Understanding endometriosis

Are you plagued by pain during intercourse, major menstrual cramps and other discomfort down there? Don’t dismiss your symptoms; you could have endometriosis, a condition that affects around 10% of reproductive-age women worldwide, according to the World Health Organization.

What is endometriosis?

Endometriosis is a disease where endometrial glands, typically found inside the uterus, grow outside of it, most commonly within the pelvis or in the wall of the uterus (where it’s called “adenomyosis”). Less commonly, this glandular tissue can be found in other parts of the body, such as the belly button, liver, appendix, diaphragm or lung.

“Endometrial glands, whether in the uterus (normal) or outside it (endometriosis), are stimulated by estrogen and suppressed by progesterone. Both hormones occur naturally during the menstrual cycle,” said Mary Ellen Wechter, MD, MPH, a minimally invasive gynecologic surgeon with North Florida Gynecologic Specialists who serves patients at Baptist Medical Center Jacksonville and Baptist Medical Center Beaches. “Endometriosis is inflammatory and causes pelvic pain, abnormal bleeding, scarring and infertility. It also increases the risk of ovarian cancer.”

How do you know if you have endometriosis?

People with endometriosis often experience abdominal bloating and pain during:

• Periods (which are often heavy)
• Intercourse
• Bowel movements

“If a patient comes in and is experiencing these symptoms, we’ll perform a physical exam and collect information about the severity and duration of the symptoms. Advanced imaging, such as MRI, is most useful,” Dr. Wechter said. “If we suspect endometriosis and need to confirm the diagnosis, we’ll proceed to a laparoscopic or robotic [minimally invasive] surgery to obtain a biopsy."

What are the treatment options for endometriosis?

Endometriosis symptoms are often inadequately treated with over-the-counter pain relievers. Better control is achieved when the endometriosis itself is suppressed using various forms of progesterone (oral medications such as birth control pills or progesterone-only pills) or medications that remove estrogen stimulation by creating a temporary menopause, according to Dr. Wechter.

“These medications can decrease pain and improve overall quality of life, but surgery to remove the growths is the only way to truly diagnose the condition and treat deep or extensive disease. For women interested in becoming pregnant, surgery is often the only option because medications to suppress endometriosis also prevent pregnancy,” she said. “Deep, severe disease is most effectively approached with robotic surgery and a multidisciplinary team experienced in complex cases. This allows us to offer safer treatment, faster recovery, and better preservation of organs and organ function.”

After surgery, patients should speak with their provider about preventing recurrence, as the same gland tissue can spill into the pelvis even during the next period.

Can endometriosis be prevented?

The exact cause of endometriosis is unknown, so it’s difficult to know how to prevent it; however, since endometriosis is misplaced endometrial tissue, any medication that suppresses a period (progesterone) can reasonably be assumed to help suppress or prevent endometriosis.

Can endometriosis cause infertility?

People with endometriosis can have a higher rate of infertility or difficulty getting pregnant.

Will pregnancy be difficult?

“Fortunately, once pregnant, women experience high levels of progesterone, which suppresses endometriosis,” explained Dr. Wechter.

More good news: As people share their journeys with endometriosis, awareness of the condition spreads. That means faster diagnoses and quicker treatment, which improves quality of life and limits long-term problems.

Reference: World Health Organization