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If you’ve been feeling pain in your lower back or numbness in your legs, your friends might be throwing the words “sciatic nerve pain” or “sciatica” at you and telling you it’s time to hit the doctor’s office.
Any time the nerves come up, we get, well, nervous! But is a little pain in your rear end actually sciatic nerve pain? And even if it is, do you really need to visit a doctor?
Maybe. Then again, maybe not.
The truth is, most of us suffer from low back pain at some point—we’re a nation of people who spend long days sitting in uncomfortable office chairs that offer little lumbar support and plenty of problems for the back. A 2015 study published in the Annals of Internal Medicine estimates that more than half of the average person’s waking hours are spent sitting between computer work, commuting, and TV watching. In turn, all that time on our collective tuchases is linked to everything from an increased risk of heart disease to an increased incidence of lower back pain.
But for an estimated 10 percent of us, low back pain isn’t just low back pain. It’s a problem with the sciatic nerve, the biggest nerve in the whole body, which travels directly through our middles, down the spine into our rear ends and then down our legs.
So how do you know when it’s just regular old aches and pains or when it’s something more? Let’s go nerve deep, shall we?

Sciatic Nerve Pain or Sciatica?

The terms sciatic nerve pain and sciatica don’t just sound similar, they’re the exact same thing. The former tends to be used by physicians, while the latter is the word we tend to throw around when we’re sounding off with our friends, but at the end of the day, you can use them interchangeably.
No matter what you call it, sciatica is rooted in the sciatic nerve, one of 43 pairs of nerves in the human body, and the body’s biggest. It’s formed when the L4-S3 nerve roots merge together after exiting the spine, says Neel Anand, professor of orthopaedic surgery and director of spine trauma at Cedars-Sinai Spine Center in Los Angeles, California.
“Once [the sciatic nerve] exits the spine, it travels through the buttock and along the back side of the leg where it then divides into three branches,” Anand explains. “These nerve branches provide our lower extremities with their strength and sensation.”
If you’re scratching an itch on your thigh, the nerves will tell your brain you’re getting relief, for example, or it can help the body respond to some sweet, sweet deep tissue massage. But in instances of sciatica, the sensation in the lower extremities is uncomfortable or downright painful.
The sciatic nerve typically causes pain when there’s nerve compression, meaning something is pressing on the sciatic nerve itself, irritating it and causing it to signal to the brain that you’re in pain.
The leading cause of nerve compression is a herniated disc in the low back. That means that one of the spinal discs (or intervertebral fibrocartilage) located between the spinal vertebrae has pushed out, bulging between the vertebrae and putting pressure on the spinal nerves.
In other cases, sciatica can be ascribed to arthritis, pregnancy, or other mechanical irritants. “Sometimes the nerve itself can be irritated more distally in the pelvis,” says Daniel Resnick, MD, a neurosurgeon at the University of Wisconsin, School of Medicine & Public Health and the president of the North American Spine Society (NASS).
Sciatica isn’t a disease so much as a side effect of whatever condition causes it, be it a bulging disc or arthritis, which can result in sciatic nerve pain symptoms.
Speaking of symptoms, sciatic nerve pain typically involves sharp, searing, electric-like or shooting pains that lead from the buttocks down the leg. The pain can occur when sitting or standing, and especially when spending a prolonged time in either position. Sciatic nerve pain sufferers may also feel numbness, tingling, and muscle weakness, and the symptoms can occur anywhere along the pathway of the sciatic nerve. Typically the pain will radiate from the spine, through the butt, down one leg or the other, and all the way down below the knee. Sometimes the pain can be felt into the foot, although just how extensive the reach is varies from person to person.
Speaking of…

Who’s going to get sciatic nerve pain?

