Tags Archives: signs of endometriosis

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How Common is Infertility with Endometriosis

Endometriosis, a medical condition affecting women globally, often poses a significant question:

how common is infertility with endometriosis? This article aims to shed light on this critical question, discussing endometriosis and its relationship with fertility issues, the possible causes and treatments, and the hope that exists for women battling both endometriosis and infertility.

Understanding Endometriosis

Endometriosis is a chronic disorder characterized by the growth of endometrial-like tissue (the lining of the uterus) outside the uterus, inducing a chronic inflammatory reaction. This misplaced tissue can be found on the ovaries, fallopian tubes, and even on the bladder or intestines. The growths can lead to complications, including the formation of scar tissue and cysts, causing pain and potentially affecting fertility.

Read More: Can Endometriosis Be Treated Without Surgery? – Endometriosis Supportive Therapy

Prevalence of Endometriosis

Endometriosis affects an estimated 10–15% of women between 15-50. However, the prevalence dramatically rises to about 25%–50% in women with infertility. Despite the well-supported association between endometriosis and infertility, a causal relationship is yet to be definitively established.

Endometriosis and Infertility: The Connection

Endometriosis can impact fertility in multiple ways, leading to the following complications:

  • Impact on Gametes and Embryos: The increased number of inflammatory cells in the peritoneal fluid of women with endometriosis can damage the oocytes (eggs) and sperm and even have toxic effects on the embryo.
  • Impairment of Fallopian Tubes and Ovarian Function: Endometriosis can lead to pelvic adhesions, blocked fallopian tubes, and damaged ovaries, which can hinder the process of ovulation and egg release, thus affecting fertility.
  • Endometrial Receptivity: The chronic inflammatory state induced by endometriosis can impair endometrial receptivity, affecting the implantation of a pregnancy.

Read More: Can Minimal Endometriosis Cause Infertility

Endometriosis-Associated Infertility: Treatment Approaches

The treatment for endometriosis-associated infertility usually involves a combination of medical and surgical interventions. The choice of treatment depends on several factors, including the age of the woman, the severity of the symptoms, the desire for pregnancy, and the extent of the disease.

Medical Treatment

Medical treatments for endometriosis aim to suppress the growth of endometriosis tissue and relieve symptoms. These treatments include hormonal therapies such as birth control pills, gonadotropin-releasing hormone (GnRH) agonists, and progestins. However, these treatments do not improve fertility rates and are typically used to alleviate pain and other symptoms. They are temporary solutions.

Surgical Treatment

Surgical treatment aims to remove endometrial tissue and restore normal pelvic anatomy. Surgical options include laparoscopy, a minimally invasive procedure. Studies have shown that surgical treatment can improve fertility rates, especially in women with severe endometriosis.

Assisted Reproductive Technology (ART)

In cases where medical and surgical treatments are unsuccessful, assisted reproductive technologies (ART) such as in vitro fertilization (IVF) may be considered. IVF involves the extraction of eggs from the ovaries, which are then fertilized with sperm in a laboratory. The resulting embryos are then transferred back into the uterus.

The Hope for Women with Endometriosis and Infertility

Despite the challenges posed by endometriosis, it’s crucial for women to know that having this condition does not necessarily mean they cannot get pregnant. With the right treatment approach, many women with endometriosis can successfully conceive and carry a pregnancy to term.

In conclusion, understanding how common infertility is with endometriosis is essential for providing effective treatment and support to women dealing with this condition. While endometriosis can indeed impact fertility, it’s important to remember that it’s not the end of the road. With advances in medical technology and treatments, many women with endometriosis are able to overcome their fertility challenges and fulfill their dreams of motherhood.

Read More: Life After Endometriosis Surgery: A Comprehensive Guide

References:

https://www.pennmedicine.org/updates/blogs/fertility-blog/2016/august/endometriosis-and-fertility

https://www.reproductivefacts.org/news-and-publications/fact-sheets-and-infographics/endometriosis-does-it-cause-infertility/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3538128/

https://www.frontiersin.org/articles/10.3389/fsurg.2014.00024

https://obgyn.onlinelibrary.wiley.com/doi/10.1111/aogs.13082

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Can Endometriosis Grow Inside the Bladder

Endometriosis, a medical condition that affects many women worldwide, is often associated with the reproductive system. However, this disorder can manifest in other regions of the body, leading to a pertinent question:

Can endometriosis grow inside the bladder?

In this article, we will explore the nature of endometriosis, its ability to affect the bladder, the related symptoms, causes, diagnosis, and available treatment options.

Understanding Endometriosis

Endometriosis is a gynecological condition where cells similar to the ones lining the uterus, known as endometrial-like cells, grow outside of the womb. These cells can attach themselves to various organs such as the ovaries, fallopian tubes, and in rare instances, the bladder. This phenomenon is known as bladder endometriosis.

Read More: Endometriosis and Inflammatory Bowel Disease: Distinguishing the Differences

Bladder Endometriosis: An Overview

Bladder endometriosis is a specific form of endometriosis where endometrial-like cells grow inside or on the surface of the bladder. These cells respond similarly to hormones as the cells within the womb, causing them to build up, break down, and bleed. However, being outside of the uterus, these cells have no way of exiting the body, leading to inflammation, pain, and scar tissue.

Bladder endometriosis is considered a rare form of the disorder, affecting only about 1 to 2% of patients with endometriosis. However, for those suffering from deep endometriosis (DE), a severe form of the condition, the prevalence increases to nearly 50%.

There are two types of bladder endometriosis:

  • Superficial Endometriosis: Endometrial-like cells are found on the outer surface of the bladder.
  • Deep Endometriosis: Endometrial-like cells infiltrate the bladder lining or wall. This infiltration can cause a nodule, potentially affecting the ureter.

Read More: What Does Bowel Endometriosis Feel Like? Understanding the Pain and Symptoms

Recognizing the Symptoms of Bladder Endometriosis

The symptoms of bladder endometriosis can vary, often aligning with the menstrual cycle and intensifying during or just before a period. However, many women may remain asymptomatic until the disease has progressed significantly.

Common symptoms of bladder endometriosis include:

  • Bladder irritation
  • Urgency to urinate
  • Pain when the bladder is full
  • Occasional presence of blood in the urine during menstruation
  • In some cases, pain in the area of the kidneys

Identifying the Root Causes of Bladder Endometriosis

The exact cause of bladder endometriosis remains unknown. However, several theories have been proposed, including:

  • Early Cell Transformation: Cells leftover from embryonic development may transform into endometrial-like cells.
  • Surgery: Endometrial cells may spread to the bladder during pelvic surgeries, like a cesarean delivery or hysterectomy.
  • Hematogenous/Lymphatic Spread: Endometrial-like cells might travel through the blood or lymph system to the bladder.
  • Genetic Factors: Endometriosis has been observed to run in families, indicating a possible genetic link.

Diagnosing Bladder Endometriosis

Bladder endometriosis is diagnosed through a comprehensive evaluation involving a physical examination, medical history, and various diagnostic tests. These tests may include:

  • Vaginal examination
  • Ultrasound
  • Urine sample analysis
  • Cystoscopy and Laparoscopy
  • CT and/or MRI scan

Bladder Endometriosis Treatment Options

The primary aim of bladder endometriosis treatment is to control symptoms and inhibit the growth of endometrial-like cells. Treatment options include:

Medication

Hormone therapy can slow the growth of endometrial-like cells, relieve pain, and help preserve fertility.

Surgery

Surgery is typically required for bladder endometriosis. The surgical options can vary depending on the severity and area affected. The areas affected by endometriosis can be excised to remove them.

Complications and Prognosis

If left untreated, bladder endometriosis could lead to kidney damage. However, surgery can prevent this complication. The condition doesn’t directly affect fertility, but if endometriosis is present in other parts of the reproductive system, conceiving might be challenging.

Endometriosis, including its bladder variant, is a chronic condition that can impact daily life. Yet, it can be effectively managed with proper treatment and a supportive healthcare team.

Read More : Life After Endometriosis Surgery: A Comprehensive Guide

Final Thoughts

So, to answer the question, Can endometriosis grow inside the bladder? — yes, it can. However, through increased awareness, early diagnosis, and effective treatment strategies, bladder endometriosis can be managed, improving the quality of life for those affected.

References:

https://www.endometriosis-uk.org/endometriosis-and-bladder

Bladder Endometriosis symptoms

Endometriosis Symptoms And Treatments

https://www.healthline.com/health/womens-health/bladder-endometriosis

https://consultqd.clevelandclinic.org/urinary-tract-endometriosis-has-serious-health-implications/

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Do Endometriomas Automatically Make You Stage 4?

Endometriosis, a complex and often painful condition, is characterized by the growth of endometrial-like tissue outside the uterus. This tissue, which differs molecularly and in behavior from the lining of the uterus, can cause severe discomfort and various health complications. One such complication is the formation of endometriomas, sometimes referred to as “chocolate cysts”, which predominantly affect the ovaries. They’re named for their dark, chocolate-like appearance, resulting from the accumulation of old blood within the cyst.

But does the presence of endometriomas automatically classify a patient as having stage 4 (also designated Stage IV) endometriosis? This primer delves into the stages of endometriosis, the nature of endometriomas, and the relationship between the two.

Understanding Endometriosis and Its Stages

Endometriosis is categorized into four stages according to the American Society of Reproductive Medicine (ASRM), with each stage reflecting the location, extent, and superficial vs deep endometriosis implants, presence and severity of adhesions, and the presence and size of ovarian endometriomas.  The current revised ASRM system (rASRM) was adopted in 1996 and remains the most common staging system.  Unfortunately, there is a lot of inter-observer variation, so reproducibility of the score is poor.  It also is limited because it mixes visual staging and actual biopsy proven staging.  So, one surgeon might call it one stage and another surgeon may arrive at a different stage.  In addition, rASRM stages do not correlate well with degree of pain and does not fully consider presence and location of deeply infiltrating endometriosis (DIE).  

