Endometriosis is a chronic disease that causes the endometrial tissue inside the uterus to spread and grow in other parts of our body, including the ovaries and fallopian tubes but most commonly inside the pelvis, near the bladder or rectal area. It affects roughly 1 in 10 women, causing symptoms that range from mild discomfort to severe pain and even infertility.
Invasive and difficult to diagnose, severity of symptoms will not always reflect the severity of the disease, says OB-GYN Kyle Garner, MD, FACOG, Associate Chief Medical Officer at SMH-Venice, making endometriosis a troubling disease for both patients and physicians.
“A lot of women expect endometriosis to manifest as uterine pain or ovarian pain,” says Dr. Garner “The surprise is that it involves so many other structures. It can invade the bladder, the nerves, the muscles, and the surrounding tissues of the pelvis. Patients may even get thigh pain.”
How to Recognize Endometriosis - Common Symptoms You Shouldn’t Ignore
The single most common symptom of endometriosis is cyclic pelvic pain aligned with, but distinct from, the body’s natural menstrual cycle.
This pain most often presents after ovulation, in the midpoint of the menstrual cycle and leading up to the next period. Some women experience the pain as particularly severe cramping, others describe it as bladder pain, difficult with bladder function, pain during bowel movements, or even pain during intercourse. The pain often ebbs and flows, worsening throughout the cycle and then dissipating, only to return with the next menstruation.
Be Your Own Advocate
“One of the big problems women face is that endometriosis is often not diagnosed in a timely fashion,” Dr. Garner says, noting that many women suffer for years before the disease is identified. “But it's not appropriate that women just accept this pain as part of the natural cycle."
“If symptoms are affecting your life and your relationships, physicians need to pay attention.”
Aligning with the natural menstrual cycle can sometimes make symptoms of endometriosis difficult to distinguish from menstrual pains. This is good reason to:
- Never ignore your body when you experience pain that you think is abnormal, exceptionally severe, in a new location, or simply troubling.
- Always notify your healthcare provider about bodily changes or concerning discomfort.
As the disease gets more severe, the symptoms may become more consistent and widespread, appearing throughout the month or even daily, particularly if the disease begins to affect other organs causing damage and scar tissue.
How Is Endometriosis Diagnosed?
The first—and one of the best—ways to check for endometriosis is an ultrasound.
Non-invasive and quick to perform, an ultrasound can reveal formations like ovarian cysts or scar tissue, as well as assess the movement of pelvic structures.
For a deeper evaluation of chronic pain and the pelvic anatomy, an MRI gives physicians a closer look at the uterine anatomy, as well as the surrounding muscles and nerves that may be affected.
“It's ultimately a surgical evaluation though,” says Dr. Garner. “The symptoms may not accurately reflect the severity of the disease, so surgery is ultimately necessary to definitively evaluate whether the disease is present and how to treat it.”
How Is Endometriosis Treated?
The primary method of treating endometriosis is hormonal.
Because endometriosis is primarily driven by estrogen, which is counteracted by progesterone, birth control pills are a common way to help manage and treat the disease. (Adolescent response to birth control pills is actually one way to diagnose endometriosis early.) Similar effects can be achieved through high-dose progestin therapy, while other medications can suppress the growth of endometriosis.
Long-term relief from severe endometriosis, however, may require a combination of laparoscopic surgery and hormone therapy. The complexity of the surgery will depend on the severity of the disease and whether it has spread to the bladder, ureters, and surrounding nerves.
This is rare, though, and most surgical treatment for endometriosis is performed as an outpatient procedure, with patients returning home the same day and to work within a couple weeks.
Endometriosis & Fertility
Can Endometriosis Cause Infertility?
If left untreated, severe endometriosis can lead to infertility.
This most often occurs due to the inflammation associated with endometriosis, which can cause destructive scar tissue to form in or damage the fallopian tubes, preventing the egg from passing through to the uterus for fertilization and implantation.
However, the trauma caused by endometriosis can cause infertility in other ways, as well, even if the fallopian tubes are undamaged.
Can someone with endometriosis still get pregnant naturally?
“Absolutely!” says Dr. Garner. “In fact, pregnancy is actually a great treatment for endometriosis.”
Endometriosis is a disease primarily driven by estrogen, which means that the progesterone that patients naturally produce during pregnancy is actually the natural treatment for endometriosis. In fact, many times, patients will see their endometriosis symptoms lessen after pregnancy, as well.
To schedule an appointment with a physician from First Physicians Group Obstetrics/Gynecology, click here.
To hear more from Dr. Garner about endometriosis, watch the HealthCasts video below.