Sciatica can crop up in the elderly, and the vision of a grandpa or grandma standing up only to yelp, “My sciatica!” is fairly common. It’s also a bit of a misunderstanding. Sciatic nerve pain isn’t unique to the geriatric population.
“Though it is frequently believed that sciatica is a side-effect of aging, it can actually occur in people of all ages,” Anand says. “People in their twenties can experience it and in fact, the peak age at which sciatica as a result of disc herniation usually occurs is in the forties to fifties.”
Although men are three times more likely than women to suffer from sciatica, pregnancy is a common cause of low back pain in women, and at least 1 percent of those who  have low back pain during pregnancy will encounter sciatic nerve pain during the nine months they spend carrying a baby.
That said, sciatica is not technically a pregnancy-related condition, either, according to Anita Somani, MD, an OB-GYN with OhioHealth in Columbus, Ohio, so while it can happen, it’s not a given for moms-to-be. The weight of the uterus and the fetus pressing on the nerve can be to blame, but often pregnant women who suffer from sciatic nerve pain have other issues that are causing the problem.
“It can happen with a weak back, herniated disc, bone spurs, or spinal stenosis,” Somani says. “Anything that pinches the sciatic nerve can cause this condition.”
If the problem is the uterus and fetus bearing down on that nerve, the good news is that the pain can go away temporarily or permanently when the baby changes position and should be gone for good after delivery.
Not pregnant, but still feeling the pain? Other risk factors for sciatica are a mix of genetics and lifestyle.
In fact, Resnick shares that “bad luck” is actually on his list of reasons someone might be struggling with shooting pains down their rear end, but he also tacks on lack of exercise, aging, and even smoking.
Yes, smoking. Although researchers haven’t been able to pinpoint the exact reasons why smoking and sciatica might be linked, a number of studies have determined that smoking is a “modest risk factor for lumbar radicular pain and clinically verified sciatica.” According to a 2016 study published in the American Journal of Medicine, however, quitting smoking will reduce your risk, although it won’t eliminate it entirely.
As for lack of exercise, it stands to reason that excess weight puts stress on the discs of the lower back, which in turn can cause disc herniation, which—you guessed it—paves the way for sciatic nerve pain. While keeping your core tight and weight in line with medical guidelines isn’t a guaranteed fix, it will reduce your risk.

Treatment Talk

No matter the cause, if you’re suffering from any of the symptoms of sciatica, there’s typically good news on the horizon. Most cases of sciatic nerve pain will go away within three months, if not sooner. Ninety percent of the time, Resnick says, it will actually go away without any treatment at all.
If you’re aching and want to stick to at-home treatments, over-the-counter anti-inflammatories are typically recommended, along with heat and ice therapy, which can soothe your aching back, butt, and legs.
Resting can help too, so if you want to curl up in bed for a day with Netflix, feel free to pamper yourself…for awhile. Just but be careful not to overdo your rest and relaxation period.
“Research now shows that prolonged inactivity or bedrest can actually end up making your symptoms worse, so keep moving,” Anand warns.
That said, if there are certain activities you’ve been pursuing, like a specific workout, make the pain worse, it’s wise to lay off and modify your lifestyle for awhile. Try to reduce the need to carry heavy objects, even if that means something as simple as cleaning out a bulky purse and downsizing for a while.
When it comes to working out, it’s important to keep on moving, but Anand suggests sticking to gentle stretching exercises that avoid twisting, jerking, and bouncing, as you’ll want to move without exacerbating your symptoms.
If you’re a yoga fan or interested in giving it a go, child’s pose and downward dog are both recommended to help stretch out the low back and ease sciatic nerve pain. Provided you’re open about your symptoms, a yoga teacher can help with developing a workout that can stretch your muscles and provide relief without worsening the sciatica.
If sitting makes your nerve pain flare up, but work requires you spend a lot of time seated, practice good posture. Sit up straight rather than leaning over toward your work. Don’t cross your legs. Position your feet flat on the floor, and keep your hips and knees bent at 45 degree angles.
If you can, grab an office chair that provides lumbar support, and look for one that has wheels. When you’ve got to move around your desk, taking advantage of the wheels to move your body as a single unit can help you avoid twisting and turning. Also, be careful about how you move from sitting to standing.
As often as possible, take standing breaks to avoid remaining in one static position for too long. Do not bend at the waist to stand up, as this can make the pain worse. Instead, slide forward on your seat, then use your legs to push yourself into a standing position.
And don’t underestimate the power of positive thinking.
“Though it is impossible to completely eliminate your sciatica risk, understanding that a painful episode is likely short lived can go a long way to putting your mind at ease when one decides to strike,” Anand notes.
If you’re still hurting after a few months, a trip to the doctor can help you get to the root of the problem. Your healthcare provider may call for x-rays or an MRI to see what’s going on internally.
“Doctors often require some type of imaging examination to get to the bottom of sciatica symptoms that haven’t resolved on their own by the three-month mark,” Anand explains. “The purpose for these exams is to connect the symptoms the patient is experiencing with something on the imaging exam that helps us identify why.”
Unfortunately, even with imaging, it isn’t always possible for doctors to identify what’s causing sciatica symptoms. Idiopathic sciatica—or sciatica with no known cause—can be frustrating for sufferers who just want an answer about the origins of their pain. But even idiopathic sciatica tends to go away with conservative treatments, Anand says.
If doctors do decide a patient needs something beyond over-the-counter anti-inflammatories for pain management, most wind up prescribing steroid treatments, injecting the medicine right into the area of pain, or prescribing steroid pills.
In rare cases, surgery may be required, but the surgeons will be working to fix the cause of the sciatica rather than looking to simply cure the sciatic nerve pain. If surgery is required, the solution to the sciatica winds up being a secondary benefit, while the primary focus is addressing the overarching issue that’s causing the sciatica and any other symptoms.

