it is more common in women 25–35 years old. Occasionally, we find endometriosis in young girls before they begin having periods which is called premenarcheal endometriosis.

You might be more likely to get endometriosis if you have:

  • Never had children
  • Menstrual periods that last more than seven days
  • Short menstrual cycles (27 days or fewer)
  • A family member (mother, aunt, sister) with endometriosis
  • A health problem that blocks the normal flow of menstrual blood from your body during your period

What causes endometriosis?

No one knows for sure what causes this disease. Researchers are studying possible causes:

  • Problems with the menstrual period flow. Retrograde menstrual flow is the most likely cause of endometriosis. Some of the tissue shed during the period flows through the fallopian tube into other areas of the body, such as the pelvis.
  • Genetic factors. Because endometriosis runs in families, it may be inherited in the genes.
  • Immune system problems. A faulty immune system may fail to find and destroy endometrial tissue growing outside of the uterus. Immune system disorders and certain cancers are more common in women with endometriosis.
  • Hormones. The hormone estrogen appears to promote endometriosis. Research is looking at whether endometriosis is a problem with the body’s hormone system.
  • Surgery. During abdominal surgery, such as a Cesarean (C-section) or hysterectomy, endometrial tissue can be picked up and transmitted to other areas of the body. For instance, endometrial tissue has been found in surgical scars.

How can I prevent endometriosis?

You can’t prevent endometriosis. But you can reduce your chances of developing it by lowering the levels of the hormone estrogen in your body. Estrogen helps to thicken the lining of your uterus during your menstrual cycle.

To keep lower estrogen levels in your body, you can:

  • Talk to your doctor about hormonal birth control methods, such as pills, patches, or rings with lower doses of estrogen.
  • Exercise regularly (more than 4 hours a week). This will also help you keep a low percentage of body fat. Regular exercise and a lower amount of body fat help decrease the amount of estrogen circulating through the body.
  • Avoid large amounts of alcohol. Alcohol raises estrogen levels. No more than one drink per day is recommended for women who choose to drink alcohol.
  • Avoid a large amount of caffeine. Studies show that drinking more than one caffeinated drink a day, especially sodas and green tea, can raise estrogen levels.

How is endometriosis diagnosed?

If you have symptoms of endometriosis, talk with your doctor. The doctor will talk to you about your symptoms and do or prescribe one or more of the following to find out if you have endometriosis:

  • Pelvic exam. During a pelvic exam, your doctor will feel for large cysts or scars behind your uterus. Smaller areas of endometriosis are harder to feel.
  • Imaging test. Your doctor may do an ultrasound to check for ovarian cysts from endometriosis. An ultrasound uses sound waves to create pictures of your reproductive organs.
  • Magnetic resonance imaging (MRI) is another common imaging test that can take a picture of the inside of your body.
  • Medicine. If your doctor does not find signs of an ovarian cyst during an ultrasound, he or she may prescribe medicine:
  • Hormonal birth control can help lessen pelvic pain during your period.
  • Gonadotropin-releasing hormone (GnRH) agonists block the menstrual cycle and lower the amount of estrogen your body makes. GnRH agonists also may help pelvic pain.
  • If your pain gets better with hormonal medicine, you probably have endometriosis. But, these medicines work only as long as you take them. Once you stop taking them, your pain may come back.
  • Laparoscopy. Laparoscopy is a type of surgery that doctors can use to look inside your pelvic area to see endometriosis tissue. Surgery is the only way to be sure you have endometriosis. Sometimes doctors can diagnose endometriosis just by seeing the growths. Other times, they need to take a small sample of tissue and study it under a microscope to confirm this.

How is endometriosis treated?

There is no cure for endometriosis, but treatments are available for the symptoms and problems it causes. Talk to your doctor about your treatment options.