For all of the above reasons, other staging systems have been introduced.  The ENZIAN system, which more robustly considers the location and depth of DIE, was intended to supplement the rASRM system but due to numerous misunderstandings it is not widely used.  The endometriosis fertility index (EFI) focused mainly on predicting pregnancy rates. The American Association of Gynecological Laparoscopists (AAGL) proposed a comprehensive system to try to address pain, infertility/subfertility, and surgical excision difficulty. However, it was only recently published in 2021, continues to have limitations of not addressing upper abdominal and extra-abdominal disease, and is not yet widely accepted.

So, we are left with the rASRM system in terms of best communicating surgical outcomes, treatment planning and comparing results.  The Stages are based on a numerical score and are as follows:

Stage I: Minimal Endometriosis

In stage I, there are only a few small clumps of endometriosis tissue, also known as implants. These may be found in the tissue lining the abdomen or pelvis. 

Stage II: Mild Endometriosis

In stage II, there are more implants than in stage I, which may be either superficial or deep, with mild adhesions. Stage II is typically characterized by more extensive endometriosis with deep implants present.

Stage III: Moderate Endometriosis

In stage III, deep implants of endometriosis tissue are present. Adhesions may be dense rather than filmy and thin. As a result, endometriosis at this stage is more widespread than in stage II.

Stage IV: Severe Endometriosis

Stage IV, or severe endometriosis, is typically associated with numerous deep endometriosis plaques, large endometriotic cysts on one or both ovaries and many dense adhesions. There is usually also extensive scar tissue in the abdomen and signs of intense inflammation and scarring or fibrosis.

Read More: Can Endometriosis Cause Bowel Issues?

The Nature of Endometriomas

Endometriomas are endometriosis cysts that primarily affect the ovaries. Endometriomas can occur on one ovary or both and affect between 20-40% of patients with endometriosis, many of whom also have stage III-IV disease. The origin of endometriomas is incompletely known, just like endometriosis in general, but likely multifactorial in principle. 

Endometriomas and Stage 4 Endometriosis: The Connection

The question is, “Do endometriomas automatically make you stage 4?” The answer is not straightforward. The presence of ovarian endometriosis or an endometrioma of course contributes to the staging of endometriosis. Each ovary can contribute between 1 and 20 points, varying based on tiny implants to endometriomas greater than three centimeters in size.   However, the presence of endometriomas alone does not automatically classify a patient as having stage 4 endometriosis, which requires 40 or more points.  In addition to ovarian endometrioma,  presence or absence of surrounding adhesions also contributes to the point total. Also, larger endometriomas are often associated with extensive deep pelvic disease.  So, in general, small endometriomas may not mean Stage 4.  But larger ones are quite likely to mean Stage 4 disease is present.  

Read More: What Does Bowel Endometriosis Feel Like? Understanding the Pain and Symptoms

Treatment Options for Stage 4 Endometriosis and Endometriomas

The treatment of stage 4 endometriosis and endometriomas is complex and highly individualized. It depends on various factors, including the patient’s symptoms, age, desire for pregnancy, and overall health.

Treatment options for stage 4 endometriosis can include a combination of hormonal therapy, pain management, and surgery. While hormonal therapy may help control pain it is highly unlikely to shrink endometriomas, let alone resolve them, or effectively treat endometriosis.  This is due to the relative resistance of endometriosis to progesterone and progestins and incomplete dependence on estrogen.  There are major potential health risks and this should be part of the discussion with your chosen endometriosis specialist.  Pain management strategies include over-the-counter and prescription medications, as well as physical modalities like pelvic floor therapy and transcutaneous electrical nerve stimulation (TENS) units.  While this can help manage chronic pain associated with the condition this does not treat the root cause, which is endometriosis and resulting fibrosis.

Minimally invasive surgery under the care of an extremely well trained surgeon is the cornerstone of advanced endometriosis treatment.   This is not surgery that should be undertaken by novices or most general gynecologists.  The reason is mainly due to the fact that anatomy can be severely distorted, making surgery very challenging in terms of achieving excision while limiting complications which can be life threatening or at least very morbid. 

Specifically regarding endometriomas, endometriomas require excision, not drainage.  Draining is very ineffective and the endometrioma can soon recur.  Ideally, any surgical spillage should be minimized because it is not just old blood but also potentially endo-related stromal stem cells, which can implant and grow elsewhere.  Overall, the planning and timing of surgery varies significantly.  Often decisions have to be made based on whether or not fertility is the main concern or pain, or both in equal degrees.  Surgical planning is complex and requires a master surgeon for optimal outcomes.  Especially for the management of Stage 4 endometriosis and endometriomas a highly trained and skilled endometriosis specialist and surgeon is mandatory for your success. 

Read More: Life After Endometriosis Surgery: A Comprehensive Guide

References:

Risk factors for coexisting deep endometriosis for patients with recurrent ovarian endometrioma

Diagnosis and management of endometriosis

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What Does Bowel Endometriosis Feel Like? Understanding the Pain and Symptoms

Endometriosis is a condition affecting roughly 11% of women worldwide, predominantly those of reproductive age. An even more specific form of this ailment is bowel endometriosis, which impacts around 5% to 12% of those diagnosed with endometriosis. In this comprehensive guide, we delve into the intricacies of bowel endometriosis, exploring what it feels like, the symptoms, causes, diagnosis, and treatment options.

What is Bowel Endometriosis?

Bowel endometriosis occurs when endometrial-like tissue, which typically grows inside the uterus, begins to develop on or inside the bowel walls. This can lead to a range of gastrointestinal symptoms, often causing significant discomfort and negatively impacting the quality of life.

Read More: Understanding Bowel Endometriosis

Where Does Bowel Endometriosis Occur?

The condition predominantly affects the rectum and sigmoid colon, with approximately 90% of bowel endometriosis cases directly involving these regions. However, the appendix, small intestine, stomach, and other parts of the large intestine can also be affected.  In many cases, bowel symptoms occur because of the mere presence of intensely inflammatory endo lesions on the peritoneum in the pelvis and abdomen and not even involving the bowel directly with implants. 

Symptoms of Bowel Endometriosis

The symptoms of bowel endometriosis often mimic common gastrointestinal disorders, including small intestinal bacterial overgrowth (SIBO), making it difficult to diagnose. They can range from mild to severe, and often fluctuate depending on the menstrual cycle. 

Common Symptoms

Common symptoms may include:

  • Abdominal pain, particularly in the lower quadrants
  • Bloating, often referred to as “endo belly”
  • Changes in bowel movements, including constipation or diarrhea
  • Nausea and vomiting
  • Pain during bowel movements, which might increase during menstruation
  • Rectal bleeding

Non-Bowel Symptoms

In addition to bowel symptoms, individuals with endometriosis might experience:

  • Chronic pelvic pain
  • Difficulties with fertility
  • Painful sexual intercourse
  • Pain during urination
  • Pelvic heaviness
  • Fatigue
  • Impaired psychological well-being

Causes of Bowel Endometriosis

The exact cause of bowel endometriosis remains unknown. However, Mullerianosis of embryogenic origin and retrograde menstruation are two often-quoted theories. Mullerianosis of embryogenic origin suggests that developmental abnormalities lead to cells being present in atypical locations which later turn into endometriosis.  This includes potential genetic, genomic and immunologic influencing factors.  Retrograde menstruation proposes that period blood flows upward towards the Fallopian tubes and into the pelvis instead of out through the vagina, potentially leading to endometriosis. Given that most women experience retrograde menstruation, and only 10% or so experience endometriosis, this theory is antiquated and has been challenged because of this disconnect.  Far more likely, some combination of embryologic, molecular, immunologic and genetic factors are in play and this can vary between individuals.  

Read More: Can Endometriosis Cause Bowel Issues?

Diagnosis of Bowel Endometriosis

Diagnosing bowel endometriosis is a complex process. It often requires a combination of a good evaluation of symptoms history, physical examination, imaging techniques like ultrasound or MRI, and sometimes minimally invasive laparoscopic or robotic surgery. However, diagnosis could be delayed due to its symptom similarity with other gastrointestinal diseases.  Imaging can only help with diagnosis and potential mapping for surgery.  It is absolutely not reliable enough to exclude the diagnosis of endo

Misdiagnosis

Misdiagnosis is common in bowel endometriosis, with many patients being misdiagnosed with irritable bowel syndrome (IBS) or other gastrointestinal disorders. Therefore, a high index of suspicion is necessary for diagnosis, and any bowel symptoms correlated with the menstrual cycle should be critically evaluated.

The Role of Minimally Invasive Surgery

Surgery with biopsy is considered the “gold standard” in diagnosing endometriosis, including bowel endometriosis. It provides a more accurate diagnosis and gives healthcare providers an exact idea of how much scar tissue and endometrial-like tissue they’re dealing with. Ideally, the surgeon should be prepared to perform a therapeutic surgery at the same time as a diagnosis.  However, a bad surgery is worse than no surgery if the surgeon is unprepared and performs some variation of fulguration (burning) of endometriosis lesions as opposed to proper excision of the lesions or implants.  If diagnostic surgery uncovers a situation where the surgeon is unprepared to properly perform therapeutic excision it is better to back out and refer to an appropriate surgeon. 

Treatment of Bowel Endometriosis

Treatment for bowel endometriosis often involves surgery, as medical management has generally been deemed ineffective for these specific lesions. The chosen surgical method depends on the extent of the condition. In many cases, hormonal options may also be recommended after surgery to reduce recurrence risk.  The better the surgery the less likely this would be required but there are exceptions.   