Preventing Sciatic Nerve Pain

Maybe you’ve been through a bout of sciatic nerve pain and never want to experience it again. Or maybe you’ve read all about it and are thinking, “Thanks, but no thanks.”
While the cases of “bad luck” that cause sciatica can’t be avoided, there is increasing evidence that a focus on overall better health can prevent you from experiencing a flare up.
Case in point: Undoing the bad habits that come with sitting all day or standing for long periods of time.
“Exercise regularly to help keep your spine strong, maintain good posture while you’re in a seated position, and use good body mechanics if you stand for long periods or do a lot of heavy lifting for work,” Anand says.
Looking to lengthen and strengthen? Try these yoga poses for core strength and consider incorporating resistance bands or kettlebells into your current fitness routine.
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Whether you’re running around constantly for yourself and your family, expecting a new baby, or just beginning to explore means of better caring for yourself, you may be painstakingly aware of how often you find yourself tired out, short of breath, or looking pale. Are you just having an off day, or could your fatigue be the sign of something more sinister?
For many women, these signs are just part of the strain of modern life and hint at a need to slow down and prioritize self-care. That said, they can also indicate iron deficiency, a condition that tends to impact women and young children and can lead to a variety of health issues. In fact, according to the National Institutes of Health (NIH),“infants, young children, teenaged girls, pregnant women, and premenopausal women are at risk of obtaining insufficient amounts” of iron, which means whether you’re a mother or kid free and loving it, knowing the signs of iron deficiency is critical.

It can be hard to keep track of all the nutrients and vitamins that we’re supposed to eat daily to keep our bodies running at optimum health, but being aware of whether or not you’re getting enough iron in your diet is especially important because the nutrient is critical for producing blood—which is literally your life force. Being iron deficient will leave you feeling zapped, tired, and sometimes even sick.
Luckily, once you know what to look for, it’s easy to tell whether you might be iron deficient and to take steps to ensure that you—and your children, if you have any littles—are getting enough iron to stay healthy. Here’s everything you need to know about iron’s role in your body, where the nutrient comes from, and how to make sure you are getting enough.

What is iron (and what does it do for the body)?

According to the NIH, iron is a mineral that is critical for bodily functions including making blood, maintaining a healthy metabolism, and supporting healthy growth. Iron’s most important function in the body is supporting the production of hemoglobin, a protein found in your blood that helps transfer oxygen from the lungs to your tissues.
Because your body cannot make iron itself, it is critical to get your recommended daily intake of iron from the foods you eat.
“Iron helps produce hemoglobin, which is the part of the red blood cell that transports oxygen to our brain, heart, muscle, and all tissues within the body,” explains Ehsan Ali, MD, a primary care physician in Beverly Hills. “With a low iron level, the body won’t have enough hemoglobin, which means oxygen is not being delivered to our cells properly. Having iron levels that are too low can be very dangerous.”
If you don’t have enough iron, your body can have a hard time producing hemoglobin. This means that oxygen will not circulate throughout your body as it should, which can leave you feeling tired and run-down.

