Ask Your Ob-Gyn—Dr. Sarah Whitehead Answers Questions about Endometriosis

woman in Doctor's office with abdominal discomfortWhat is endometriosis?

Endometriosis in a condition in which tissue normally found in the lining of the uterus begins to grow in other areas of a woman’s abdomen. It is normal tissue, not a cancer, but it can still cause great discomfort and other medical problems. Endometriosis is very common, affecting about one in ten women.

The misplaced endometrial tissue can become attached to the ovaries, fallopian tubes, the outside surface of the uterus, the bladder, bowel, or other places in the pelvis.

What problems does endometriosis cause?

Most often, endometriosis causes pain. When a woman tells me that her periods cause significant pain that interferes with her normal life during those days, I consider the possibility of endometriosis. Commonly, women describe very painful menstrual cramps, but symptoms can also include pain during intercourse, pain associated with bowel movements or urination, and very heavy periods.

Just like the lining of the uterus, endometrial tissue outside the uterus responds to a woman’s hormones by growing thicker and then bleeding each month.  This irritates the surrounding tissues in the pelvis. Scar tissue can develop, causing organs in the pelvis to become stuck together (adhesions). The inflammation and scarring cause pain especially before and during the period.

Various studies estimate that 30 to 50% of women with endometriosis have difficulty getting pregnant. The causes of infertility are complex, so an accurate estimate is difficult. Endometrial tissue and the adhesions it produces can interfere with the path of an egg from the ovary to the fallopian tube and onward to fertilization. Inflammation in the pelvis causes other changes that may also reduce fertility.

What are the risk factors for endometriosis?

Endometriosis can affect any woman who has periods, but it is most often diagnosed the in one’s 30s or 40s. It is more likely to develop in women—

  • who have not had a child
  • who have very heavy periods, periods lasting longer than 7 days, or short menstrual cycles (less than 27 days)
  • who have a mother, sister, daughter, with endometriosis
  • who began their periods early (before age 11)

How can your Ob-Gyn determine whether you have endometriosis?

We will discuss your symptoms and do a pelvic exam. A surgical procedure called laparoscopy is the only sure way to diagnose endometriosis. This minimally-invasive procedure allows us to look for misplaced uterine tissue inside the pelvis. We generally recommend a laparoscopy only if conservative treatment like medication does not manage your menstrual pain.

What treatments can your gynecologist offer for endometriosis?

Our recommendations will depend on how severe your symptoms are and whether you want a future pregnancy. Medications like ibuprofen (non-steroidal anti-inflammatory drugs—NSAIDs) can relieve mild to moderate pain. We also use hormonal medications, primarily birth control pills, to treat endometriosis. These medications suppress the growth of endometrial tissue and may therefore ease symptoms.

We consider surgery when these more conservative treatments are not sufficient or when a woman with more severe endometriosis is experiencing infertility. We are able to remove areas of misplaced endometrial tissue using laparoscopy or robotic surgery. Endometriosis often returns after a time, although the period of improvement may be longer if hormone therapy follows surgery. For this reason, we consider a medication to suppress the function of the ovaries for six months.

For severe endometriosis, your doctor may recommend a hysterectomy (surgery to remove the uterus). Your doctor will also remove as much endometrial tissue as possible. Whether we recommend removing or leaving the ovaries depends on a woman’s age and the severity of her endometriosis. Removing the ovaries does reduce the chance that endometriosis will return.

Many options are available to help women with endometriosis achieve a successful pregnancy. Your doctor, along with an infertility specialist, will help you to choose a treatment plan considering your individual situation, age, and the severity of your endometriosis.

We encourage you to talk with your gynecologist if your periods are painful. More study is needed to know for sure whether early treatment improves the future course of the disease. But early treatment can very much improve your quality of life.