At least 5 million women in the U.S. experience endometriosis, a condition that affects the lining of the uterus.

Published: February 16, 2018 | Updated: June 5, 2024

Lena Dunham, writer and actress for HBO’s “Girls,” chronicled her experience with severe endometriosis for Vogue magazine.

Dunham had nine surgeries during her decade-long struggle with the condition before choosing to have a hysterectomy at age 31. The surgery removes the uterus and ovaries. Dunham’s essay focuses on the emotional effects of losing her chance at pregnancy, something she had always wanted.

At least 5 million women in the U.S. experience endometriosis, a condition that affects the lining of the uterus, called the endometrium. It occurs when the endometrium grows outside the uterus onto the ovaries, fallopian tubes and other abdominal organs. The growth is not cancerous, but causes pain and can make it difficult for a woman to become pregnant. The severity of the pain is different for every woman.

Signs of endometriosis include:

• Pain in the lower abdomen or pelvis and/or lower back, mainly during periods
• Very painful menstrual cramps that worsen over time
• Chronic pain in the lower back and pelvis
• Pain during or after sex
• Intestinal pain
• Painful bowel movements or painful urination during menstrual periods
• Spotting or bleeding between menstrual periods
• Diarrhea, constipation, bloating or nausea, especially during menstruation
• Fatigue
• Infertility

How is endometriosis treated?

You can work with your gynecologist to find the treatment that is best for you.

Over-the-counter pain relievers such as ibuprofen or naproxen may help for mild symptoms. Your doctor may prescribe stronger pain relievers if needed. For women who aren’t trying to get pregnant, hormone therapy can help women who have small growths that do not cause severe pain.

Most birth control pills contain two hormones, estrogen and progestin, which decreases menstrual flow and can prevent overgrowth of the tissue that lines the uterus. Other hormone therapies include GnRH agonists/antagonists as well as progestin. If you are considering hormone therapy, discuss it with your physician to determine the appropriate treatment plan for your condition.

Surgery may be recommended for women like Dunham who have severe endometriosis that includes many growths, severe pain or infertility. Minimally invasive surgery may be performed to remove the areas of endometriosis. In more severe cases, a hysterectomy (removal of the uterus and ovaries) may be needed. The type of surgery your physician may recommend depends on factors such as age, severity of symptoms and whether you want children in the future.

• Laparotomy: This is major surgery that involves a large incision in the abdomen, allowing the surgeon to reach and remove growths in the pelvic or abdominal area.
• Laparoscopy: This minimally invasive surgery uses small incisions through which the surgeon removes growths and scar tissue or burns them away. The goal is to treat endometriosis without harming the healthy tissue around it. Women recover from laparoscopic surgery much faster than from major abdominal surgery.