“Low levels of oxygen can lead to symptoms such as fatigue, heavy periods, pale complexion, shortness of breath, problems regulating body temperature, headaches, pica, anxiety, brain fog, hair loss, and hypothyroidism,” says Rebecca Lee, a registered nurse from New York City.
Iron is important for more than just blood flow, however.
“Iron also helps convert blood sugar into energy, protects the immune system, and maintains normal cognitive function in children,” Lee explains.

How does iron function in the body (and what does being a woman have to do with it)?

For your body to stay healthy, you need to have adequate iron stores. Most of the iron in your body (about 70 percent of it) is stored in your blood and muscles according to a resource hosted by the University of California San Francisco Medical Center. Iron in your blood is concentrated in hemoglobin, the protein that helps deliver oxygen throughout the body, whereas iron in your muscles is found in myoglobin, the substance that stores and releases oxygen in your muscles during intense muscular activity.

In addition to the iron found in your blood and muscles, which is easily accessible to your body and helps keep everything functioning smoothly on a regular basis, you also have iron stores in your liver, spleen, and bone marrow. It is the amount in these stores that makes women particularly susceptible to iron deficiency. Whereas men have—on average—1,000 milligrams of iron stored in their bodies (which is enough to last up to three years!) women’s bodies store an average of just 300 milligrams of iron, which is only enough to last us about six months.
Because women have limited iron stores—and because we menstruate, gestate, and lactate, all of which put increased demands on our iron reserves—we’re at a significantly greater risk of developing iron deficiency.

What causes iron deficiency (and what does iron deficiency look like)?

Iron deficiency occurs when your body’s iron stores become depleted.
“Iron deficiency means a patient has low levels of iron,” explains Ali. “Common symptoms and signs are fatigue, tired feeling, and low energy. You may also notice your skin and nails starting to look very pale.”
Irony deficiency can happen in two ways, Lee explains. Either your body suddenly needs more iron, or your body is taking too little iron in because the foods you’re eating don’t contain adequate amounts of iron, or because you’re experiencing an issue with absorption.
Certain groups of individuals are at an increased risk for iron deficiency according to the NIH, including pregnant women and young children.

Pregnant Women

During a healthy pregnancy, a woman’s blood volume will increase by 50 percent to support the needs of the fetus and to prepare for blood loss during childbirth. Creating all that new blood means that the body needs more iron than ever before.
“During pregnancy, plasma volume and red cell mass expand due to dramatic increases in maternal red blood cell production,” explains Elizabeth Trattner, an acupuncture physician. “The amount of iron that women need increases during that time.”

Having insufficient iron levels during pregnancy can lead to health complications for mom and baby including low birth weight and central nervous system issues, which is why many healthcare providers carefully monitor iron levels in pregnant women. The NIH recommends that all pregnant women take a low-dose iron supplement, and iron is often included in prenatal vitamins.
If you’re pregnant or thinking about trying for a baby, it’s important to note that women who have low iron stores before pregnancy should work with their doctors to develop a more aggressive plan for increasing their iron levels during gestation. In addition to the toll iron deficiency can take on an expectant mother, pre-conception and early-pregnancy iron deficiency can actually result in brain abnormalities associated with slow language learning and behavioral issues that last long after a baby’s gestation period.

Infants and Toddlers

Like pregnant women, infants and toddlers are also at risk for iron deficiency, in part because they are growing so quickly.
“An increased iron need can be caused by a growth spurt, especially in growing infants and toddlers,” says Lee, noting that their picky eating habits don’t help. “It may be more difficult for them to obtain iron from their diet than older children and adults.”

Research cited by the NIH shows that 12 percent of infants and 8 percent of toddlers are iron deficient. Iron deficiency in the early stages of life can lead to cognitive delays and psychological effects including social withdrawal. Because the impacts of iron deficiency in infancy and early childhood can be irreversible, it’s essential for young children to get enough iron.
Breastmilk is a great source of iron, especially for children under 12 months old. That said, the American Academy of Pediatrics recommends that starting at four months of age, parents of breastfed infants begin giving them a 1 milligram per kilogram iron supplement every day until they are eating iron-supplemented foods like infant cereals. If your baby is breastfeeding, your pediatrician can help you determine the right supplement dosage based on their age and weight.
Most infant formulas sold in the U.S. already contain iron, so there is no need to supplement formula-fed infants.
A resource posted by MedlinePlus also points out that infants who drink cow’s milk instead of breast milk or iron-fortified formula are more likely to be iron deficient because cow’s milk contains less iron, can cause intestinal issues, and is much harder for the body to absorb than breast milk. Likewise, children who are over a year old whose diets contain too much cow’s milk and not enough nutrient-dense, iron-rich food are at an increased risk of iron deficiency.
According to the Mayo Clinic, the following symptoms can be signs of iron deficiency in children and may warrant a talk with their pediatrician:

• Pale skin
• Lethargy
• Slowed growth and development
• Poor appetite
• Abnormally rapid breathing
• Behavioral problems
• Frequent infections
• Unusual cravings for non-nutritive substances, like ice, dirt, or paint

So how much iron do I need to prevent iron deficiency (and where should it come from)?

Given all the factors that impact how women and children’s bodies rely on and store iron, it’s especially important that they ingest enough iron to prevent iron deficiency. That can be complicated, though, because iron isn’t the easiest mineral to absorb.
According to Lee, “Only about 10 percent of consumed iron is absorbed into the body.”
In order to get enough iron, the NIH recommends that women consume 18 milligrams of iron each day (although if you’re pregnant you’ll need to increase that to 27 milligrams). Women who have stopped menstruating only need about 8 milligrams of iron each day, while toddlers ages 1 to 3 need 7 milligrams and children ages 4 to 8 need 10 milligrams daily to prevent iron deficiency.

The most well-known way to get iron is by eating red meat, which can contain up to 5 milligrams of iron per serving. However, if you or your kiddo isn’t a fan of red meat, or you choose to steer clear of meat altogether, there’s no need to worry. There are many non-meat sources of iron that you can incorporate into your diet to ward off iron deficiency. Oysters and white beans both contain 8 milligrams of iron per serving, while a 3-ounce serving of dark chocolate can give you 7 milligrams.
In the United States, many cereals are also fortified with iron and can contain up to 100 percent of the recommended daily value in just one serving, making them an easy way to help kids (or yourself!) get the iron needed to prevent deficiency. This nutrition data resource ranks hundreds of ready-to-eat cereals based on their iron content. Note that cereals more aggressively marketed toward children—like Lucky Charms and Cocoa Puffs—are lower in the ranking, whereas quick oats and and bran flakes top the list.

Lee also suggests that eating foods that are rich in vitamin C can help increase iron absorption, which highlights the importance of a balanced, nutrient-rich diet.

Other Risk Factors for Iron Deficiency

While Lee’s assertion that iron deficiency typically occurs when someone suddenly needs more iron or isn’t getting enough, other conditions including cancer and gastrointestinal bleeding can increase a person’s risk for iron deficiency. However, the fact remains that iron deficiency is most common in women of childbearing age, for both biological and social reasons.
“Women in this age group seem to be low in body stores of iron for several reasons,” says Arielle Levitan, MD. “Firstly, they often do not consume large quantities of red meat. They also continually lose significant amounts of iron from having periods, pregnancies, and breastfeeding.”
It is especially important for women who are breastfeeding or who have heavy periods to be sure they are getting enough iron, and Levitan suggests supplementation as a valid means of addressing and preventing iron deficiency.
“Many women make the mistake of stopping a prenatal after giving birth,” she says. “This is a time when they may need it the most given bleeding during the birth, nursing, and months of giving up your own iron for the baby. Many women remain deficient into their menopausal years starting with pregnancy.”

Are anemia and iron deficiency the same thing?

You’ve probably heard of anemia, but even if you know someone who has it, you might not understand exactly what the condition is. According to Ali, anemia occurs when there are not enough red blood cells (which are made from hemoglobin) in the blood to transport oxygen throughout the body. Because iron helps with the production of hemoglobin, he notes that iron deficiency and anemia often go hand-in-hand, although that isn’t always the case.
Symptoms of anemia are similar to those of iron deficiency, including fatigue and pale coloring, according to another Mayo Clinic resource. Over time, if anemia is not treated, these conditions can get worse and grow to include chest pain, dizziness, and yellowing of the skin. If you think that you are suffering from anemia, it is important to speak with your doctor to identify the cause and develop a treatment plan.

