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What Is Endometriosis? Symptoms, Pain, and Fertility Impact
Endometriosis is a disease where endometrial cells (the cells that normally grow inside the uterus and is shed every month during one’s period) grows outside of the uterus instead - for example, on the outside of the uterus, on the tubes or ovaries, or on the bladder or intestines.
Due to this, not only does a person with endometriosis have vaginal bleeding during her period, but she may also have bleeding elsewhere inside the abdomen, which causes irritation and inflammation inside. This can cause the periods to be very painful, and sometimes associated with other menstrual symptoms such as nausea and vomiting.
In addition, there can also be inflammation during the rest of the month - in particular, people with endometriosis are more likely to experience cramping and pain for several days prior to the period starting. Over time, this inflammation can lead to scarring within the abdomen, which may create chronic pelvic pain that is not related to menstruation at all.
Other symptoms due to endometriosis may include pain with intercourse, pain during bowel movements, or even blood in the stool or urine. In addition, if scarring happens within the uterine tubes (previously known as Fallopian tubes), fertility may be impacted.
Approach to Diagnosis
While endometriosis may be suspected based on symptoms, at this time we are unable to confirm the diagnosis without performing surgery (usually laparoscopy - using a camera to view inside the abdomen through a small incision). However, it is not generally recommended for patients to get a definitive diagnosis through surgery before initiating treatment. In fact, the preferred treatment of most of the symptoms of endometriosis is the same whether the diagnosis is made or not.
Hormonal Management
In general, the goal of endometriosis treatment is both to address symptoms, as well as to prevent further growth of the abnormal cells which can lead to worsening symptoms or infertility in the future. Since the abnormal cells grow in response to monthly hormone fluctuations with the menstrual cycle, the preferred treatment for endometriosis is to control these hormone fluctuations, typically with some type of hormonal birth control, such as pills, patches, vaginal rings, injections, or implants (Nexplanon). Ideally, the birth control should be taken “continuously,” meaning the intended period days (for pills, patches, and rings) are skipped - so hormone levels stay constant. With this treatment, many patients can experience relief from symptoms and avoid worsening symptoms and complications in the future. This is the mainstay of endometriosis treatment.
Additional Treatment Options
There are also other treatments which may be helpful in addition to (or instead of) the above mentioned treatment - including dietary and lifestyle changes, hormone blockers, pelvic floor physical therapy, pain medications, or surgery to removal endometriosis tissue from where they don’t belong - this may include hysterectomy (surgical removal of the uterus) and/or oophorectomy (surgical removal of the ovaries). If fertility is an issue due to endometriosis, then in vitro fertilization or other assisted reproductive technologies may be necessary if childbearing is desired.
Make an appointment with your doctor if you suspect you may have endometriosis, so we can come up with a personalized treatment plan for you!
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