ENDOMETRIOSIS
Most frequent questions and answers
Endometriosis is a common condition that can cause incapacitating pain,difficulty getting pregnant, organ failure, and other severe medical consequences if not adequately treated. It was described in medical literature more than 300 years ago and was even found in ancient medical texts from nearly 4,000 years ago.
The “endometrium” is the name for the inner lining of the uterus. In people with endometriosis, cells like those normally found in the endometrium grow outside of the uterus. When these endometriosis cells grow, they cause inflammation, which can lead to symptoms. The most common places where endometriosis occurs are the ovaries, the fallopian tubes, the bowel (large and small intestine), and the areas in front, in back, and to the sides of the uterus, sometimes even outside the pelvic area such as diaphragm, thoracic cavity, and umbilical area or even to a scar of previous surgery such as cesarean section scar.
And, far from being a rare disease, it’s estimated that as many as 200 million women and girls from around the world have endometriosis.
Endometriosis may be associated with infertility, pain, or organ dysfunction. Millions of people around the globe are affected by it.
One out of every 10 couples who try to have children are not able to. In some countries, this issue has led to zero or negative birthrates, which is a social issue.
In our experience, more than 90% of “no-reason found infertility also known as unexplained infertility” patients have endometriosis, so endometriosis is a social issue.
In the same way, incapacitating pain or organ dysfunction could be a manifestation of endometriosis as millions are affected.
Endometriosis could interrupt the lives of all these people. It could disrupt education, school, college, work, social engagements, and even dreams, so it is a social issue.
If endometriosis is treated surgically by a VERY EXPERIENCED ENDOMETRIOSIS SURGEON, the result is excellent for fertility, pain relief, and restoration of organ function. Consult today with Dr. Azer to discuss your treatment options.
The cause of endometriosis is not known. A common theory is that some menstrual blood and endometrium flows backward from the uterus through the fallopian tubes and into the pelvis during the monthly menstrual period. This tissue then grows where it lands in the pelvis. This is called the “retrograde menstruation theory.” There are several other theories as well as the menstrual blood and endometrium flows travel blood stream to different areas of the body, this explains endometriosis found outside the pelvic area such as the diaphragm or lungs or surgery scar, and research is ongoing to find a cause for this condition.
For centuries the symptoms of endometriosis have been dealt with as a supposedly normal part of women’s life, nothing more than painful periods or cramps. However, endometriosis is a serious disease which can lead to serious medical consequences if it is not timely diagnosed or inadequately treated.
Symptoms of Endometriosis
- Chronic fatigue: One of the most unexpected symptoms is chronic fatigue syndrome. Continuous fatigue, stress, and lack of focus on school or work are more common in women with endometriosis. Even seasonal fatigue may actually be a symptom of endometriosis.
- Painful menstruation: One of the most frequent problems caused by endometriosis is the pain that accompanies and/ or precedes menstruation. However, many women have been led to believe that pain with a period is ‘very normal.’ They are falsely reassured by friends or family who claim as much.
- Painful sexual intercourse: Many women do not know that endometriosis can cause painful sexual intercourse, hence they do not consult with the gynecologist about their sexual problems that can cause serious problems between the partners, even to the point of divorce, which is the final blow rendered by infertility. I find it useful to think of a possible chocolate cyst -cyst that is caused by endometriosis on your ovary- when sex is painful.
- Infertility: The relationship between endometriosis and infertility has been well established in the medical literature, especially with involvement of your tubes, blocking fertilization when sperm cannot meet egg. Sometimes no symptoms other than difficulty getting pregnant will prompt me to suspect endometriosis, which is often the case!
- Back and/or groin pain: is one of the most common complaints of endometriosis, it is unbelievable to me when a gynecologist doesn’t ask about these types of pain. Indeed, endometriosis may cause these exact symptoms.
- Gas and bloating in the abdomen: The disease causes bloating in the intestines. Many women will complain of ‘swelling in my belly.’ When this is cyclic, endometriosis should always be considered.
7. Depression: Because this chronic disease limits a woman’s entire life. She cannot participate in sports or the usual activities of daily living, enjoy meals, is constantly tired, and generally is miserable and depressed.
In an attempt to distinguish different phenotypes of endometriosis, the American Society of Reproductive Medicine (ASRM) established a classification system comprising 4 stages:
- Minimal Disease (Stage 1),
- Mild Disease (Stage 2),
- Moderate Disease (Stage 3),
- Severe Disease (Stage 4).