Surgical Treatment

The surgical treatment of endo usually involves removing all of the peritoneal lesions by an excisional technique. In deeply infiltrating endometriosis, the approach may vary based on the involvement of the rectal wall or the mesentery, which is where the blood vessels to the rectum are located. The treatments for bowel endometriosis include shaving, nodulectomy, disc resection, and bowel resection.  The surgeon should be capable of performing any of these procedures as needed at the time.  In some cases this may be the main excision surgeon, if they have bowel surgery training and hospital prvileges, and in other cases, this may be another surgeon who is part of the backup team.   In the latter situation, it is best if the possibility of bowel surgery and options are addressed before surgery and not as an emergency during surgery, when appropriate surgeons may not be readily available.  

Lifestyle Changes

Alongside medical treatment, lifestyle changes can aid in managing bowel endometriosis symptoms. Some patients find that certain foods or lifestyle habits, such as stress or irregular sleep, may trigger their symptoms. Keeping a journal to track triggers and consulting with a healthcare provider or nutritionist when making dietary changes can be beneficial.

Read More: How to Treat Bowel Endometriosis: A Comprehensive Guide

Coping with Bowel Endometriosis

Living with bowel endometriosis can be challenging, but with the right diagnosis, treatment, and management, individuals can lead fulfilling lives. It’s essential to communicate openly with healthcare providers about symptoms and concerns, as this can aid in diagnosis and treatment planning.

In conclusion, bowel endometriosis is a painful and often misunderstood condition. Increased awareness and understanding of the disease can help in early diagnosis, effective treatment, and improved quality of life for those affected. If you suspect you might have bowel endometriosis or are experiencing any of the symptoms mentioned, do not hesitate to seek medical advice.

References:

Surgical Outcomes after Colorectal Surgery for Endometriosis: A Systematic Review and Meta-analysis

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How to Treat Bowel Endometriosis: A Comprehensive Guide

Bowel endometriosis, a complex and severe variant of endometriosis, is a condition best navigated with a deep understanding of its details. This guide aims to shed light on the various aspects of bowel endometriosis, from its origins to symptoms, diagnostic approaches, and treatment options, to empower those affected.

What is Bowel Endometriosis?

Endometriosis, a chronic health disorder predominantly affecting women in their reproductive years, is characterized by the growth of endometrial-like tissue, which usually lines the uterus in regions outside the uterus. This misplaced tissue prompts an inflammatory reaction, leading to distressing symptoms. When this aberrant tissue growth takes place on or inside the bowels, the condition is referred to as bowel endometriosis.

How Common is Bowel Endometriosis?

While the exact prevalence of bowel endometriosis remains uncertain, it’s estimated to occur in 5-15% of all endometriosis cases. Predominantly, it manifests on the rectum or sigmoid colon but can also affect the appendix or small intestine.

Read More: https://icarebetter.com/endometriosis-and-inflammatory-bowel-disease-distinguishing-the-differences/

Recognizing the Symptoms

Symptoms of bowel endometriosis may not always be apparent, especially in the early stages of the disease. However, as the condition progresses, women may experience discomfort associated with their menstrual cycle, sexual intercourse, bowel movements, and even infertility.

Symptoms commonly associated with bowel endometriosis include:

  • Painful Bowel Movements: This is often accompanied by constipation or diarrhea.
  • Rectal Bleeding: This symptom, which is more uncommon, usually occurs during menstruation.
  • Infertility: Some women may experience difficulty conceiving.
  • Pelvic Pain: Chronic pelvic pain is a common symptom associated with endometriosis, often more severe during menstruation or ovulation.
  • Painful Intercourse: This is often due to the endometriosis lesion causing a distortion of the pelvic anatomy.

It’s important to note that bowel endometriosis can sometimes mimic symptoms of other gastrointestinal conditions, like irritable bowel syndrome (IBS), making it challenging to diagnose.

Diagnosing Bowel Endometriosis

A comprehensive diagnosis of bowel endometriosis usually involves a combination of physical examination, medical history analysis, and advanced imaging techniques. The diagnostic process may include:

  • Physical Examination: This includes a manual check for growths in the rectum or vagina.
  • Imaging Tests: These can include ultrasound, MRI, colonoscopy, and barium enema.
  • Laparoscopy: This surgical procedure is considered the gold standard for diagnosing endometriosis, as it allows for visual examination of the uterus, ovaries, and other pelvic structures. And surgeons can take samples for histopathology evaluations.

Read More: Understanding Bowel Endometriosis

Treating Bowel Endometriosis: An Overview

Treatment for bowel endometriosis is complex and multifaceted. It requires a personalized approach, taking into account the severity of the disease, the patient’s age, fertility goals, and personal preferences. The primary treatment options include:

  • Hormonal Therapy: This involves medications that control estrogen levels, which can influence the progression of endometriosis. These medications can help manage pain and other symptoms.
  • Pain Management: Over-the-counter or prescription nonsteroidal anti-inflammatory drugs (NSAIDs) may be recommended to help alleviate pain.
  • Surgery: Surgical interventions aim to remove as much endometrial tissue as possible while preserving organ function.

Surgical Treatment Options

Surgery is typically the primary treatment for bowel endometriosis, particularly for severe cases. The goal of surgery is to remove endometrial implants without compromising the functionality of the organs involved. There are three main surgical options:

  • Segmental Bowel Resection: This involves removing the section of the bowel affected by endometriosis and reconnecting the healthy portions. This option is often recommended for larger areas of endometriosis.
  • Rectal Shaving: This procedure involves shaving off the endometriosis from the top of the bowel without removing any portion of the intestines. It’s often used for smaller areas of endometriosis.
  • Disc Resection: In this procedure, a surgeon cuts out a small disk where the endometriosis lesions appear and then closes the remaining hole.

Understanding the Risks of Surgery

Surgery for bowel endometriosis is a complex procedure associated with certain risks. These can include short-term complications such as infection, leakage of bowel content during the postoperative healing phase, peritonitis, and septicaemia. Long-term risks might include bowel dysfunction, characterized by frequency, urgency, and incontinence.

Read More: Finding an Excision Specialist: What you Need to Know

Hormone Treatment Options

Although hormonal treatments cannot halt the progression of endometriosis, they can help manage symptoms. Hormonal treatments for bowel endometriosis can include birth control pills, progestin injections, or, less favorably, gonadotropin-releasing hormone (GnRH) agonists.

Read more: What are the long-term side effects of Lupron?

Managing Symptoms and Quality of Life

Bowel endometriosis can significantly impact the quality of life of those affected. However, with appropriate treatment and management strategies, many women affected by this condition can lead fulfilling lives. Communication with your healthcare team, lifestyle modifications, and psychological support can all contribute to improving the quality of life.

Conclusion

Understanding how to treat bowel endometriosis is crucial for managing this complex and often painful condition. With the right approach, it’s possible to mitigate symptoms, improve fertility outcomes, and enhance the quality of life for those affected. If you suspect you have bowel endometriosis, it’s important to speak with a healthcare provider who can guide you through the diagnostic process and treatment options. With the right knowledge and resources, you can navigate this challenging condition and find a path to improved health and well-being.

References:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4229526/

https://weillcornell.org/news/what-is-bowel-endometriosis

https://www.webmd.com/women/endometriosis/bowel-endometriosis

https://www.healthline.com/health/womens-health/bowel-endometriosis

Bowel Endometriosis

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Can Endometriosis Cause Bowel Issues?

Endometriosis is a common but often under-recognized condition, primarily affecting women between 15-50. It results from the growth of tissue similar to the endometrium (the lining of the uterus) outside the uterus. This article explores the question: Can endometriosis cause bowel issues?

Understanding Endometriosis

Endometriosis is a condition where tissue, similar to the kind that lines the uterus (the endometrium), grows outside the uterus. This condition usually affects the ovaries, fallopian tubes, and the tissue lining the pelvis. However, in some cases, it can also affect other organs, including the bowel.

Endometriosis and Bowel Involvement

When endometriosis affects the bowels, it typically occurs in two forms:

  • Superficial: The endometriosis tissue is located on the surface of the bowel.
  • Deep: The endometriosis tissue passes through the bowel wall.

In both cases, doctors usually find a small mass of tissue, known as a lesion, on the bowel wall. More rarely, these lesions can penetrate into the muscular layer of the bowel.

Read More: Endometriosis and Inflammatory Bowel Disease: Distinguishing the Differences

Causes of Endometriosis

While the definitive cause of endometriosis remains unknown, several contributing factors have been identified. These include hormonal imbalances, immune system problems, and genetic factors.

Symptoms of Bowel Endometriosis

The symptoms of bowel endometriosis can vary, depending on the location and size of the lesion, and how deep it is within the bowel wall. These symptoms often mimic those of irritable bowel syndrome (IBS), but there are key differences.

Some of the common symptoms include:

  • Trouble pooping or loose, watery stools (constipation or diarrhea)
  • Pain during bowel movements
  • Menstrual discomfort
  • Painful sex
  • Difficulty getting pregnant (infertility)
  • Blocked bowel (this is a rare symptom)

Diagnosing Bowel Endometriosis

Diagnosing bowel endometriosis can be challenging due to its similarities with other conditions. However, if you have other endometriosis symptoms, such as painful periods, painful sex, lower back pain, or abdominal bloating and discomfort, it’s critical to talk to your doctor.

Read More: Understanding Bowel Endometriosis

Misdiagnosis of Bowel Endometriosis

Unfortunately, bowel endometriosis is often misdiagnosed as irritable bowel syndrome or other gastrointestinal diseases. This is because the symptoms of bowel endometriosis can mirror those of IBS, Crohn’s disease, and appendicitis.

Read More: Finding an Excision Specialist: What you Need to Know

Treatment for Bowel Endometriosis

Treatment for bowel endometriosis is usually tailored to the patient’s symptoms and medical history. The most common treatments include surgery, hormone treatments, and counseling.

Coping with Bowel Endometriosis

Bowel endometriosis is a challenging condition to live with. It not only affects your physical health but also your mental well-being. Many patients have found some symptom relief through lifestyle changes, including dietary adjustments and regular exercise.

The Importance of Early Detection

Given the potential complications of bowel endometriosis, early detection and treatment are crucial. If you experience bowel issues alongside painful menstruation, it’s essential to consult with a healthcare professional.