Medication options

If you are not trying to get pregnant, hormonal birth control is generally the first step in treatment. This may include:

  • Extended-cycle (you have only a few periods a year) or continuous cycle (you have no periods) birth control. These types of hormonal birth control are available in the pill or the shot and help stop bleeding and reduce or eliminate pain.
  • Intrauterine device (IUD) to help reduce pain and bleeding. The hormonal IUD protects against pregnancy for up to 7 years. IUDs can reduce pain and bleeding.

The hormonal treatment works only as long as it is taken, and is best for women who do not have severe pain or symptoms.

Elagorix (brand named Orilissa) is a new medication indicated for endometriosis. It works by interacting with the hormones LH (luteinizing hormone) and FSH (follicle-stimulating hormone) to reduce the amount of circulating Estrogen. This medication is highly effective at reducing moderate to severe pain associated with endometriosis

If you are trying to get pregnant, your doctor may prescribe a gonadotropin-releasing hormone (GnRH) agonist. This medicine stops the body from making the hormones responsible for ovulation, the menstrual cycle, and the growth of endometriosis. This treatment causes a temporary menopause, but it also helps control the growth of endometriosis. Once you stop taking the medicine, your menstrual cycle returns, but you may have a better chance of getting pregnant.


Surgery is usually chosen for severe symptoms, when hormones are not providing relief or if you are having fertility problems. During the operation, the surgeon can locate any areas of endometriosis and may burn, destroy, or remove the endometriosis implants. The surgeon may also test to see if the fallopian tubes are open (chromotubation). After surgery, hormone treatment is often restarted unless you are trying to get pregnant.

Other treatments you can try, alone or with any of the treatments listed above, include:

  • Pain medicine. For mild symptoms, your doctor may suggest taking over-the-counter medicines for pain. These include ibuprofen (Advil and Motrin) or naproxen (Aleve).
  • Complementary and alternative medicine (CAM) therapies. Some women report relief from pain with therapies such as acupuncture, chiropractic care, or supplements such as thiamine (vitamin B1), magnesium, or omega-3 fatty acids.

Does endometriosis go away after menopause?

For some women, the painful symptoms of endometriosis improve after menopause. As the body stops making the hormone estrogen, the growths shrink slowly. However, some women who take menopausal hormone therapy may still have symptoms of endometriosis.

If you are having symptoms of endometriosis after menopause, talk to your doctor about treatment options.

Can I get pregnant if I have endometriosis?

Yes. Many women with endometriosis get pregnant. But, you may find it harder to get pregnant. Researchers think endometriosis may affect as many as one in every two women with infertility.

No one knows exactly how endometriosis might cause infertility. Some possible reasons include:

  • Patches of endometriosis block off or change the shape of the pelvis and reproductive organs. This can make it harder for the sperm to find the egg.
  • The immune system, which normally helps defend the body against disease, attacks the embryo.
  • The endometrium (the layer of the uterine lining where implantation happens) does not develop as it should.

If you have endometriosis and are having trouble getting pregnant, talk to your doctor. He or she can recommend treatments, such as surgery to remove the endometrial growths.

What other health conditions are linked to endometriosis?

Research shows a link between endometriosis and other health problems in women and their families. Some of these include:

  • Allergies, asthma, and chemical sensitivities
  • Autoimmune diseases, in which the body’s system that fights illness attacks itself instead. These can include multiple sclerosis, lupus, and some types of hypothyroidism.
  • Chronic fatigue syndrome and fibromyalgia
  • Certain cancers, such as ovarian and breast cancer

Thank you to BeingWell for publishing this article on Medium

Article Originally published at on July 9, 2020.


Blog Author: Dr. Jeff Livingston

Main Blog Photo by: Anthony Tran on Unsplash

Should I go the Emergency Room / ER?

Why It’s Crucial to Avoid the ER If You Can

With the news regarding COVID-19 changing hourly, many are asking what the criteria are to visit an urgent care facility, such as an emergency room. Dr. Livingston has posted a public service message about guidelines for visiting Emergency Rooms.


