What is Endometriosis?
Endometriosis happens when endometrial tissue grows outside the uterus. It’s not definitively known what causes endometriosis, but it is not the same as endometrial cancer. Endometriosis affects about 1 in 10 women in the United States, although many more are undiagnosed.
Endometriosis can cause dysmenorrhea (painful periods), dyspareunia (painful intercourse), chronic pain, and infertility. Dysmenorrhea is dull or crampy pelvic pain that typically begins several days before your period, worsens during your period, and can continue for several days afterward. These symptoms can range from minimal to severely debilitating. Many of the symptoms of endometriosis overlap with other conditions, making it difficult to diagnose.
Women with endometriosis are often diagnosed during their reproductive years along with pelvic pain, infertility, or an ovarian mass. During pregnancy, lesions and their symptoms often disappear and improve, which has been attributed to changing hormones.
Why is Endometriosis Important?
Endometriosis should be viewed as a chronic disease that requires a lifelong management plan with the goal of using medications to avoid the need for surgery. It’s important to note that treatments don’t improve fertility, diminish endometriomas, or treat complications of deep endometriosis. The treatment of infertility associated with endometriosis involves a combination of surgery and assisted reproduction technology. In short, endometriosis can often have a significant impact on your reproductive capabilities and day-to-day life, meaning it’s important to manage symptoms and consider your childbearing options with your gynecologist.
How Can My Gynecologist Help?
There are no laboratory tests for endometriosis. This means that endometriosis is often diagnosed by laparoscopy to take a biopsy of a lesion. Then, your gynecologist can create a treatment plan based on factors like symptoms (pain, infertility, mass), severity, extent and location, reproductive desires, age, medication side effects, surgical complication rates, and cost.
If you have mild to moderate pain (pain that doesn’t cause regular absence from school or work) and no ultrasound evidence of an endometrioma, the first line of treatment is nonsteroidal anti-inflammatory drugs (NSAIDs) and continuous birth control pills. This regimen is highly effective for most patients. If you cannot or choose not to use estrogen therapy, progestin-only contraceptive pills with an NSAID are often used.
Do I need surgery?
If your pain doesn’t respond to first-line treatments, then laparoscopy can be recommended for diagnosis and treatment. Surgery can remove endometrial implants, endometriomas, and adhesions, and can be conservative (retaining the uterus and ovarian tissue) or definitive (removing the uterus and possibly the ovaries), depending on factors like your age and family plans. After surgery, hormonal suppression (usually with continuous oral contraceptives) can help prevent the recurrence of symptoms. Your gynecologist can discuss whether surgery is the right course for you during an appointment.
Schedule an Appointment
Endometriosis can be difficult to live with and even more difficult to manage. To meet with our expert team and create the right treatment plan for you and your health, contact our New York City office by calling or filling out our online form.