I think I’m struggling with iron deficiency: What’s next?

Iron deficiency can be diagnosed by a blood test, and some medical researchers actually suggest that all young women should be tested for iron deficiency and anemia given their heightened risk for developing the conditions. That said, if you think you might not be getting enough iron, the first step is to try to increase your iron intake. Levitan says this can be done by eating more iron-rich foods like red meat, legumes, and spinach. For young kids, fortified cereals are a great way to boost iron intake.
If you’re still experiencing symptoms associated with iron deficiency, talk to your doctor about incorporating an iron supplement. Iron supplements are usually the first line of treatment for iron deficiency and even anemia, but it’s important to work with a healthcare provider to find the right one for you since iron supplements can have unpleasant side effects.

“Iron from supplements is generally used by your body very readily,” Levitan says. “The challenge tends to be finding a supplement without side effects. Many people find that vitamins containing iron are hard on the stomach and can cause stomach aches, constipation, and other side effects. Finding a supplement that you can tolerate is essential.”
Your doctor may also advise taking the supplement with vitamin C to increase your absorption.
In some extreme cases, doctors recommend iron deficient patients receive iron supplements via IV, but this is uncommon and typically limited to cases in which oral supplementation isn’t an option, for example when a patient has a serious gastrointestinal condition, is on dialysis, or has celiac disease.

I don’t think I have an iron deficiency, but could I be consuming too much iron?

Women under 50 are much more likely to be iron deficient than to have too much iron in their bodies, but it is important to note that according to the NIH, there are negative health consequences and serious risks associated with consuming too much iron.
Nausea, vomiting, and faintness are associated with over-supplementation, and iron overdoses can result in multi-system organ failure, coma, and death. The upper healthy limit of iron is 40 milligrams per day for children under 13 and 45 milligrams per day for adults. If you or a child accidentally ingests more than that, it is important to seek medical attention immediately.
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iWhen Dawn Hauschild’s period showed up shortly after the birth of her second child, she expected it to be a normal adjustment to her pre-pregnancy state. Instead, the third-grade teacher’s period refused to go away, and with it came debilitating pain. The problem? Endometriosis, a chronic and painful disorder that allows uterine tissue to flourish in areas of the body other than the uterus.
It’s a lonely disease, Hauschild says.
“Your hormones are messed up, which messes with your entire body. You are in pain like the first-day period cramps every day, and people look at you like you are crazy,” she tells HealthyWay. “I talked to my best friend, who really didn’t understand what I was going through. My husband was my biggest support. But really and honestly, I felt ALONE.”
Hauschild is far from alone. An estimated 1 in 10 women in the world suffer from endometriosis, but it’s a condition that’s often misunderstood—in part because women don’t all show the same symptoms. For every woman like Hauschild, who was wracked with pain after her son’s arrival, there are women who show few or no symptoms at all.
Wondering whether you’re one of them? Here’s what the experts say.

What’s endometriosis, anyway?