MacArthur Medical Center is hard at work during this difficult time in our country. Our patients and our staff are our top priority. A number of public school districts in north Texas are announcing a two-week closure to help prevent the spread of coronavirus. We understand the stress and anxiety this causes all of us. We are collaborating with state and county health officials to provide the most updated information and guidance. The ongoing issue continues to be a lack of access to testing due to a lack of supply of test kits, and clinics and hospitals continue to have a limited supply.

According to the WHO, 80% of those that contract Covid-19 will have a mild illness that can be managed at home. The hospital emergency rooms are being overrun and should only be recommended for truly sick patients whose symptoms warrant hospitalization. Please note we will ask screening questions prior to your appointment according to CDC guidelines. The goal is to minimize infectious contact with other patients, staff, and providers. During this crisis, we ask that you come to your appointment alone, if possible. Family members should stay home to minimize the number of people passing through the office. We must minimize potential exposure to our pregnant patients. 

We ask each of you to do your part to help prevent the spread of disease by staying home and limiting your attendance at social gatherings and large public events. Wash your hands regularly and isolate yourself if you begin experiencing symptoms like flu-like symptoms, fever, sneezing, or coughing.

Useful Links

Dallas County Up to Date Information on Covid-19

The CDC is maintaining an up-to-date resource that contains many guidelines.

7 Ways to Fall Asleep Faster



A ruffled mind makes a restless pillow.

~ Charlotte Brontë ~

My wife is one of those lucky people who falls asleep before her head hits the pillow. I am not so lucky. When I lie down my mind begins to race at Quantum speeds processing a million random thoughts. My parents tell the story of waking up in the middle of the night finding the three year old me playing my Mr Roger’s records while singing “It’s a beautiful day in the neighborhood.” 40+ years later. It still happens…well without the Mr. Roger’s records.

Sometimes insomnia comes in handy for an Obgyn since babies do not seem to follow the Monday through Friday 9 to 5 schedule. I hear from patients every day that they also suffer from insomnia. Over the years I have found a few things that help. I wanted to find tools that avoid addictive medication. Here is my TOP Seven List of all natural ways to treat insomnia.

    1. Cut Screen Time
      Electronics stimulate the mind. Turn the phone off. Instagram and Facebook will still be there tomorrow.
    2. Mindfulness
      I was a skeptic about meditation and now my nine year old daughter Lucia and I do a brief mindfulness exercise together every night. We use an app called Headspace. Insight Timer is great too.Meditation has many health benefits and helps calm the mind. Leave your skepticism at the door and give it a try. Commit to doing it daily for two weeks before you give up. That was my plan, and I am still doing it daily a year and half later. This is an awesome way to help get the kids to sleep after reading a bedtime story. You spend time with your children, you both get health benefits and you both develop habits that can last a lifetime.

    1. Bulletproof Sleep Induction Mat
      This is my favorite product. It looks like a bed of nails. Ok it is a bed of nails. The mat stimulates acupressure points in the back to trigger relaxation, release endorphins and increase blood circulation. It feels great and “hurts” just enough to stop the mind from racing.

    1. Bulletproof Sleep Mode Supplement
      Most over the counter supplements contain too high a dose of Melatonin. Over time they can deplete your body’s ability to produce its own. This is a combination product of bio identical Melatonin, L-Ornithine and Brain Octane oil designed to put the brain into sleep mode. I recommend taking this with an over the counter Magnesium supplement.

    1. Daily Exercise
      Get your steps in. We all make a million excuses why we can not exercise. The truth is we all need to commit to this key health habit. Start with something simple like walking around the block. Do it everyday. Set an easily achievable goal that you can stick with over a long period of time. As exercise gets easier you can increase your goal. The key step is to set the bar low enough that your excuses to NOT exercise just seem silly. I remember telling myself one time “I can’t exercise today because I would have to change my shoes.” #badexcuse

    1. Dodow
      Dodow is a LED light metronome that helps you relax. A glowing, pulsating blue light is projected on the ceiling. You coordinate your breathing to the dynamic light changes. I find it extremely calming and peaceful.