Conclusion

The question, “Can endometriosis cause bowel issues?” is undoubtedly answered with a resounding yes. However, with timely detection, appropriate treatment, and necessary lifestyle changes, it’s possible to manage the symptoms and lead a healthy life.

Additional Information

This article is a comprehensive exploration of how endometriosis can impact bowel health. It’s essential to remember that while this condition can cause significant discomfort and health issues, effective treatments are available. If you suspect you have endometriosis, don’t hesitate to reach out to a healthcare provider.

References:

https://www.webmd.com/women/endometriosis/bowel-endometriosis

https://www.endofound.org/gastrointestinal-distress

https://maidenlanemedical.com/endometriosis/endometriosis-and-constipation/

https://drseckin.com/bowel-endometriosis/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4604671/

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Anti-Mullerian Hormone & Endometriosis – What’s The Connection?

Endometriosis has been associated with a marker called Antimullerian hormone (AMH), which is a pivotal marker of ovarian reserve, and is commonly measured in women with endometriosis specifically in relation to fertility. There is debate among the community that your AMH level is what it is and it cannot change. I would challenge this notion though as I have seen people with endometriosis have significant increases after proper excision surgery, which is a point of debate. Recently, I had another patient send me lab work that demonstrated what some may call a low AMH, has confirmed endometriosis, but likely a surgery that was incomplete and is continuing to suffer ongoing symptoms. Though I have seen this change in my patients, I recognize this is only a small fraction of the people suffering, so it was time to review what the research says. This article aims to provide a review of the various studies conducted on this critical subject, exploring how endometriosis and AMH interact, the effect of surgical intervention on AMH levels, and the subsequent impact on fertility.

The Antimullerian Hormone (AMH): A Brief Overview

AMH, a hormone playing diverse roles during embryonic development and puberty, is produced by ovarian follicles smaller than 8 mm, hence linking ovarian reserve to AMH levels in the blood. The normal range for AMH hovers between 1 and 4 ng/mL. However, women’s AMH levels greatly vary based on factors like age, ethnic background, lifestyle, and genetics. Additionally, someone at the low end of range may still suffer problems despite them being “in range.” 

AMH Testing in Reproductive Health

AMH testing is a crucial tool for evaluating female fertility. It can assist in:

  1. Assisting with understanding the prognosis of a woman’s response to assisted reproduction techniques (ART) such as in vitro fertilization (IVF)
  2. Confirming other markers of menopause
  3. Providing a more comprehensive evaluation when certain conditions are confirmed or suspected such as polycystic ovarian syndrome (PCOS), premature ovarian failure, and endometriosis

Endometriosis and AMH Levels

Endometriosis is a common culprit behind infertility, affecting nearly half of the women suffering from this ailment. This infertility arises from various factors, including inflammation in the reproductive tract, scar tissue-induced decreased blood supply to the ovaries, and pelvic anatomical distortions. Research reveals a significant correlation between endometriosis and lower than average AMH levels.

Some argue that surgical intervention of endometriosis often leads to a reduction in AMH levels, though many of us in the community may argue that this is a more nuanced topic and this highly depends on the skill of the surgeon, something that is often overlooked in endometriosis research.  Various studies have attempted to decipher the impact of endometriosis surgery on AMH levels and fertility outcomes. A retrospective study conducted in 2016 found that preoperative AMH levels did not influence pregnancy rates after surgery. This is consistent with the literature we have on surgical impact, and thus the need for better research in the future. In my experience, this is the opposite of what I have seen, as many of us have seen when people get to the right surgeon. 

Laparoscopic Cystectomy on AMH Levels

Laparoscopic ovarian cystectomy, a common surgical procedure to treat endometriomas, has been associated with decreased ovarian reserve. A study in 2019 demonstrated significantly lower AMH levels in women who underwent laparoscopic endometrioma cystectomy, especially in cases with bilateral cysts larger than 7 cm and stage 4 endometriosis. 

Considerations: I want to highlight that we do not know the skill of the surgeon, but we do know that the skill of the surgeon matters. That being said, large endometriomas can often overtake ovarian tissue which is what happened to Christina. Hear her story here. This is why it is extremely important to find a knowledgeable surgeon that you feel comfortable with. If you need help finding a surgeon, you can start here. 

Laparoscopic Endometriosis Surgery on AMH Levels

A literature review and meta-analysis of 19 studies conducted between 2010 and 2019 on the impact of laparoscopic endometriosis surgery on AMH levels post-surgery revealed a decline in AMH levels, extending beyond six months post-surgery. This decline was more pronounced in cases where surgery was performed on both sides of the body, compared to a single side.

Again, I would argue that we consider the quality of the research and the skill of the surgeon. Remember, ablation is different from excision and this may be another factor that is skewing results. I repeat this because, like many of us in the community, this is not our experience, thus I often read research with these things in mind. If many others in the community are also seeing this, there must be more to consider than what is presented. The bottom line is that we need better research. 

AMH Levels Post-Surgery for Endometrioma

Several studies have observed that laparoscopic ovarian cystectomy results in a significant and progressive decrease in AMH levels post-surgery. However, other studies have noted that this decrease may only be temporary, with levels potentially returning to normal within a year. Another factor to consider is when the AMH was measured post-surgery and what other factors may have impacted the levels! 

Certain studies have observed a temporary decrease in AMH levels following endometrioma ablation. However, this decrease did not persist beyond six months in most cases, suggesting a potential recovery of ovarian reserves. 

Several studies have compared the decrease in AMH levels following ovarian cystectomy and endometrioma vaporization. The general consensus suggests a higher postoperative decline in AMH levels following cystectomy compared to vaporization, particularly in bilateral endometrioma cases.

This caught my attention and highlights my thoughts on how the surgery (excision) is being performed as to not compromise ovarian tissue. Using ablation, which is what the CO2 laser is referring to, may not compromise the ovarian tissue, but it also may not treat the disease. Paul Tyan, MD discusses this complex topic in our interview which you can find here. 

The combined technique, involving partial cystectomy and ablation, has been shown to have less detrimental effects on the ovary, resulting in a lesser decline in AMH levels post-surgery.

The role of endometriosis surgery in improving pregnancy rates remains a topic of debate. Some studies suggest that surgery might improve the success rates of fertility treatment, while others highlight the risk of ovarian damage due to surgical intervention.

In conclusion, the Antimullerian hormone is a vital marker for assessing the impact of endometriosis and its surgical intervention on ovarian reserve and fertility. Understanding the complex relationship between AMH levels, endometriosis, and surgical intervention along with identifying gaps in the research can help medical professionals devise more effective treatment strategies, improve the quality of research studies which ultimately improves patient outcomes.

IRelated Reading:

  1. Does Endometriosis Cause Infertility? Covering the Basics
  2. Endometriosis and Pregnancy: Natural, Medical, & Surgical Options

References:

  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6603105/
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7865255/
  3. https://drseckin.com/endometriosis-surgery-and-amh-levels/

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Colon Chronicles: Delving into Bowel Endometriosis

In our recent blog, we highlighted the significance of addressing bowel endometriosis, a condition prone to misdiagnosis. Whether individuals have struggled with lifelong bowel issues or are suddenly facing disruptions, determining what’s considered normal can be perplexing. The “normal” range spans anywhere from three times a day to as infrequent as three times per week. In many sources, the focus is typically limited to frequency and to some degree consistency; however, there’s an overall scarcity of information on what defines normalcy. 

ICYMI: Understanding Bowel Endometriosis

This ambiguity is particularly challenging for those with endometriosis, where gastrointestinal symptoms vary widely, making it tough to discern what’s amiss. About 90% of endometriosis cases involve some form of gastrointestinal symptoms, often leading to an IBS (irritable bowel syndrome) diagnosis, which essentially offers a label for persistent symptoms without an identifiable cause. The usual next step in diagnostics is often a colonoscopy, a key tool for identifying or ruling out certain diseases. This article explores the nuances of bowel endometriosis, with a primary focus on the role and precision of colonoscopy in diagnosing this condition.

Bowel endometriosis is considered to be deep infiltrating endometriosis and can lead to a variety of symptoms which we discussed in the previous blog, but is often concerning if not diagnosed timely and may risk more complex surgeries including resection if the disease is not properly addressed. 

Related Reading: How to Get an Endometriosis Diagnosis

The Role of Colonoscopy – Is it helpful?

A colonoscopy is a diagnostic procedure commonly used to examine the inner lining of the large intestine (colon and rectum). It involves the use of a long, flexible tube called a colonoscope, which has a small camera attached to its end. This tool allows physicians to visualize the interior of the colon to identify any abnormal conditions or changes.

In the context of bowel endometriosis, a colonoscopy can potentially detect signs of endometrial tissue growth within the bowel. However, its effectiveness and accuracy in diagnosing this condition have been subjects of ongoing research and debate. Aside from its ability to detect endometriosis, there is also consideration of the provider performing the procedure and their level of knowledge of endometriosis. 

The use of colonoscopy in diagnosing bowel endometriosis has been a topic of considerable discussion among medical professionals. Given the invasive nature of the procedure and the often non-specific symptoms of bowel endometriosis, the role and necessity of colonoscopy in its diagnostic process have been questioned.

However, several case studies and research findings suggest that colonoscopy can indeed play a crucial role in identifying bowel endometriosis. In particular, it has been found to be effective in detecting endometriosis growth in the bowel, with certain colonoscopic findings such as eccentric wall thickening, polypoid lesions, and surface nodularities often being associated with endometriosis.

Evaluating the Accuracy of Colonoscopy for Diagnosing Bowel Endometriosis

While the potential of colonoscopy in detecting bowel endometriosis has been recognized, its accuracy in doing so has been the subject of extensive research. A number of studies have sought to evaluate the sensitivity, specificity, and predictive values of colonoscopy in diagnosing this condition.

