What is endometriosis?
Imagine dealing with a condition as common as diabetes or asthma, yet it often goes undiagnosed or misunderstood. That’s endometriosis - affecting 1 in 10 people of reproductive age. It can show up anytime between your first period and menopause, though it’s most common in your 20s and 30s.
So, what exactly is it? Endometriosis happens when the tissue that normally lines the uterus (the endometrium) starts growing where it shouldn’t - outside the uterus, in places like the ovaries, fallopian tubes, bladder, and even the intestines. Since this tissue responds to estrogen just like the uterine lining does, it can cause inflammation, pain, and a whole lot of discomfort.
What are the symptoms of endometriosis?
The classic presentation of endometriosis is painful periods. Pain typically begins before your period and continues until after. Patients with endometriosis often describe pain in their lower abdomen that travels to their back and down their legs.
Other common symptoms include:
- Pain with sex
- Pain with bowel movements
- Painful urination
- Pelvic pain outside of periods.
Endometriosis can also cause infertility. Up to 7 in 10 women with pelvic pain and infertility will have endometriosis.
Finally, some patients with endometriosis are asymptomatic or have mild symptoms. However, it’s important to note that the severity of symptoms does not correlate with how much endometriosis is present at the time of surgery.
How is endometriosis diagnosed?
Endometriosis is tricky to diagnose, which is why so many cases go undetected for years. In fact, on average, it takes about seven doctors and seven years from the first symptoms to get a proper diagnosis. That’s because the only way to confirm endometriosis is through a biopsy done during surgery.
That said, many doctors diagnose it based on symptoms and a physical exam. There’s also a strong genetic link - if a family member has had it, your chances of having it are higher. While there’s no simple blood test for endometriosis, imaging - such as ultrasounds - can help doctors get a better idea. If a patient has classic symptoms, many doctors will start treatment based on the likelihood that endometriosis is the culprit. The more symptoms someone has, the greater the chance they’ll be diagnosed during surgery.
How is endometriosis treated?
Since the most common symptom of endometriosis is painful periods, it’s recommended patients take nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen, or celecoxib - starting two to three days before your period begins and continuing through the entire cycle. This alone may alleviate pain and improve quality of life, allowing you to carry on with work, school, and social relationships.
If the pain doesn’t improve, a doctor may recommend a hormonal medication to help relieve symptoms. Hormonal options include:
- The combined (estrogen and progesterone) birth control pill
- Progesterone-only pill
- Depo-Provera shot
- Progesterone intrauterine devices (IUDs)
- Gonadotropin-releasing hormone (GnRH) agonists and antagonists.
Speak with your provider about the risks and benefits of each method and to understand which options are best for you.
Who should consider surgery for endometriosis?
If your symptoms don’t improve with medications, surgery may be the next step. The goal of surgery is to both diagnose and treat endometriosis.
Typically, this surgery is performed through a minimally invasive approach (either laparoscopic or robotic) and does not require an overnight hospital stay. Surgery for endometriosis can be very difficult due to the scarring endometriosis causes. Consult with your provider to ensure your surgeon is experienced with endometriosis surgery.
During surgery, endometriosis implants are removed and/or destroyed. Depending on your life stage, your surgeon may recommend fertility-sparing surgery or removal of your uterus (hysterectomy) with or without removal of the ovaries.
The good news: research shows long-term symptom relief following surgery for endometriosis. The bad news: endometriosis can recur after surgery. Recurrence is more common in younger patients with advanced disease who have fertility-sparing procedures.
The goal of an expert endometriosis surgeon is to educate our patients using evidence-based research and patient-reported outcomes to give our patients the best quality of care. We want to be your partner in making surgical decisions to improve your quality of life.
Our experts will help guide you through the operative experience, from the initial consultation to recovery. Using an interdisciplinary team, we treat the most refractory and complex cases. Our priority is respecting your choices regarding ovarian and uterine conservation.
Endometriosis and Fibroids
People often confuse endometriosis and fibroids. If you have fibroids, you are more likely to have endometriosis and vice versa, but they are distinctly different. One does not cause the other.
Fibroids cause heavy bleeding with your period.
Endometriosis causes painful periods.
Why should patients care about endometriosis?
Many patients suffer from painful periods without knowing why. If your quality of life is impacted by pelvic pain, painful periods, painful sex, or infertility, you should seek consultation with your doctor about treatment options.
You should not be missing work, school, or social events, or limiting your daily activity due to painful periods. Partner with your healthcare provider to determine if you suffer from endometriosis.
Disclaimer: While I am a doctor, I am not your doctor. The content in this blog is for informational and educational purposes only and should not serve as medical advice, consultation, or diagnosis. If you have a medical concern, please consult your healthcare provider, or seek immediate medical treatment.
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Written by Christine Foley, MD Obstetrics and Gynecology Specialist and
Minimally Invasive Gynecologic Surgery (MIGS surgeon),
Women & Infants Hospital
