Endometriosis is endometrial glands, tissue we see on a pad during a period, transported and growing on the organs outside of the uterus. We don’t know for certain how this happens but have many theories. Suffice it to say that once the endometrial tissue gets to the inside of the abdomen it can quickly attach and grow on the ovaries, bowel, fallopian tubes, and any other pelvic and abdominal organ. Endometriosis is fed by hormones secreted from the ovaries, therefore, puberty is thought to be the start of the spread of the implants. Estimates are that 15% of women may have this condition.
As a woman sheds the endometrial lining during menstruation, the implants also grow and bleed inside the abdomen. Blood and inflammation results in pain and damage to pelvic organs. Pain with time worsens and can become debilitating. Damage to organs in the pelvic area may result in infertility. Some of the most common signs of endometriosis are chronic pain with menstruation, infertility, pain on intercourse, and bloody ovarian cysts.
The most common age of presentation for evaluation is in the mid to late 20’s. By this time endometriosis has grown for many years and symptoms become noticeable. In most cases, however, the degree of the disease does not correlate with the degree of pain. 80%.of women with difficulty achieving pregnancy with no identifiable cause for infertility have been found to have endometriosis.
Diagnosis may be made by history of progressive pain and a suspicious pelvic exam or finding of a bloody cyst on ultrasound. The definitive diagnosis, however, is made through a minimally invasive operation called laparoscopy. The operation is conducted through a 5mm incision in the umbilicus and lesions consistent with endometriosis are identified and biopsied. It can also be treated during the diagnostic laparoscopy.
Surgical treatment through laparoscopy is an outpatient procedure. The goal is to remove as much of the endometriosis implants as safely as possible. Treatment can also be in the form of medical therapy. Numerous treatment options for the alleviation of pain and other side effects from endometriosis are available now. Early, individualized, and aggressive treatment improves the quality of a woman’s life and reduces the risks of future complications such as infertility.
Dr. Tahery is a member of the Cedars Sinai Center of Excellence in Minimally Invasive Surgery and is an expert in the treatment of endometriosis.
What are the symptoms?
Even though there are symptoms associated with this condition, some women can be asymptomatic until the condition is severe. One symptom that most patients tend to experience is pain during periods and intercourse. Another symptom is heavy menstrual bleeding which may require frequent pad or tampon changes. Infertility is also another symptom of endometriosis which tends to decrease the chances of getting pregnant as the condition worsens.
Who is likely to get it?
It affects women around the age they begin having menstrual cycles until menopause. The majority of women begin experiencing endometriosis related symptoms while they are teenagers. Women with other family members with the condition are also more likely to be diagnosed with this condition.
Will it cause Infertility?
Infertility can be a symptom of endometriosis but not all women will experience infertility. Approximately only 3 out of 10 women with endometriosis have infertility issues. Early treatment can help in preventing infertility. Studies find 40% of women with unexplained infertility have endometriosis.
How is it diagnosed?
Unlike other conditions, endometriosis is not an easy condition to diagnose because blood tests, physical exams and even ultrasounds will not give a definitive diagnosis. The proper way to diagnose endometriosis is by performing a laparoscopy, a minimally invasive operation performed through the belly button, and analyzing the tissue under the microscope. Presumptive diagnosis can be made by reviewing patient symptoms. Pelvic examination can sometimes offer a clue to the presence of endometriosis.
What are my treatment options?
Your recommended treatment may either be medical or surgical dependant on your symptoms and treatment objectives. Medical options are usually used to suppress endometriosis while surgical options are used to diagnose and remove endometriosis. Choice of medical options may also depend on the stage of the disease as evaluated through surgery.
Our experience and success with endometriosis has shown the importance of individualized treatment based on a women’s symptoms and health objectives.