One such study was conducted by Milone M et al., who performed a prospective observational study that included women diagnosed with deep pelvic endometriosis. The study aimed to evaluate the accuracy of colonoscopy in predicting intestinal involvement in deep pelvic endometriosis.

The results of the study suggested that colonoscopy did have the potential to detect bowel endometriosis, with a number of cases accurately diagnosed through the procedure. However, the overall sensitivity, specificity, and predictive values of colonoscopy were found to be variable, indicating room for improvement in its diagnostic accuracy.

In another study conducted by Marco Milone and his team, the researchers also found that while colonoscopy could indeed identify bowel endometriosis, its accuracy was not optimal. The study elucidated that the presence of colonoscopic findings of intestinal endometriosis in deep pelvic endometriosis was quite low, indicating that routine colonoscopy may not be justified for all women with deep pelvic endometriosis.

A Case Study: Bowel Endometriosis and Colonoscopy

To illustrate the potential role of colonoscopy in diagnosing bowel endometriosis, let’s consider a case study involving a 45-year-old woman who presented with abdominal pain in her left lower quadrant. This woman underwent a colonoscopy, which revealed a submucosal tumor-like lesion in her sigmoid colon.

Upon further examination using magnifying endoscopy, the lesion was found to contain sparsely distributed round pits – a finding that was suggestive of endometrial glands and stroma (the histological definition of endometriosis). This discovery led to a biopsy of the lesion, the results of which confirmed the presence of intestinal endometriosis.

This case study serves to highlight how colonoscopy, when combined with other diagnostic methods like magnifying endoscopy and biopsy, can aid in the detection and diagnosis of bowel endometriosis.

The Future of Bowel Endometriosis Diagnosis

While the role and accuracy of colonoscopy in diagnosing bowel endometriosis have been explored, research in this area is ongoing. The development and refinement of diagnostic methods are crucial for improving the detection and treatment of bowel endometriosis.

In parallel with the innovations in medical technology, new diagnostic methods such as magnifying chromoendoscopy, target biopsy, and virtual colonoscopy are being explored and studied for their potential to improve the accuracy of bowel endometriosis diagnosis. These advancements, coupled with a deeper understanding of the condition, may pave the way for more accurate and less invasive diagnostic options in the future.

Bowel endometriosis is a complex condition that can significantly impact the quality of life of those affected. While colonoscopy can play a role in its diagnosis, its effectiveness and accuracy are subject to continuous research and improvement. Exploring new diagnostic methods and refining existing ones are crucial steps toward enhancing the detection and treatment of this condition. As we continue to learn more about bowel endometriosis and its nuances, we can hope for more efficient and accurate diagnostic tools in the future.

Related Reading:

  1. Endo-Fighting Microbiome Optimization: Research-based Tips
  2. Endometriosis and the Microbiome: Insights and Emerging Research

References:

  1. Walter SA, Kjellström L, Nyhlin H, Talley NJ, Agréus L. Assessment of normal bowel habits in the general adult population: the Popcol study. Scand J Gastroenterol. 2010;45(5):556-566. doi:10.3109/00365520903551332
  2. Habib, N., Centini, G., Lazzeri, L., Amoruso, N., El Khoury, L., Zupi, E., & Afors, K. (2020). Bowel Endometriosis: Current Perspectives on Diagnosis and Treatment. Int J Womens Health, 12, 35-47. https://doi.org/10.2147/IJWH.S190326 
  3. Milone, M., Mollo, A., Musella, M., Maietta, P., Sosa Fernandez, L. M., Shatalova, O., Conforti, A., Barone, G., De Placido, G., & Milone, F. (2015). Role of colonoscopy in the diagnostic work-up of bowel endometriosis. World J Gastroenterol, 21(16), 4997-5001. https://doi.org/10.3748/wjg.v21.i16.4997 
  4. Tomiguchi, J., Miyamoto, H., Ozono, K., Gushima, R., Shono, T., Naoe, H., Tanaka, M., Baba, H., Katabuchi, H., & Sasaki, Y. (2017). Preoperative Diagnosis of Intestinal Endometriosis by Magnifying Colonoscopy and Target Biopsy. Case Rep Gastroenterol, 11(2), 494-499. https://doi.org/10.1159/000475751 

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Endometriosis: Is it a Disability?

Endometriosis, a debilitating condition affecting millions of women globally, often prompts questions about its influence on daily life and work ability. This article provides an in-depth analysis of endometriosis, how it affects women’s work ability, and the possibility of qualifying for disability benefits.

Endometriosis is a medical condition that primarily affects women during their reproductive years, and is very prevalent, with over 80 million women diagnosed worldwide, typically between the ages of 20 and 40. Treatments such as surgery and medical management as well as physical therapy can alleviate some symptoms, but there is currently no definitive cure for the disease.

Endometriosis and Disability: An Intricate Relationship

The symptoms of endometriosis vary greatly among individuals. The most common symptom is pelvic pain, particularly during menstruation, sexual intercourse, bowel movements, or urination. Other symptoms include abdominal bloating, nausea, as well as infertility, among other symptoms. 

Endometriosis can significantly disrupt daily functioning due to associated symptoms such as pain, fatigue, and psychological distress especially during one’s menses (period) but is not always confined to that time of the month. Consequently, the disease might qualify as a disability under the Americans with Disabilities Act (ADA) in certain cases. However, it is important to know that the Social Security Administration (SSA) does not automatically classify endometriosis as a disability.

Endometriosis and Social Security Disability Benefits

Qualifying for Social Security disability benefits due to endometriosis is not straightforward. The SSA considers two primary factors when determining if an individual qualifies for SSDI (Social Security disability insurance) or SSI (Supplemental Security Income) disability benefits:

1. Does the individual’s condition meet (or equal) the requirements of a listed impairment?

2. If not, do the symptoms of endometriosis significantly interfere with the individual’s ability to function, to the point where they cannot perform any type of job safely?

Since endometriosis is not listed as a qualifying condition, sufferers cannot automatically meet the first criterion. However, they might still qualify for Social Security disability if their symptoms significantly impede their ability to work, what the SSA calls “substantial gainful activity,” or SGA.

How to Qualify for Social Security Disability for Endometriosis

To qualify for Social Security disability due to endometriosis, it must be demonstrated that the symptoms of the disease prevent the afflicted individual from performing their job. The SSA will then assess if there is any type of job that the individual can safely perform. This evaluation considers medical records, age, work experience and job skills, education, and residual functional capacity (the minimum work that can be expected from an individual).

Applying for Social Security Disability for Endometriosis

Applications for Social Security disability benefits can be made online, through a phone call to the Social Security’s national office, or in person at a local Social Security field office. Winning a disability claim for endometriosis can be challenging, but applicants can seek assistance from an experienced disability attorney or non-attorney representative.

Endometriosis and Employment: A Complex Scenario

While endometriosis can significantly impact an individual’s ability to work, it does not automatically lead to unemployment or early retirement. In fact, many women suffering from endometriosis are able to maintain their employment status, albeit with certain adjustments to accommodate their symptoms.

Work Ability and Endometriosis

A woman’s ability to work can be severely compromised by endometriosis, with the disease often linked to poor work ability at age 46. This decreased work ability can lead to increased absence from work due to health issues. However, despite the increased absenteeism, women with endometriosis often maintain an employment rate comparable to women without the disease. It makes you question why? 

Over the past few years, emphasis has been put on staying home if you are sick, as a safety measure for spreading disease, though many with endometriosis may not be able to afford days off of work either because financially they are unable, or there is worry about saying PTO for an unexpected turn of event such as a necessary surgery, or increased symptoms causing debilitating pain. So we suffer through expecting there to be worse days. Women in general, tend to minimize their own symptoms or question if they are “really that bad” as a result of societal influences.

Disability Retirement and Endometriosis

The emergence of disability retirement due to endometriosis is not common. Despite the debilitating symptoms of the disease, the risk of early retirement is not significantly higher for women with endometriosis compared to those without the condition. This finding is encouraging and demonstrates the resilience and determination of women battling this condition. Or, is it that those with endometriosis stay working longer because of the financial need and medical bills?

Conclusion

Endometriosis is a complex and debilitating condition that can significantly impact a woman’s ability to work. However, it does not inevitably lead to unemployment or early retirement per the literature, though that does not mean that those living with the condition are able to work feeling well or without worry about consequences of not working.  With appropriate medical treatment and workplace accommodations, we hope that not only can those with endometriosis keep working, but with a higher quality of life while working. 

Related Reading:

  1. Endometriosis Facts & Myths: Dispelling the Misconceptions
  2. Endometriosis Signs and Symptoms: Everything You Need to Know
  3. Endometriosis Signs and Symptoms: Everything You Need to Know

References:

  1. The Americans with Disabilities Act www.ada.gov
  2. Rossi, H., Uimari, O., Arffman, R., Vaaramo, E., Kujanpää, L., Ala‐Mursula, L., Piltonen, T.T., 2021. The association of endometriosis with work ability and work life participation in late forties and lifelong disability retirement up till age 52: A Northern Finland Birth Cohort 1966 study. Acta Obstetricia et Gynecologica Scandinavica 100, 1822–1829. 

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The History of Endometriosis: Unraveling the Theories and Advances  [or lack thereof]

Endometriosis is a complex condition that affects a significant number of women (XX) and on average takes 7-10 years for a diagnosis. The majority of people date their symptoms back to adolescence though go years seeking answers. Throughout their journey, many people  receive either a wrong diagnosis or were simply dismissed altogether.  In recent years, there has been a marked improvement in the recognition of the word ‘endometriosis’ but why does this disease remain such an enigma to so many healthcare professionals? Furthermore, endometriosis has been a subject of medical investigation for over a century with debates about how to approach treatment, understanding of the pathogenesis, clinical manifestations, and treatment methods.