    1. Read a book
      Fill your time before sleeping with a book. Reading books expands your mind and opens you up to new ways of thinking. Reading even a few minutes a day can help calm your mind and prepare it for sleep. If you read for just 10 minutes a day you can complete on average 10 books a year. Reading can be life changing. Here are a few of most recent favorites:

Get inspired with The Seed by Jon Gordon

Get Motivated with The Miracle Equation by Hal Elrod

Got Focused with The One Thing by Gary Keller

Get life started with The Compound Effect by Darren Hardy

The links above are tied to Amazon. Proceeds generated are donated to the Irving ISD Teen Parenting program, a drop out prevention program for students who are pregnant or parenting

Thank you to Live Your Life on Purpose for publishing this a article on Medium.

Control de la natalidad y contracepcion

¿Ya no desea más hijos? ¿Está completa su familia? ¿Está cansado de lidiar con el control de la natalidad? ¿Sabía que hay una opción permanente donde usted puede tomar el control y no preocuparse por volver a quedar embarazada?


    Birth Control Options

    A great video of Dr. Livingston covering lots of different birth control options.

    The Power of One

    You Got Pregnant, What’s Next? How To Beat The Odds And Live A Successful Life

    Dr. Jeff MacArthur Inspires Young Women Who Are Dealing With Unplanned Pregnancy

    Your life has a ripple effect. You can make choices today that set you on the path for happiness, success and an abundant life.

    Our lives are like a ripple effect. One action can make a big impact. We all have the power to make choices that affect not just ourselves but all those around us, including our future family. With our one life, let us make good choices.

    Being A Dad

    Dad’s You Are The Model For Your Kids

    Dr. Jeff Livingston shares life-changing and amazing truths for young dads.

    The greatest thing that ever happened to me in my life was becoming a father. It is magical. It is amazing.

    Fathers, you are the model for your kids. They watch everything you do. They watch how you greet your girlfriend or wife, how you work, how you dress and how you talk.

    The Talk: Discussing The Birds And The Bees

    Where do babies come from? What is puberty? Read more

    Permanent Birth Control

    Are you done having kids? If you are looking for  a permanent option that is hormone free and decreases the risk of ovarian cancer then check out this video now to learn more. You have probably heard about “getting your tubes tied.” In this video we cover the basics about this simple outpatient procedure.

      Wikipedia Goes Dark but the Doctor is In

      Today Wikipedia and other websites have gone dark in protest of the online privacy bill. This got me thinking about the issues of copying the online work of physicians across the country. There is a growing group of physicians like me who are involved in social media, blogging and online patient outreach. Most of us do this based on a passionate belief that patient engagement matters. We believe that providing high quality information online is important. We believe that these efforts will lead to more engaged patients and ultimately better patient outcomes. We believe that by using technology we can expand the doctor-patient relationship beyond the four walls of the office.

      I have given dozens of lectures across the country teaching physicians how to develop a social media strategy. I am well aware that as a result of these presentations many physicians will go check out the work MacArthur OB/GYN is doing and seek to replicate it. I have seen some physician’s Facebook pages that bear a striking resemblance to the MacArthur OB/GYN Facebook page. To that I say “Great! Go for it.” Imitation is the best form of flattery. Those of us leading the way, like my Twitter friends in #HCSM and fellow Healthtap docs, are trying to create a movement. We hope to develop more E-patients and more “E-doctors.” In fact, most of what I am doing online I learned from following smart, progressive people on Twitter. I love reading blog posts by @dr_v on I enjoy reading the thoughts of other physicians and patients on @hjluks is now my friend. #HCSM moderator @danamlewis is one of my internet idols. Following smart people and adapting their ideas into our lives is the way we make progress.

      If using my words and thoughts help move this movement along then, by all means, copy me. Share our Facebook posts, retweet me, share my Healthtap answers and follow me on Google Plus. I am all for it. By doing this together we can show patients and physicians the value of integrating social media into their practice. More and more physicians will develop a strong web presence and patients everywhere will benefit.