Understanding Endometriosis

Endometriosis is an often painful disorder that affects 1 in 10 women during their reproductive years. From mild pain to infertility, the disorder has a range of symptoms and can impact every woman differently.

Dr. Mohamad S. Mahmoud, a gynecologic surgeon and board-certified obstetrician and gynecologist, explains the signs, symptoms, and treatment of endometriosis.

What is endometriosis?

Endometriosis is a chronic disorder in which tissue that normally grows in the uterus—and sheds during a menstrual period—grows in areas outside of the uterus. Most commonly, the tissue affects the ovaries, fallopian tubes, and the tissue lining the pelvis.

“On rare occasions, the endometrium tissue can grow beyond organs in the pelvic region and affect other areas of the body,” says Dr. Mahmoud.

What are the symptoms of endometriosis?

The most common symptom of endometriosis is pelvic pain that tends to worsen during menstrual periods. Although pain is common during periods, women with endometriosis often experience pain far worse than normal.

Other symptoms of endometriosis include:

• pain during intercourse
• pain while using the bathroom
• excessive menstrual bleeding
• infertility
• fatigue, diarrhea, constipation, bloating or nausea

“Oftentimes, if a woman planning to become pregnant is diagnosed with endometriosis, physicians will recommend that they do not delay having children because the condition may worsen over time.”

How is endometriosis diagnosed?

If a patient describes symptoms of endometriosis, there are a few tests to check for physical clues of endometriosis:

• Pelvic exam: Usually performed at an annual well-woman’s exam, a doctor will check for abnormalities in the pelvic area.
• Ultrasound: Using an imaging technique, a doctor will examine the patient’s reproductive organs to look for abnormalities that signal endometriosis.
• MRI: Magnetic resonance imaging (MRI) can determine detailed information about the endometriosis, including the location and size.
• Laparoscopy: Conducted by a surgeon, laparoscopy allows a detailed examination of the abdomen area, providing the most detailed information about the endometriosis. During this exam, a patient is placed under general anesthesia.

“During laparoscopy, a surgeon may be able to treat the endometriosis by removing the excess tissue,” explains Dr. Mahmoud.

Is there treatment for endometriosis?

While there is a possibility that endometriosis may not completely go away, there are treatments to reduce pain and excess tissue.

Hormonal therapy

The first line of treatment, hormones are sometimes effective in reducing or eliminating the pain of endometriosis.

“We aim to suppress the estrogen that stimulates the endometriosis tissue. This can be done with multiple hormones in many different forms, such as pills or injections.”

Conservative surgery

For women who are trying to become pregnant or do not see improvements after hormonal therapy, conservative surgery is the next step. In surgery, the excess tissue can be removed while preserving your uterus and ovaries.

“This surgery is a good way to remove endometriosis, however, patients should know that there is a possibility of the endometriosis tissue returning,” explains Dr. Mahmoud.

Hysterectomy

As a last resort treatment for patients with endometriosis, a full hysterectomy (removal of the uterus) and removal of the ovaries can reduce symptoms of endometriosis. However, removal of the uterus and ovaries causes early menopause, which may have long-term effects on health.

“This approach is only recommended for patients with severe endometriosis who are not planning on becoming pregnant and are of an appropriate age to begin menopause—usually we recommend that the patient is 40 years old.”

Importance of annual well-woman’s exams 

During an annual well-woman’s exam, a physician will check-up on many different aspects of the patient’s health, one of which being their reproductive system.

When examining the pelvic and abdominal area, a doctor can determine whether signs of endometriosis exist. This way, treatment can begin as early as possible, reducing the likelihood of long-term effects like chronic pain syndrome or cancer.

“Early detection and treatment of endometriosis are very important in avoiding chronic pain syndrome—a syndrome that affects the brain and spinal cord, causing a distorted perception of pain,” says Dr. Mahmoud. “If this develops, patients can perceive pain all over the body that is not actually there.”