Endometriosis

What is Endometriosis?

Normally, the tissue that lines the uterus, called the endometrium, is shed each month during a woman’s period. With endometriosis, tissue that is similar to the uterine lining implants outside the uterus. Each month, this misplaced endometrial tissue responds to the hormonal menstrual cycle. It builds up, breaks down and bleeds. But because the blood has nowhere to go, surrounding tissue becomes inflamed or swollen. Endometriosis can also cause scar tissue, chronic pain or heavy periods, and can cause infertility.

Endometriosis Symptoms

Endometriosis is most common in women ages 25 to 40. Every woman may experience symptoms differently, but these are the most common symptoms of endometriosis:

• Severe cramps and period pain
• Pain during sex
• Infertility
• Painful bowel movements
• Pain with urination
• Heavy periods
• Gastrointestinal problems, such as diarrhea, constipation or nausea

Pain levels are not always related to the severity of endometriosis. Sometimes, women with severe endometriosis may not have pain. Other women with a milder form of the disease may have severe pain, heavy bleeding or other endometriosis symptoms.

Endometriosis Diagnosis

Thought it is quite common, endometriosis is challenging to diagnose. Women may go for several years without an accurate diagnosis and treatment. Some may not find out they have it until they have difficulty getting pregnant, or if they undergo pelvic surgery for a different reason. Because the symptoms of endometriosis can be similar to many other conditions, it can make diagnosing endometriosis tougher.

If you are experiencing severe pelvic pain, pain during sex or heavy, painful periods, it’s important to seek care from a medical provider. Getting a proper diagnosis is the first step to finding relief from pelvic pain.

Your initial appointment with a UH OB/GYN expert involves getting a detailed medical history and performing a general physical exam. From there, your provider can determine referral sources to support your overall care. Other tests may include:

• Pelvic exam: Physical examination of the reproductive organs to look for growths, cysts, nodules or other areas of concern.
• Ultrasound: Using either an external ultrasound pressed against the stomach or a transvaginal ultrasound placed in the vagina, an ultrasound uses soundwaves to visualize the internal reproductive organs and look for growths or other unusual changes.
• Magnetic resonance imaging (MRI): Another imaging technique to examine the organs and tissues of the body and visualize any endometriosis growths.
• Laparoscopic surgery: A laparoscopy is the only definitive way to diagnose endometriosis, though symptoms can still be managed without a diagnostic surgery. This minimally invasive surgery allows the surgeon to look for signs of endometriosis tissue. It is performed by inserting a small instrument with a camera, called a laparoscope, through a tiny incision in the abdomen. The procedure can help the surgeon pinpoint the location and extent of endometrial tissue. They can also obtain a tissue sample for a biopsy to confirm an endometriosis diagnosis. In some cases, endometrial tissue can be removed during a diagnostic laparoscopy.

Endometriosis Treatment Options

Treatment for endometriosis depends on the extent of the disease, symptoms and whether a woman wants to have children. Treatment options for endometriosis may include medication, surgery or both. Other treatments may include acupuncture, massage, nutritional support and pelvic floor physical therapy.

The Endometriosis Center at UH guides patients through the endometriosis treatment process by offering preoperative imaging services and collaborative care from pelvic floor physical therapists, urogynecologists, colorectal surgeons, reproductive endocrinologists, behavioral medicine specialists and nutritionists.

Medications

Medication is usually the preferred first line of treatment, especially in younger women. Management with medication can slow the growth of endometrial tissue, help prevent the disease from advancing, and help control pain.

Medications can include birth control pills and other hormonal contraceptives such as shots, patches, vaginal rings and intrauterine devices (IUDs). These medications suppress ovulation and make periods lighter and shorter. Another medication that may be prescribed for endometriosis is Orilissa (elagolix). This medication decreases the body’s estrogen levels, which can be helpful for relieving endometriosis pain.

In addition to hormone therapy, menstrual pain associated with endometriosis can often be managed using over-the-counter pain relievers and non-steroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen or naproxen sodium.

Minimally Invasive Surgery for Endometriosis

For more advanced stage endometriosis, minimally invasive surgical procedures may be necessary. Surgical treatments include laser ablation, which uses heat to destroy the endometrial tissue and may be helpful for patients with milder endometriosis. Another option is surgically removing the endometrial tissue, or excision. Excision is the preferred surgical treatment for most patients and is thought to improve long-term pain control and slow the recurrence of endometriosis. Both surgeries are performed laparoscopically through tiny incisions in the abdomen.

UH offers robotic surgery using the da Vinci surgical system as an option for treating endometriosis. This sophisticated surgical system uses an advanced set of surgical tools that the surgeon manipulates during the procedure. These tools allow more precision and better range of motion than traditional surgical instruments. Gynecologic surgeons at UH use da Vinci to excise endometriosis while preserving the uterus. Robotic surgery uses small incisions, which can mean less blood loss, lower risk of infection or complications, and less scarring than with traditional surgery.

Fertility Treatment

Some, but not all, women with endometriosis have trouble conceiving. Scar tissue from endometriosis can sometimes block the fallopian tubes, making it difficult to get pregnant. Minimally invasive surgery to remove endometrial scar tissue can be an effective infertility treatment option for these patients. Women with endometriosis-related infertility can also consult with a reproductive endocrinologist (fertility specialist), who may recommend other fertility treatments such as drugs to stimulate ovulation or in vitro fertilization (IVF), depending on their individual situation.