Endometriosis can be (and often is) confused with endometrium, a term that refers to the mucous membrane lining the uterus. It’s an easy enough mistake to make when you look at the two words, but having one doesn’t mean you have the other.
Most cisgender women have endometrium. It’s the lining that will thicken during the menstrual cycle in anticipation of embryo implantation then shed during your period if you aren’t pregnant.
But for the millions of women with endometriosis, the endometrium doesn’t just show up in the uterus, says Sherry Ross, MD, an OB-GYN at Providence Saint John’s Health Center in Santa Monica, California. Endometrial implants, as they’re called, will show up in other parts of the body—from the ovaries to the fallopian tubes and beyond the reproductive system in the bowels, bladder, and other parts of the pelvis.
These implants become problematic because—just like the endometrium in the uterus—endometrial implants in other parts of the body respond to hormonal shifts and they slowly wreak havoc.
“With each period, the endometrial implants will bleed no matter where they are located in your body,” Ross explains. “As a result of the bleeding implant(s), scar tissue or ‘spiderwebs’ as I like to refer to them, develop in your pelvis, causing pain and all the other symptoms related to endometriosis.”
Those symptoms include everything from heavy menstrual bleeding and pelvic discomfort to painful intercourse and irregular periods.
It was both pain and bleeding that prompted Hauschild’s diagnosis. But although she had already gotten pregnant with one son, doctors said she might deal with yet another common sign of the disease: infertility. In fact this is how many women discover they have endometriosis.
Doctors still don’t know why a quarter of patients never show any of the more obvious side effects, but there’s a correlation that can’t be ignored. Anywhere from 25 to 50 percent of infertile women have endometriosis, and 30 to 50 percent of women with endometriosis are infertile. Although it is one of the most treatable causes of infertility, it also remains the least treated.
In the end, Hauschild was able to get pregnant a second time, albeit after several years of trying. But the second pregnancy and the hormones that flooded through her body seemed to make her condition worse. Still, she considers herself blessed.
“I was lucky,” Hauschild says. “I was able to have my boys. Some people are not able to have kids if they have it.”
Even those who do get pregnant, like Hauschild, often find that endometriosis worsens with each pregnancy. And the diagnosis process can be all the more frustrating, Ross says, because of the wide range of different symptoms each patient might experience.
“Since symptoms vary between women, so does the time it takes to make the diagnosis,” Ross explains. “Diagnosis can be tricky even for the specialists.”

What endometriosis is not

Whether you have endometriosis or you’re facing a possible diagnosis, there’s one thing that’s certain: It’s not your fault.
Although researchers have yet to pinpoint any one particular cause of the condition, it’s been verified that endometriosis is not something women can control. It’s not sexually transmitted, nor is it something that you can “bring on” by any one behavior or action.
Studies have ruled out a link between using the IUD for birth control and developing endometriosis, as well as the chance that previous sexually transmitted diseases might increase your chances of encountering the disease. What’s more, endometriosis and polycystic ovary syndrome (PCOS) may both be reproductive in nature and occur in about the same percentage of the population, but the two conditions are not linked. Having one won’t increase your chances of having the other.
Most of the risk factors are things you’re born with, says Gerardo Bustillo, MD, an OB-GYN at MemorialCare Orange Coast Medical Center in Fountain Valley, California. They include:

• Never having been pregnant, early onset of menses, late menopause
• Being taller and/or thinner than most women
• Having a family history of endometriosis—having a mother, sister, or daughter with endometriosis raises your risk about six-fold
• Being Caucasian or Asian
• Having red hair, freckles, sensitivity to the sun, and pre-cancerous skin moles

On the other hand, a period that doesn’t begin until late adolescence correlates to a lower risk, as does being black or Hispanic.
None of those things are changeable. But Ross says there are some things that may help to lower your risk if you’re already in a higher-risk group.
“Many believe that keeping your estrogen levels low can help reduce your risk,” she notes. “The birth control pill, regular exercise, [and] avoiding excessive alcohol and caffeine all help keep estrogen levels low in your body and help reduce your risk.”

Getting diagnosed with endometriosis

If you’ve been hammered by painful periods or struggled with infertility, an endometriosis diagnosis won’t be automatic…and you may have to fight for it, even at your physician’s office. Some studies have found that women can wait for as long as 11 years for a proper diagnosis.
It’s not just that the disease presents differently from woman to woman. Many practitioners are ill equipped to handle an endometriosis diagnosis. According to statistics from the American College of Obstetricians and Gynecologists (ACOG):

63% of general practitioners [GPs] indicated they felt ill at ease in the diagnosis and follow-up of patients with endometriosis. One-half could not cite three main symptoms of the disease out of dysmenorrhea, dyspareunia, chronic pelvic pain, and infertility.

In the ACOG survey, just 38 percent of GPs indicated that they perform a gynecological examination for suspected endometriosis; 28 percent recommended magnetic resonance imaging (MRI) scans to confirm the diagnosis.
Your best bet if you think you may have endometriosis is to work with an OB-GYN. If endometriosis is suspected, your doctor will likely call for diagnostic laparoscopy first. This minimally invasive outpatient surgery makes use of a tiny incision to give doctors a look inside the pelvis, where they’ll keep an eye out for endometriosis implants and/or scar tissue (some of which can be treated during the procedure).
Diagnosis can come at any time. While many women are in their 20s or even 30s at diagnosis, Jordan Davidson recalls being diagnosed at just 12 years old. Davidson, who is the founder of Endo Warriors, an online support group for endometriosis patients, is on the younger end of the spectrum, but she’s far from alone. Girls as young as 11 have been diagnosed with endometriosis, and estimates put the number of endometriosis patients at 1 in 10 women between the ages of 15 and 49.

