Solving the Puzzle of Endometriosis

The American College of Obstetricians and Gynecologists (ACOG) estimates that one in 10 females of reproductive age will develop endometriosis. There are no known causes or proven cures, and many live with pain for years before being diagnosed.

Understanding Endometriosis

Most often identified in women in their 30s and 40s, endometriosis occurs when tissue resembling the uterine lining grows outside of the uterus where it does not belong—implanting on the ovaries, fallopian tubes, and other parts of the pelvis. Less often, the disease affects the bladder, bowels, and other areas.

Endometriosis reacts to hormonal changes, thickening and shedding a sticky substance. But, unlike the uterine lining, which exits the body when you menstruate, this tissue is trapped inside the body. With nowhere to go, the tissue grows, leading to scarring, inflammation, and hormonal changes, according to Dr. Scott Dinesen, an OB/GYN who treats the disorder. Sometimes, scar tissue binds organs together.

Symptoms include

• Painful periods
• Bloating
• Nausea
• Lower back or pelvic pain
• Painful intercourse
• Infertility

Endometriosis makes it harder to become pregnant. The American Society for Reproductive Medicine estimates that 30% - 50% of women with endometriosis may have infertility. However, with treatment, many conceive and carry a pregnancy to term.

Endometriosis Without Symptoms

"Endometriosis doesn't always cause symptoms. We sometimes discover the condition during infertility treatment or an unrelated surgery," says Dr. Dinesen.

Is it Period Pain or Endometriosis?

Normal period pain should not take you out of commission or last more than a few days. "Endometriosis is just one of several potential causes of painful periods," says Dr. Dinesen. "Not everyone with endometriosis will experience pain. And not everyone with painful periods has endometriosis."

Talk About Your Symptoms

You should see your healthcare provider if you have severe period pain or signs of endometriosis. Never assume your pain is normal.  Your doctor will ask about your medical history and symptoms and complete a pelvic exam to check for scar tissue and cysts. "This can result in a reasonable diagnosis in many cases," explains Dr. Dinesen. He notes that laparoscopic surgery is the only definitive way to diagnose endometriosis. 

Managing Symptoms  

We don't have a cure for endometriosis, but effective treatments are available. According to Dr. Dinesen, whether you have painful periods or endometriosis, pain medicines, and hormone therapy are the first line of treatment. However, surgery to identify and treat endometriosis may be necessary if symptoms continue to affect a person's quality of life.

Other treatments include:

• Anti-inflammatory medications (NSAIDs) like ibuprofen  
• Birth control pill
• Gonadotropin-releasing hormone (GnRH) agonists that influence estrogen and progesterone production
• Pelvic floor therapy can help treat pelvic floor muscles that have tightened. This tightening is often a response to the pain caused by inflammation

When Surgery is Needed

Specialized instruments and a tiny camera inserted through small incisions allow your doctor to examine your abdominal cavity on a video screen.

"Taking a look inside the abdomen using minimally invasive laparoscopy is a possible solution when medical therapy is not working, if infertility is involved, or if a diagnosis is unclear, says Dr. Dinesen. "We can look for abnormal tissue, collect a sample for testing, and simultaneously remove endometriosis."

Your doctor may also suggest robotic surgery, which expands on what surgeons can do laparoscopically. Both have similar outcomes and use small incisions and a miniature camera. "The robot allows surgeons to work precisely in areas of the body other minimally invasive techniques cannot reach. The platform offers enhanced views and a finer touch for advanced endometriosis with significant scarring.

More information is available by visiting ACOG’s FAQs about Endometriosis.