If you’re among the 10 percent of American women diagnosed with endometriosis, you understand all too well the pelvic pain, fatigue and frustration that accompanies the condition. As an OB/GYN who specializes in laparoscopic treatment of endometriosis, I often see patients who’ve been suffering for a decade or more. Fortunately, treatment is less invasive and more effective than ever.
What is endometriosis?
Endometriosis is a painful condition in which the uterine lining shed during menstruation attaches to pelvic organs, typically the ovaries, fallopian tubes and other surfaces such as the colon. While 25 percent of women with the condition have no symptoms, endometriosis is a common cause of infertility, heavy menstrual cycles, chronic pelvic pain and painful intercourse. For years symptoms went misunderstood by the medical community, and were even dismissed as signs of hysteria or mental disorder among women. Fortunately science has proven otherwise, and today’s gynecologists can offer hope to women who have endured years of pain, unmanageable periods, missed workdays and countless misdiagnoses.
Ultrasound of the pelvis can be useful in the diagnosis but often falls short as it cannot visualize subtleties of disease in the pelvis. The most effective test to confirm the presence of endometriosis is a diagnostic laparoscopic procedure performed in an outpatient surgery setting. This is a minimally invasive surgery that requires small incisions and minimal recovery. Endometriosis plaques can sometimes be removed during this initial scope, depending on the location and complexity of the problem.
Treatment for endometriosis
Robotic-assisted laparoscopy is now the treatment of choice for endometriosis, as it offers smaller incisions, increased visibility and the precision to operate in tight or difficult-to-reach locations and improves the goal of fertility preservation. Patients typically return home the same day and are back at work in just a few short days. Management techniques after surgery can include long-term birth control pills to prevent ovulation and surges of estrogen, along with other treatments aimed at decreasing estrogen levels.
While endometriosis affects 10 percent of the female population, it’s most common among women in their 30s and 40s and among those who start their cycles at an early age, or have unusually short or heavy cycles. Delayed child bearing can also increase risks, along with a woman’s genetics. (If mom had endometriosis, there’s a considerable chance you will too.) Now that more women are using hormone replacement therapy, endometriosis can also flare back up in a woman’s post-menopausal years.
Endometriosis and infertility
For many women, endometriosis is only discovered during a workup for infertility -defined as a year of attempting pregnancy without a positive pregnancy test. Women who have been trying for more than a year, and especially those with very painful cycles, should speak with their provider about the possibility of endometriosis.
Talk to your doctor
For too many women, a diagnosis of endometriosis takes multiple years, doctors and misdiagnoses. Others come into my office well studied on their suspected disease process. Over and over, I remind patients that the key to early detection and treatment is willingness to discuss seemingly embarrassing symptoms with their provider. It’s not uncommon for a woman’s OB/GYN to learn about symptoms years after they start, because the patient believes painful periods are simply her lot in life. I believe women in 2018 are more educated and more aware of what’s going on with their bodies, and many will continue seeking medical help when they’re not getting answers. If you have symptoms of endometriosis, including unusually heavy periods or pain, and past diagnoses or treatment from your doctor don’t align with your symptoms, I encourage you to keep pushing for answers. Speak to your OB/GYN and bring a list of symptoms and your medical history. Every day researchers are learning more about the physiologic causes for endometriosis, and treatment options are on the horizon.
About Dr. De
Nidhi De, M.D., is a board-certified OB/GYN at Vanderbilt Franklin Women’s Center. Dr. De specializes in abnormal uterine bleeding, contraception, high-risk pregnancy, obstetrics and gynecology. Her office can be reached by calling (615) 794-8800.Share this Article