Endometriosis: What You Should Know

While often associated with pain, endometriosis can exist silently, often discovered only during infertility evaluations. 70% of women experiencing infertility without any pain symptoms are also discovered to have endometriosis. 

Why is this problematic?

This is problematic because endometriosis causes significant inflammation and can affect surrounding structures, including the fallopian tubes, ovaries, bowel and bladder. Many women experience abdominal bloating around their menstrual period because of this inflammation. Additionally, nerves deep within the pelvis can signal pain.

What are common symptoms of endometriosis?

• Pain or pelvic cramping before or during menstrual periods
• Pelvic pain during or after sex
• Pain or irritation with urination during menstrual period
• Pain, irritation, or loose bowel movements during menstrual period
• Difficulty achieving a pregnancy

How is endometriosis diagnosed?

A formal diagnosis of endometriosis is made during surgery. There is no specific test to definitively diagnose endometriosis. The most important first step is a thorough and detailed history and physical examination with a physician experienced in diagnosing and treating endometriosis.

Imaging studies, such as ultrasound or MRI, are frequently used to help identify if there are any large endometriosis collections, known as an endometrioma. If present or discovered on imaging, there is expected to be endometriosis elsewhere in the abdomen and pelvis.

What should I do if I think I have endometriosis?

Speaking with your physician about your pelvic pain is an important first step.  A consultation with a pelvic pain and endometriosis specialist, such as a minimally invasive gynecologic surgeon, may help uncover underlying causes and provide appropriate treatment options.

Can endometriosis be treated?

Treatment plans are designed based on the patient’s age, desire for future fertility, and their individual wishes and goals.

Medications

Medications are available to help manage the pain and inflammation caused by endometriosis, but do not target endometriosis directly. This includes NSAIDs or non-steroidal anti-inflammatory drugs, including over-the-counter and prescription medication.

There are also a wide variety of hormone-based medications that help suppress endometriosis, thereby limiting its activity. These medications interfere with the usual hormones in a woman’s menstrual cycle, and so are not appropriate if trying to achieve a pregnancy. Although the medications reduce the activity of endometriosis, they are unable to remove endometriosis that is already present.

Surgery

Surgery is used to formally diagnose endometriosis by direct visualization and biopsy. This is performed with either laparoscopy or robotic-assisted surgery. Several small incisions are made on the abdomen to look inside with a camera known as a laparoscope. Any endometriosis or endometriomas that are found should be removed completely. Depending on the extent of endometriosis, the appendix may also be affected, and may need to be removed at the same time.

The goal of surgery is to remove all endometriosis while restoring normal anatomy. This can be especially useful for women trying to achieve a pregnancy. Surgical excision of endometriosis currently achieves the most significant resolution in symptoms and patient satisfaction as compared to medical management options.

Learn more about Pelvic Health Services at Catholic Health.  Call 1-866-247-3584 (866-CH-PELVI) for a pelvic health appointment.