So what does endometriosis mean for your overall health?

The results are a mixed bag. While endometriosis is exceedingly painful for some, others never notice symptoms and can live a pretty normal life. Even the number of endometriosis implants in the body does not necessarily mean you will have pain. Some women have very few implants with significant pain. Others have a lot…with little pain.
And while it may be correlation rather than causation, Ross says it bears noting that endometriosis is often associated with other health problems such as asthma, allergies, multiple sclerosis, hypothyroidism, chronic fatigue syndrome, fibromyalgia, and ovarian and breast cancer. A diagnosis with one won’t necessarily mean you’ll be diagnosed with the others, but your risks may be higher.

There’s help.

The goal with any treatment is to reduce pelvic pain with as little intervention as possible, says Rachel Cannon, MD, an OB-GYN and instructor of obstetrics and gynecology at Boston University. Typically that means starting with medication such as birth control pills. Because the implants respond to hormones, similarly to the way the uterine lining does, the pill’s regulation of the body’s hormones can help reduce the reaction and the pain.
Of course, if you’re trying to become pregnant, birth control pills are not helpful, as they will prevent conception. The laproscopic procedure used in diagnosis may help clear up enough of the endometriosis to allow your body to become pregnant.
If a patient is in pain but isn’t interested in conception and has no pelvic masses, Bustillo says that medical therapy will likely include non-steroidal anti-inflammatory drugs, such as ibuprofen or naproxen, and/or oral contraceptives.  
If pain is not well controlled with anti-inflammatory medication and/or oral contraceptives, the next step is usually gonadotropin-releasing hormone (GnRH) agonist drugs (such as Lupron).  
“These drugs cause a temporary menopause-like state by sharply lowering estrogen levels in the body,” Bustillo says. “As a result, the endometriosis implants shrink and cause less pain.”
So why not start with GnRH agonists? There are drawbacks; they produce menopausal side effects and can result in bone loss.
Unfortunately, endometriosis has a high rate of recurrence. In patients treated surgically, it’s as high as 40 percent at 10-year follow-up, and about 20 percent of patients will need to undergo additional surgery within two years. Because of this, some may opt for a hysterectomy down the road, including removal of both ovaries.
Hysterectomy is a complicated decision, Cannon says, because it both eliminates a woman’s ability to become pregnant and has menopausal side effects. Nor is it always a simple cure. There may still be endometriosis in the body that can cause issues.
Making sense of all of your options will require your doctor’s advice, but Jordan Davidson likes to think it’s other sufferers who can help you with the emotional component. It’s why she started Endo Warriors along with fellow endometriosis sufferer Jill Fuersich.
“Growing up, I knew very few people with the condition. When I moved to New York City for college, I thought ‘Great, if there are millions of women with endometriosis in the U.S., surely there must be thousands living with the condition in the nation’s biggest city.’ Except I couldn’t find a support group,” she recalls.
Like Hauschild, she felt alone, until she met Fuersich and began to put together the pieces that now make up Endo Warriors, which offers in-person and online support. There is a private Facebook group for those living with the condition and a public page with general resources for people with endometriosis. They also provide resources for the loved ones of people with the condition. The group has regular meetings in New York City and is in the process of adding more services…and it’s open to anyone with endometriosis questions.
Others with endometriosis can find support from groups like Nancy’s Nook or Endometropolis. Resolve, a national non-profit organization for folks dealing with infertility, also has resources for those whose infertility is linked to endometriosis.
In the end, the most important thing is to speak up, Ross says.
“Women are becoming more aware of their bodies and have more access to medical information. Many women already suspect the diagnosis of endometriosis after doing their own research online before going to see their healthcare provider,” she notes.
“This is a positive step in women becoming their own patient advocate. It is incredibly important to find a healthcare provider who is comfortable and competent in treating endometriosis and who can guide your treatment based on your personal needs.”
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