Research in this field has evolved over time, but are we really that much further along than we were a century ago? One of the most frustrating concepts for those of us who truly understand endo, is the regurgitation of the theory of retrograde menstruation postulated in the 1920’s by Dr. John A. Sampson. The theory that endometriosis is derived from retrograde menstruation is an incomplete understanding of this original theory, that has perpetuated misinformation and our current recommended treatments – hormonal suppression and hysterectomies. Sampon’s original theory was more involved, but future research into alternative theories seems much more promising. Even so, our current “validated or trusted treatments” are still rooted in early understanding. This article delves into the intricate history of endometriosis, tracing its theories and advances, or lack thereof, to provide a comprehensive overview of this complex condition.

The Early Recognition of Endometriosis

Initial Observations and Descriptions

The first description of a disease resembling endometriosis can be attributed to Thomas Cullen in the early 20th century.1 Cullen identified endometriosis and adenomyosis as a single disease, characterized by the presence of endometrium-like tissue outside the uterine cavity.2 This breakthrough laid the foundation for future research and understanding of endometriosis.

Sampson’s Theory of Retrograde Menstruation

The term “endometriosis” was coined by John A. Sampson in the late 1920s.3 Sampson proposed the theory of retrograde menstruation as the primary cause of endometriosis, due to the observation during surgery of the similarity in endometriosis lesions and the endometrium, suggesting that endometrial cells are transported to ectopic locations via menstrual flow. This theory gained widespread acceptance and significantly influenced the direction of endometriosis research. Though he did note early on that there were additional factors to allow the growth of these lesions to transform, similar to more current theories and the immune system involvement.

Advances in Diagnosing Endometriosis

The Advent of Laparoscopy

The introduction of laparoscopy in the 1960s revolutionized the diagnosis of endometriosis.4 This minimally invasive surgical procedure allowed physicians to visually identify and classify endometriosis lesions, leading to a significant increase in the diagnosis of the disease.

Differentiating Clinical Presentations

With the advent of laparoscopy, three distinct clinical presentations of endometriosis were identified: peritoneal, deep adenomyotic, and cystic ovarian.5 These classifications, along with advances in imaging techniques such as ultrasound and magnetic resonance imaging (MRI), have improved the precision of endometriosis diagnosis.

Development of Medical Therapies for Endometriosis

Early Interventions

The first attempts at treating endometriosis with synthetic steroids began in the 1940s.6 Initially, androgenic substances were used, but their side effects led to a search for more effective and tolerable treatments. Fun fact: testosterone was actually the first hormone used in attempts to “treat” the disease. 

The Pseudo-pregnancy Regimen

The 1950s saw the advent of the “pseudo-pregnancy” regimen, where hormones were used to mimic the hormonal environment of pregnancy, thereby suppressing ovulation and endometrial growth.7 During this time, there were limited options and this suggestions came from the observation that symptoms were improved when pregnancy occurred. This approach utilized a combination of estrogen and progestin medications and marked a significant advance in the medical management of endometriosis. At this time, birth control was becoming more widespread and more options were being developed. The myth that is still perpetuated today by uninformed practitioners and society of “just get pregnant, it will cure your endo” or “just have a baby” stems from this belief. In 1953 a physician legitimized the limited options and made recommendations suggesting that frequent and often pregnancy was one of the only options and “subsidize your children” was the solution for the increased financial burden. There are so many infuriating suggestions at this recommendation, but the 50’s were a different time, with limited research and options. 

Gonadotropin-Releasing Hormone (GnRH) Agonists

Gonadotropin-releasing hormone (GnRH) agonists emerged as a primary medical therapy for endometriosis in the late 20th century.8 These drugs work by reducing the production of estrogen, thereby limiting the growth of endometriotic tissue, at least in theory. However, the side effects of hypoestrogenism led to the development of ‘add-back’ therapies to mitigate these effects.Not to mention poor regulation and research practices present in the 1990’s including falsified data on the true impact of these drugs. 

Evolution of Surgical Treatments

Conservative Surgery & Advancements in Endoscopic Surgery

The development of laparoscopy also transformed the surgical management of endometriosis. Conservative surgical techniques, including the excision of visible endometriosis lesions and adhesion lysis, became feasible.9 These procedures aimed to preserve fertility while effectively managing the disease. The late 20th century saw further advancements (again, in theory) in laparoscopic surgery for endometriosis. Techniques such as CO2 laser vaporization and the use of circular staplers for bowel resection improved the effectiveness and safety of surgery.10

Unraveling the Pathogenesis of Endometriosis

The Role of the Peritoneal Environment

Research in the 1980s began to focus on the peritoneal environment’s role in endometriosis. Studies found evidence of a local peritoneal inflammatory process, including increased activation of peritoneal macrophages and elevated cytokine and growth factor concentrations.11

Endometrial Dysfunctions

Investigations also revealed biochemical differences between eutopic and ectopic endometrium in women with endometriosis. These differences suggested that endometriosis might be associated with endometrial dysfunction, contributing to both the pathogenesis and sequelae of the disorder.12 While research exists that shows differences in BOTH the endometriosis lesions and the endometrial environment, this is correlational research, and does not imply causation. 

Immunological Factors

The involvement of the immune system in the pathogenesis of endometriosis was another significant discovery. Altered immune responses, including decreased T-cell and natural killer cell cytotoxicities, were observed in those with endometriosis.13

The Connection Between Endometriosis and Adenomyosis

In the late 20th century, researchers revisited the connection between endometriosis and adenomyosis, suggesting that the two conditions might represent different phenotypes of the same disorder.14 This theory proposed that both endometriosis and adenomyosis are primarily diseases of the junctional zone myometrium.

Modern Approaches to Endometriosis Treatment

Use of Gonadotropin-Releasing Hormone Agonist and Levonorgestrel-Releasing Intrauterine System

In more recent years, GnRHa therapy, often combined with ‘add-back’ therapy, has become a popular “treatment” for endometriosis.15 The levonorgestrel-releasing intrauterine system (LNG-IUS), which releases a progestin hormone into the uterus, has also shown promise in the management of endometriosis-associated chronic pelvic pain.16 In reality, this may be more true for adenomyosis and further research is needed. Research with less bias seems to oppose these claims stating that “GnRH drugs show marginal improvement over no active treatment” when compared with other hormonal suppression medications. Thanks to marketing, this is not well known among consumers. 19 Not to mention the significant side effects that further contribute to the various chronic overlapping pain syndromes associated with endometriosis. 

The Future of Endometriosis Research and Treatment

The evolution of endometriosis theories and advances underscores the complexity of this condition. As we continue to unravel the mysteries of endometriosis, there is an ongoing need for research into its pathogenesis, diagnosis, and treatment. The future of endometriosis research and treatment lies in a deeper exploration of its genetic-epigenetic aspects, the role of oxidative stress, and the impact of the peritoneal and upper genital tract microbiomes.18

Conclusion

The history of endometriosis is marked by a continual evolution of theories, advancements in diagnostic and therapeutic approaches, and an expanding understanding of the disease’s complex pathogenesis. From the initial descriptions by Thomas Cullen to the modern laparoscopic techniques and hormonal therapies, the journey of understanding and treating endometriosis has indeed been a frustrating one.

One of the most frustrating aspects is that when we really understand the first observations of endometriosis in the 1800’s into the early 1900’s, it is not far from where we are today. This demonstrates the serious need for more research, better research, and more in depth understanding of the pathogenesis and treatment approaches for endometriosis. While this has improved in the last five years, it is not enough. We need to do more, and we need to do better. Healthcare policy change is an extremely slow process and in my personal observation, decided among individuals who show less understanding than those with the disease. 

10. References

Disclaimer: This article is intended to provide general information on the topic and should not be used as a substitute for professional medical advice. Always consult with your healthcare provider for personal medical advice.

  1. Cullen, T. (1920). Adenomyoma of the Uterus. WB Saunders.
  2. Sampson, J.A. (1927). Metastatic or Embolic Endometriosis, due to the Menstrual Dissemination of Endometrial Tissue into the Venous Circulation. American Journal of Pathology, 3(2), 93–110.
  3. Sampson, J.A. (1927). Peritoneal endometriosis due to menstrual dissemination of endometrial tissue into the peritoneal cavity. American Journal of Obstetrics & Gynecology, 14, 422–469.
  4. Brosens, I., & Benagiano, G. (2011). Endometriosis, a modern syndrome. Indian Journal of Medical Research, 133(6), 581–593.
  5. Amro, B., et al. (2022). New Understanding of Diagnosis, Treatment and Prevention of Endometriosis. International Journal of Environmental Research and Public Health, 19(11), 6725.
  6. Miller, E.J. (1944). The use of testosterone propionate in the treatment of endometriosis. American Journal of Obstetrics & Gynecology, 48(2), 181–184.
  7. Kistner, R.W. (1958). The use of newer progestins in the treatment of endometriosis. American Journal of Obstetrics & Gynecology, 75(2), 264–278.
  8. Hughes, E., et al. (2007). Ovulation suppression for endometriosis for women with subfertility. Cochrane Database of Systematic Reviews, (3), CD000155.
  9. Brosens, I., et al. (2022). New Understanding of Diagnosis, Treatment and Prevention of Endometriosis. International Journal of Environmental Research and Public Health, 19(11), 6725.
  10. Keckstein, J., & Becker, C.M. (2020). Endometriosis and adenomyosis: Clinical implications and challenges. Best Practice & Research Clinical Obstetrics & Gynaecology, 69, 92–104.
  11. Dmowski, W.P., & Braun, D.P. (1997). Immunology of endometriosis. Best Practice & Research Clinical Obstetrics & Gynaecology, 11(3), 365–378.
  12. Lebovic, D.I., et al. (2001). Eutopic endometrium in women with endometriosis: ground zero for the study of implantation defects. Seminars in Reproductive Medicine, 19(2), 105–112.
  13. Dmowski, W.P., & Braun, D.P. (1997). Immunology of endometriosis. Best Practice & Research Clinical Obstetrics & Gynaecology, 11(3), 365–378.
  14. Leyendecker, G., et al. (2009). Endometriosis results from the dislocation of basal endometrium. Human Reproduction, 24(9), 2130–2137.
  15. Surrey, E.S., & Soliman, A.M. (2019). Endometriosis and fertility: A review of the evidence and an approach to management. Journal of the Society of Laparoendoscopic Surgeons, 23(2), e2018.00087.
  16. Vercellini, P., et al. (2003). Endometriosis and pelvic pain: relation to disease stage and localization. Fertility and Sterility, 79(2), 156–160.
  17. Sutton, C.J., et al. (1994). Laser laparoscopy in the treatment of endometriosis: a 5 year study. British Journal of Obstetrics and Gynaecology, 101(3), 216–220.
  18. Brosens, I., & Benagiano, G. (2011). Endometriosis, a modern syndrome. Indian Journal of Medical Research, 133(6), 581–593.
  19. Johnson, N. P., Hummelshoj, L., & World Endometriosis Society Montpellier, C. (2013). Consensus on current management of endometriosis. Hum Reprod, 28(6), 1552-1568. 

