(WGHP) — Endometriosis is a painful condition many women deal with for a long time before being diagnosed.

Obstetrician-gynecologist Dr. April Miller explains why endometriosis is such a complex issue. She treats patients at Atrium Health Wake Forest Baptist and is an assistant professor of obstetrics and gynecology at Wake Forest University School of Medicine.

What is endometriosis?

• A gynecologic condition that occurs in 6-10% of women
• The most common symptoms are: chronic pelvic pain, infertility, pain during periods, pain with sex, ovarian cysts, pain with bowel movements, pain with urination.
• The cause of endometriosis is complex, but it is thought to be due to the cells of the uterus implanting on the inside of the abdomen or belly. However, there are other theories for the cause of endometriosis.
• Risk factors for endometriosis include: starting your period early in life (before age 11) and heavy, prolonged menstrual cycles.
• Factors that protect against endometriosis are increased time breastfeeding and exercise.

How to diagnose

• The definitive way to diagnose endometriosis is during surgery where endometriosis spots are removed and sent to the lab
• Ultrasound, MRI, and CT can help diagnose ovarian cysts in endometriosis
• There are 4 stages of endometriosis: minimal to severe

How to treat it?

• Medical treatment. These include pain medications like ibuprofen, but also birth control pills, hormonal IUDs, the Depo-Provera shot and an injection called gonadotropin-releasing hormone (GnRH)
• Surgical treatment – removal of the endometriosis. However, many patients also need medications to treat the endometriosis even after surgery

Many women go undiagnosed, so it’s important to talk to your physician if you feel you have symptoms.