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Home > Services and Procedures > Gynecology > Endometriosis
Endometriosis

Endometriosis symptoms, diagnosis & treatment

Symptoms | Diagnosis | Treatment

Endometriosis is a common medical condition that occurs when the tissue that lines the uterus (endometrium) grows beyond or outside of the uterus. Endometriosis Symptoms, Diagnosis and Treatment Normally, the endometrium sheds each month during the menstrual cycle.  However, with endometriosis the misplaced tissue (which reacts to the menstrual cycle just as the endometrium does by breaking down and bleeding every month) is unable to exit the body through the vagina.  Therefore, the endometrium tissue that is outside of the uterus still breaks down, detaches, and bleeds, but is unable to leave.  Blood from this misplaced uterine lining can cause the surrounding tissue to become swollen and inflamed.  As a result, scar tissue may form in the area(s) of endometriosis and can develop into what is commonly termed as “lesions” or “implants” (or “nodules” or “growths”).

Pain is the most common symptom of endometriosis.  The pain levels vary from case to case.  Some women with endometriosis experience severe cramping during their period.  Or periods may become progressively more painful with time.  Endometriosis can cause a host of painful symptoms including: pain during menstruation, pain during intercourse, internal bleeding, inflammation of surrounding areas, dysmenorrhea, menorrhagia, chronic lower back or pelvic pain, painful bowel movements or urination, nausea/vomiting, intermenstrual bleeding, scar tissue formation, bowel issues, painful cysts, fibroid bands, infertility and subfertility.

It is not fully understood why endometrial tissue may grow outside of the uterus in some women, but not others.  In some cases, the causes of endometriosis may be due to genetic factors since the condition frequently runs in families.  What is known is that excess estrogen (created each month in the body) makes the condition worse.  Women in their childbearing years have higher levels of estrogen and therefore, when present, endometriosis is primarily seen during those years (from the 20s into the 40s).  Estrogen levels reduce when menopause occurs and the symptoms usually dissipate.  One of the most perplexing aspects of the condition is that some women experience severe, debilitating pain while others experience no symptoms at all.

In general, diagnosis of endometriosis remains difficult.  There are over 100 different documented appearances of endometriosis and therefore, accurate diagnosis requires a physician with extensive experience in the condition.  Furthermore, physicians can rarely diagnose endometriosis through current methods (such as pelvic exams, ultrasound, or blood tests).  The only accepted diagnosis of the disease can be rendered by visual examination of the lesions which requires a surgical procedure.  Laparoscopic surgery is the most precise method currently available and offers the only definitive diagnosis of endometriosis.

Treatment of endometriosis may include medication or surgical procedure.  There is no medication that cures endometriosis.  However, certain medications can effectively manage the pain and/or reduce bleeding.  Medications commonly used to treat endometriosis include: anti-inflammatories (NSAIDs), birth control hormones (via pills, patch, or ring), GnRH-a therapy (such as Lupron Depot injections that result in menopausal symptoms), progestin (via pills or Depo-Provera shot) or danazol (both shrink endometriosis implants and reduce pain), and aromatase inhibitors (which stop estrogen production).  Surgical treatments of endometriosis include laparoscopy, whereby the disease can be diagnosed and treated at the same time.  During laparoscopic surgery a camera is inserted via a small incision inside the belly button.  A carbon dioxide laser is then used to ablate or remove the lesions or tissue caused by endometriosis.  Studies have shown that with true excision (i.e. the Redwine method, which involves the complete and meticulous excision of all disease from the body) recurrence rates are less than 19%.  Pain may typically be managed for years after laparoscopy when the pelvis is clean of the disease.  At this point, it is usually the ideal time to begin hormonal therapy to help manage estrogen levels.  In addition, laparoscopic surgery with laser excision or ablation of the disease provides the best opportunity of restored fertility.  Other surgical procedures in practice for treating more severe cases of endometriosis include laparotomy (done to restore normal anatomy/preserve reproductive potential) and hysterectomy (complete removal of the uterus).  A hysterectomy may or may not result in the successful treatment or “cure” of endometriosis.  A physician experienced with endometriosis will implement the least invasive treatment to control the symptoms without removing any organs.  Patients with additional questions or concerns pertaining to endometriosis should consult with an endometriosis specialist or their healthcare provider.

Please contact our office to schedule an appointment with one of our experienced providers.

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