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 condition in which tissue (endometrium) typically found in the uterus grows outside of it, most commonly within the pelvis. In rare cases, this tissue can be found in other parts of the body, as well.

“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. “Stimulus of endometriosis is inflammatory and causes pelvic pain, abnormal bleeding, scarring, infertility and even increases cancer risk over time.”

How is it treated?

Endometriosis symptoms can be managed with over-the-counter pain relievers, or suppressed using various forms of progesterone or medications that suppress estrogen production 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 manage 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. “For deep, severe disease, we can offer robotic, minimally invasive surgery. Our multidisciplinary team is experienced in complex cases, which allows us to offer safer treatment and preserve organ function.”

How do you know if you have endometriosis?

People with endometriosis often experience pain during:

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

Abdominal bloating is also a common symptom.

“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 want to confirm the diagnosis, we’ll proceed to a laparoscopic [minimally invasive] surgery to see and remove any endometriosis implants, nodules or cysts."

After surgery, patients should speak with their provider about the best fit for preventing recurrence.

Can endometriosis be prevented?

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

Can endometriosis cause infertility?

People with endometriosis may 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 movement to treat, which improves quality of life and limits long-term problems.

Reference: World Health Organization