However, this system often does not correlate to the pain symptoms that women can have. For example, patients classified with only minimal disease (Stage 1) can still experience debilitating pain, while those diagnosed with severe stage 4 disease sometimes have no pain symptoms at all.
Diagnosing endometriosis can be difficult for a non-specialist because symptoms can vary widely, unfortunately many women and girls with endometriosis experience an average of about 6-10 years delay before being accurately diagnosed.
Your doctor might suspect that you have endometriosis if you have one or more of the classic symptoms mentioned above. However, the only way to know for sure if you have endometriosis is to have surgery (Laparoscopy where your gynecologist takes a camera and looks inside your belly looking for endometriotic implants) so a doctor can actually see and test (biopsy) the abnormal tissue. If endometriosis is present, your doctor can remove the tissue at this time.
Endometriosis cannot be definitively diagnosed by ultrasound, X-ray, or other noninvasive methods; however, endometriomas (cysts filled with endometriotic tissue and blood, often called chocolate cysts) are often seen with ultrasound. If you do not feel that your provider is taking your pain seriously, you may want to request an appointment with another provider, call Advanced Gynecology Practice today to speak with the expert Dr. Azer.
While some amount of discomfort around your period may be normal, endometriosis-related pain should not be dismissed, as there are treatments that can help.
If your symptoms suggest endometriosis, your doctor may recommend trying medication to see if it helps, rather than doing surgery right away to confirm the diagnosis.
Make an appointment with Dr. Azer to discuss which approach to diagnosis and treatment makes the most sense for your situation.
While theories abound, the causes of endometriosis are unknown and, sadly, there is still no cure. Endometriosis treatment depends on the extent of disease, severity of symptoms, and desire for fertility.
FOR WOMEN WITH MILD SYMPTOMS
If you have mild symptoms and do not want to have your own biological children, you may choose to have more limited medical interventions. Instead, an expectant approach could be taken, which would include regular exams so that your doctor can monitor the disease and make sure it isn’t getting worse or causing asymptomatic damage, such as silent loss of kidney function or frozen pelvis.
As mentioned, there is no absolute medical cure for endometriosis. However, for mild symptoms, the following alternative therapies and/or over-the-counter pain medication may be helpful for some women:
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen (Aleve), ibuprofen, (Advil), or prescription painkillers to relieve cramping and pain
FOR MORE SERIOUS SYMPTOMS
For women who experience more severe symptoms, treatment options can include:
-Prescription medications to control pain
-Hormone medications to possibly stop endometriosis from getting worse
-Surgery to remove the endometriosis lesions/nodules/cysts/adhesions
-Surgery to remove the entire uterus while sparing ovaries & fallopian tubes
-Surgery to remove the entire uterus, including the ovaries & fallopian tubes
SURGERY RECOGNIZED AS MOST EFFECTIVE
Although medications may help alleviate some pain, both over-the-counter and prescription pain relievers can cause fairly serious side effects and they do not stop the progression of endometriosis. Similarly, hormone treatments can cause side effects not only with serious, long-term consequences, but which, in any case, many patients find intolerable.
Given such drawbacks, most now recognize that the most effective treatment for endometriosis is surgical treatment (excision/removal) of the disease, with minimally invasive surgery considered the standard of care. Not only is this the conclusion of experts from the National Institutes of Health and ACOG, but it’s also based on several well-designed studies which have shown that, regardless of stage, surgical treatment of endometriosis is far superior to the use of medications when comparing relief of pain symptoms and fertility outcomes. Studies have even shown that women with failed infertility treatment like IVF (test tube baby), secondary to endometriosis, have a better chance of getting pregnant following surgery performed by an experienced specialist.
Even extensive disease involving the bowel, bladder, ureters, diaphragm, chest, and lungs can be treated using the minimally invasive da-Vinci assisted surgery. In fact, Dr. Azer has been using the da Vinci assisted surgical approach for treatment of all types of endometriosis for over 16 years. Call today to make an appointment with Dr. Azer to discuss your options.
Further Reading
Bowel Endometriosis
To help provide clarity among such clinical confusion, we’ve compiled the following summary to help you recognize what may be symptoms of bowel endometriosis from those of other disorders.
Bladder Endometriosis
Complicating matters further, these other conditions can co-exist with endometriosis. To help provide clarity among such clinical confusion, we’ve compiled the following summary to help you recognize what may be symptoms of bladder endometriosis from those of other disorders.
