What is endometriosis?

Endometriosis affects many women across the globe, but it often is misdiagnosed, causing a painful lifestyle and other potential health and social issues. It is a condition where cells resembling the inner lining of the uterus spread into the pelvis or other areas of the body, causing inflammation and pain. Pain can occur during and outside the menstrual cycle, and with bowel movements, urination and intercourse.

“The majority of the time, symptoms include pain during or after the period. The consequences from the pain lead to all kinds of physical and emotional change,” said Dr. Xiaoming Guan, professor and division chief of minimally invasive gynecologic surgery in the Department of Obstetrics and Gynecology Baylor and Texas Children’s Hospital.

There is an increased incidence of anxiety and depression in endometriosis patients not only because of the constant pain, but because they often go through many healthcare providers who haven’t provided an adequate form of treatment.

Endometriosis’ involvement with the urinary and gastrointestinal systems can affect the bladder and rectum as well. Blockages may occur with these organs, so some patients need a bowel, ureteral or rectal resection if their disease is severe.

A patient’s endometriosis rarely can occur outside of the pelvis or abdominal cavity. This could affect the chest cavity, leading to chest pain or collapse of the lungs during the period.

Impact

Menstrual cycle

Endometriosis can cause periods to become more painful. As the disease progresses, it can cause pain outside of your period, having no relation to your period at all. Patients can also experience an increased, heavy cycle.

While many women experience a painful menstrual cycle without endometriosis, most of these cases can be controlled by over-the-counter medication. If you take medication and the pain fails to subside, ask your healthcare provider about endometriosis.

Fertility

There are four stages of endometriosis. In higher stages (stages 3 and 4), the disease affects surrounding organs (the ovary, fallopian tube, bladder and rectum). This can impact fertility by causing inflammation and adhesion, or scar tissue between the ovaries and fallopian tubes.

Menopause

Symptoms from the disease typically improve after menopause due to the effect of estrogen on endometriosis. However, in some very rare cases, it can persist after menopause because it has been found to secrete its own estrogen supply.

Diagnosis

The condition is often mis- or underdiagnosed because healthcare providers and patients may not be as familiar with all treatment options available.

“We learn about it in medical school and residency and are familiar with medical options for treatment of endometriosis, but experience with surgical treatment of endometriosis can be subpar,” said Dr. Tamisa Koythong, assistant professor in the Department of Obstetrics and Gynecology at Baylor and Texas Children’s. “It takes more education to be familiar with the different appearances of the disease and meeting those who actively treat it.”

Patients are often unaware of endometriosis. They may see their physician or OBGYN who says their painful periods are normal and go along with thinking nothing else can be done to treat them.

Currently, the only way to definitively diagnose endometriosis is through surgery.

“Endometriosis diagnosis is very difficult because there is no medical diagnosis like a blood test,” Guan said.

Treatment

Research shows long-term management of endometriosis includes a combination of medical and surgical treatments. Excision surgery removes the endometriosis, and this can include the preservation of all your gynecological organs (the uterus and ovaries).

If a patient wants to try medical management prior to proceeding with surgery, that includes hormonal therapy, either with birth control methods or medications designed to induce medical menopause:

• Birth control pills
• Birth control injection
• Intrauterine device with progestin (IUD)
• Gonadotropin releasing agonists or antagonists

Management

Endometriosis is a chronic disease, so there is a risk of it returning or recurring. Surgery is only one part of treatment, and the patient must be treated after surgery, ensuring that all components contributing to her pain are addressed.

It often coexists with other diseases, such as IBS or interstitial cystitis, so patients must make sure their diseases are adequately addressed by a gastroenterologist or urologist. Pelvic floor physical therapy is also recommended after surgery.

“Ensuring that a strong support system is in place to get additional issues addressed, such as anxiety or depression, can help with your overall well-being,” Koythong said.

By Homa Shalchi