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Endometriosis And Menopause: Everything You Need To Know

If you’ve been told that endometriosis goes away after menopause, this may not be the case. So, this may not be a great strategy if you’re trying to “wait out” endo through perimenopause and into menopause. 

It is reasonable to think that chronic conditions of your female reproductive organs, like endo, might also go away when you stop having periods. Here’s a look at how endo may or may not change after menopause, based on what we know about molecular biology and hormonal changes as you get older.

This article will cover:

1- Does menopause cure endometriosis?

2- Endometriosis management after menopause

3- Endometriosis after menopause: The molecular biology

4- Endometriosis Symptoms after menopause

5- Endometriosis-molecular level

6- Estrogen replacement after menopause with endo: is it safe?

7- How about compounded natural or bioidentical hormones?

8- How about plant-based phytoestrogens?

9- When is surgery an option for peri and post-menopause endometriosis?

10- Surgical concerns

Does menopause cure endometriosis?

Natural menopause does not occur overnight and it might take years before estrogen levels from the ovaries become negligible.  Active growth of endo may decrease at this point but, given other estrogen sources discussed in this article and internal molecular factors, it may not stop. So, trying to wait out endometriosis until menopause is final may give it another 5 years or more to grow and cause problems.  An active treatment strategy to address endo that persists into peri-menopausal years might limit the damage and lead to better results.    

Endometriosis management after menopause

After menopause, the management of endometriosis may become more difficult because by this point in life endo may have been present for decades, even if previously removed partially once or twice by surgery.  At this point symptoms may be due to endo as well as scarring and fibrosis, which is part of the body’s normal healing process. The associated problem is that fibrosis and scar does not respond to any medical therapy.  This, in turn, means that surgery is the main, if not the only, option for treatment after menopause in many cases. Of course, everyone is different and pelvic floor therapy and supportive care are also in the mix.   

Endometriosis after menopause: The molecular biology

Endometriosis cells and tissue look very similar to the normal uterine endometrial lining.  Both are stimulated to grow and both try to shed monthly under cycling hormonal influence.  During a menstrual period,  endometrial tissue has the ability to shed and exit via the cervix and vagina.  Unfortunately, the similar-looking endometriosis tissue has no way to exit the body and gets trapped, causing inflammation, scarring, and pain.

Uterine endometrial tissue needs the hormone estrogen to grow, and usually, but not always, so does endometriosis. When you go through menopause naturally, your ovaries produce less estrogen. This causes symptoms such as hot flashes and night sweats. But the commonly held belief is that endometriosis may improve, or even go away, with the reduction in estrogen production by ovaries. We now understand why this does not happen in all women through molecular biology research.   

Endometriosis at a molecular level

While many factors control endo growth, including immunologic ones, exploring the molecular biology of hormones in menopause suggests that hormones can undoubtedly be a big part of the picture. In addition to the usual conversation about external estrogen from ovaries, which decreases towards menopause, intra-cellular production of estrogens also plays a critical role in the pathogenesis of endometriosis. This increases in peri and postmenopausal women who have persistent active endometriosis lesions.  

Without getting lost in the details of hormone enzyme activation and deactivation, which results from genetic switches getting turned on and off, suffice to say that research supports the following. There is local estrogen production in endometriosis cells, which activates other feedback loops at the cellular level. This activation of loops causes even more estrogen production and resistance to progesterone (the balancing hormone). This affects macrophages and pro-inflammatory cytokines (e.g., TNF-α and IL-1β), which sets off another chain reaction. These also create molecular signals (e.g., VEGF) that stimulate microscopic blood vessel formation to feed the endo cells and activate anti-apoptotic genes (e.g., Bcl-2), creating more endo growth. This leads to local tissue trauma, nerve stimulation, fibrosis, and pain. 

Endometriosis Symptoms after menopause

endometriosis and menopause

What happens to your symptoms could depend on the severity of your symptoms before menopause and hormonal and inflammatory balance. If your endometriosis is mild, it may get better with menopause. If your disease is severe, symptoms are more apt to persist. Why? Several reasons: scarring and fibrosis that only gets worse and a molecularly more active endo type that persists and keeps growing after menopause. It is currently impossible to predict what type you may have and what molecular signals are in play in any given individual.   

If your symptoms don’t improve even after you’ve stopped having menstrual cycles, surgery may be the best option for you. Surgery to remove all of your endometriosis and fibrosis will often be more effective than medication. Years of growth and fibrosis can lead to more local nerve noxious stimulation, and the first step is to remove this. Medications, including natural enzyme supplements, will not dissolve scars, and any persistent active endo is also more difficult to control after menopause. Many other molecular signaling paths are operational, making it harder to determine the best target to block abnormal effects. All the various inter and intracellular signaling forms are under intense research. 

Endometriosis causes

Types of Endometriosis Pain & Natural, Medical & Surgical Treatment

Estrogen replacement after menopause with endo: is it safe?

All of the above concerns how, when, and where estrogen is produced. But how this affects cells in your body, including endometriosis cells, depends on the presence or absence of estrogen receptors. You can think of the estrogen molecules as little keys which float through your bloodstream and tissues (or locally produced on or near the endo cells), and the estrogen receptors are like little locks present in and on the cells. The two have to connect, or the key has to fit the lock to produce a molecular signaling event at the cellular level. One of these signaling events is whether or not to stimulate growth. 

There are different estrogen receptors called estrogen receptor alpha (ERα) and beta (ERβ). In some estrogen-sensitive tissues, like the breast or uterus, these two types can be variably pro-growth, and in others, they can be inhibitory. In addition, there is a progesterone receptor (PR) that binds progesterone in the same fashion via a lock and key mechanism. Endometriosis cells have overexpression of mainly ERβ and underexpression of PR. This imbalanced expression of receptors leads to progesterone resistance and amplification of the growth signal provided by estrogen. This only scratches the surface of incredible complexity, but hopefully, you get the idea. 

In general, to alleviate postmenopausal hot flashes, depending on whether you have a uterus or not after menopause, estrogen alone is often prescribed (no uterus) or combined with progesterone (the uterus is in). This is because progesterone balances the effect of estrogen on the uterus and reduces the risk of endometrial cancer due to estrogen-induced overgrowth of the endometrium.   

The exact ratio of alpha (ERα) and beta (ERβ) and the amount of PR present can be variable in endometriosis. It can change over time into menopause or after surgically induced menopause due to early removal of the ovaries. So, theoretically, any hormonal replacement will affect endo cells to some degree and may amplify the degree to which local estrogen is produced, as discussed above. The degree to which this happens and evolves is not predictable from person to person. 

Where does that leave us? It comes down to risk vs. benefit discussion because a reasonable amount of estrogen replacement after menopause can help the quality of life and bone health. Studies have not proven whether or not this can activate or amplify endometriosis growth after menopause

How about compounded natural or bioidentical hormones?

The long answer to this is very complex and depends highly on the quality of these hormones and whether or not the dosages are correctly mixed and, if one were to use combinations that are applied to the skin, degree of absorption, and much more. The problem with synthetic vs. natural arguments notwithstanding, the effect on the very variable and unpredictable receptor signaling described above remains theoretically unchanged. There is also a higher risk of inadvertently taking a higher dose since many are locally prepared and thus subject to less regulation. Get a highly qualified opinion and possibly several opinions and do a lot of due diligence personal research before going this route.  

How about plant-based phytoestrogens?

Plant estrogens, otherwise known as phytoestrogens, uniquely attach to estrogen receptors. They can bind to either type of estrogen receptor but preferentially bind to ERβ. In doing so, they take up space and block the ability of regular estrogen to bind to the receptor. In terms of helping menopausal symptoms, estrogen receptors also exist on blood vessels, and the binding of phytoestrogens helps stabilize the blood vessels, reducing hot flashes. The effect is less than that caused by regular estrogen but is helpful in many women. At the same time, there can be a relative blockade at the endometriosis cell level. Again, given the differences regarding receptors and signaling effects between individuals, this is not 100% predictable but can be a win-win nonetheless.  

Along the natural, integrative line of thought, a couple of corollary strategies is how the estrobolome and seaweed figure into this puzzle. First, the estrobolome is part of your gut microbiome that can metabolize the excess estrogen in your body and eliminate it. This includes the excess estrogen produced by ovaries, local estrogen created at the cell level, and the toxin type of estrogens called xenoestrogens. Keeping your microbiome healthy and happy with probiotic supplements or fermented foods is the action time. Second, we know that seaweed can predictably reduce circulating estrogen. This can retard any hormonal influence on the regrowth of endo, especially if the bulk of any disease is removed surgically. 

Read more: Postmenopausal Malignant Transformation of Endometriosis

When is surgery an option for peri and post-menopause endometriosis?

If symptomatic endo is suspected as one gets closer to menopause, it merits discussion about expert removal of as much as possible via excision surgery. Ideally, a surgeon should remove all visible lesions in this case. Even if undetectable microscopic implants are left behind, removal of pain-producing scars/fibrosis and the bulk of any active endo limits the number of cells that might grow back over time, whether or not hormonal replacement is taken. 

There is one more reason for considering surgical removal. If you have a family history of cancer or have active endo as you enter menopause, given the known molecular abnormality overlap between endo and cancer (e.g., ARID1A), the risk of malignant degeneration may be higher. This is a highly individualized situation, but some can be critical to balancing the surgical risks vs. potential benefits.    

Surgical concerns

So, with all of the above in mind, is there a reason NOT to have surgery to remove endo, especially if you have symptoms as you get close to or enter menopause? Of course! Even minimally invasive surgery is not risk-free, and the risks can increase as you get older. Scarring and fibrosis from advanced endometriosis possibly increased from prior surgeries, leading to complications and damage to organs, including the bowel. For this reason, selecting an über expert surgeon at that point in life is crucial.   

An über expert surgeon can handle pretty much any possible finding in the pelvis and abdomen. Moreover, they can address oncology risk concerns if you are at higher risk with a family history. This means that the right surgery for cancer would be performed if cancer were suspected or found during surgery. But short of cancer, this surgeon needs to be able to handle small bowel, rectal, bladder, ureteral involvement, even disease in the upper abdomen and diaphragm. Deep infiltrating endometriosis implants are more common if they have been allowed to grow over the years. This full-spectrum surgeon might be a gynecologic oncologist who has experience in endo excision. But even they may need a cardiothoracic surgeon if endo involves the chest cavity. Cardiothoracic surgery is an entirely separate specialty of surgery. Alternatively, a minimally invasive surgery team including an endo excision trained GYN surgeon, a urologist, a general surgeon, and possibly more would need to be available. It can be a logistic challenge to gather such a team, but this is usually possible in centers that specialize in endometriosis surgery.

All symptoms of endometriosis

Join endometriosis forum and discover endometriosis stories

Read on endometriosis forum: What are the long term side effects of lupron?

Get in touch with Dr. Steve Vasilev

More articles from Dr. Steve Vasilev:

Understanding the Connection between Endometriosis and Cancer

How to tell the difference between endometriosis and ovarian cancer

What would happen to the signs and symptoms of endometriosis after menopause?

The author of this article, Dr. Steven Vasilev MD is a fellowship-trained, triple board-certified integrative gynecologic oncologist specializing in complex pelvic robotic surgery. He focuses on advanced & reoparative endometriosis excision and molecular integrative healing, especially as it applies to women of older reproductive age and in menopause.

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7 Ways to Prepare For First Endometriosis Specialist Appointment

Diagnosis. Treatment. Surgery. Many Topics May Be Discussed At Your Visit

An endometriosis specialist appointment is not something you do every day (although sometimes it might feel like all day while you’re waiting there). However, the time you get to talk with the doctor may be pretty short. During that moment of consultation with the endometriosis (endo) specialist, you might feel brain fogged or bombarded. Whether it’s the diagnosis, treatment, surgery, pain management, or an endometriosis symptom you want to bring up, it’s easy to forget an essential topic while you’re there.

To make the most out of your initial endometriosis specialist appointment with an endometriosis specialist, we’ve made a list of seven ways you can prepare for the visit. First, we will give a short description of what endometriosis is. 

Table of contents

What’s Endometriosis?

Why You Are Here

7 Ways to Prepare for Endometriosis Specialist Appointment

Endometriosis Care Process with iCareBetter

What’s Endometriosis?

Endometriosis is a female medical disorder in which tissue similar to the endometrium (tissue that lines the walls of the uterus) grows outside the uterus. This endometriosis tissue can grow on the surface of the uterus, ovaries, intestines, fallopian tubes, bladder, or other organs in the body.

During menstruation, this tissue releases blood, and it sloughs off. However, this blood and tissue often remain trapped with no way to escape the body. This increased pressure can result in moderate to severe pain, among other symptoms. If you want to learn more about endometriosis and get a general background on the condition, read our article, “Endometriosis 101: Covering the Basics.”

Why You Are Here

People of various ages and demographics are subject to this often debilitating inflammatory pelvic disorder. Whether you have confirmed the diagnosis of endometriosis or if you need surgery to verify its presence and remove lesions – these suggestions can help you prepare for the endometriosis specialist appointment. There are many stages of endometriosis. Whether you’ve got into a specialist early on your journey or later, the important thing is that you are here now – exploring treatment options.

7 Ways to Prepare for Endometriosis Specialist Appointment

Once you have found an experienced endometriosis specialist, it’s essential to prepare yourself for the doctor’s appointment ahead of time. There is no concrete test to diagnose endometriosis (outside of surgery). Therefore, it’s imperative to have a solid understanding of the signs and symptoms of endo and detailed accounts of your own experience ready. Simple things such as medical records or journals that list all your endometriosis symptoms are a vital arsenal that will help you and your doctor determine your treatment plan. 

1. Gather Your Records. 

Unfortunately, most people with endometriosis have had many doctor appointments before seeing an endometriosis specialist. Therefore, you should have some medical records for them to review during your first appointment with an endo specialist. Gather everything from your regular medical history from your general practitioner to your OB/GYN records, testing, imaging, blood work, etc. Even if you think the particular doctor appointment or medical history is insignificant, you might be surprised by the various conditions linked to endometriosis. Bring it all. This information could play a vital role in your endometriosis treatment. 

2. Keep a Journal of Endometriosis Symptoms/Pain.

Write down all the possible endo signs and symptoms you’ve had leading up to the doctor’s appointment. If you get a visit scheduled, and it’s a couple of weeks out, start the journal at that time, but also include the signs and symptoms you’ve experienced leading up to that point. Then, from that date until your appointment, write down all the different types of symptoms you experience. Include everything, even if you don’t think it’s relevant, like colds, headaches, stomach issues, shortness of breath, chest pain, etc. Also, be sure to include your emotions and feelings because endometriosis can significantly impact mental health and can lead to conditions such as depression and anxiety. Emotions and mental health are essential as you might want to include a counselor as part of your holistic endometriosis treatment team.

3. Bring This Printable Guide.

At endometriosis.org, they’ve created a convenient guide that can help you describe your symptoms and know what to ask your endometriosis specialist. Click here for the PDF. Please print it out and answer all the questions. Bring this with you to your doctor’s appointment to help specifically describe your endometriosis pain and other symptoms. 

4. Take All Your Medications With You. 

The importance of this cannot be understated. Even if you have a medication reconciliation (also known as a “med rec” for short) from your doctor, it’s important to realize those are not always up-to-date with everything you take. This inconsistency is especially true if you are on medications from multiple specialists or take supplements as well. The best way for your endo specialist to have a complete picture of all the medicines you are currently taking is by bringing them with you to the doctor’s appointment. You should include any supplements or over-the-counter medications. Bring in the physical bottles along with any medication history records.

5. Prepare Yourself Mentally. 

Go into the appointment with the bold mindset that you will ask every single question you have to gain clarity on your endometriosis diagnosis and treatment options. Endometriosis is an aggressive inflammatory disorder that can have a devastating impact on your quality of life. It would help if you carried an even more aggressive attitude toward trying to stop it dead in its tracks.

6. Bring a List of Questions.

What’s been bothering you the most? Pain? Bowel symptoms? Bring a list of all the important questions that you want answers to. Writing them down will help you not forget during the appointment. Furthermore, when the doctor sees you have a list of questions you want answers to, it makes it harder for them to get up and walk out of the room like the appointment is over. If something like that has ever happened to you, we are sorry you’ve experienced this. That’s why it’s crucial to find a vetted endometriosis expert.

7. Take a Support Person With You.

Finding a good endo expert is no easy task (unless you use iCareBetter to connect you to one). If you are the type of person who is a bit shy or feels intimidated, you should bring your best support person to the appointment with you. Even if you are not nervous about your first endometriosis specialist appointment, having someone you trust by your side can help you process the information and encourage you along your journey. If no one you would like to accompany you, consider bringing a recorder and taping the visit. Because this can help you go back later and make sure you’ve understood all the information. Most doctors will have no qualms about recording your visit.

Endometriosis Care Process with iCareBetter

1- Find an expert based on keyword/ specialty or state
2- choose your doctor from the list
3- Get the contact info
4- First call and consultation.
5- Get info regarding costs and care process
6- Receive care

We Want to Hear From You

Have you been to an endometriosis specialist (OB-GYN experienced in endo)? If so, is there anything you wished you would have done differently? If you’ve not been to an endo specialist yet, what is your biggest concern about the first doctor visit?

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Endometriosis Facts & Myths: Dispelling the Misconceptions

Debunking the Myths About Endometriosis & Exploring the Facts

One in ten women worldwide is affected by endometriosis, also known as “endo,” for short. While this number is an estimate, the actual figures may be higher. Not only is the person with this inflammatory disorder affected, so are the family members and people around her due to the often debilitating effects of this disease. Endometriosis facts are important because it is complex and often misunderstood even though it’s a common disorder. Because of this, there are many myths and misconceptions regarding endometriosis prognosis, treatment, causes, symptoms, diagnosis, complications, etc. 

Focusing on the disease itself often ignores the vicious cycles of stress, fatigue, pain, doctor visits, flare-ups, and loss of productivity experienced by the patient. These factors can lead to a decreased quality of life. Worse is that endometriosis facts come behind outdated treatment options, myths, and misconceptions about this disorder. It takes an average of eight to ten years for a patient to be diagnosed with endometriosis. One of the biggest problems with the misconceptions about endo is that they can prevent women from seeking treatment. Keep reading as we review endometriosis facts and debunk the myths. 

Overview of Endometriosis 

Endometriosis is a pelvic disorder characterized by endometriosis tissue similar but not the same as the tissue inside the uterus, growing elsewhere. Typically, the growth occurs outside the uterus, ovaries, fallopian tubes, cervix, the surface of the bladder, bowel, and distant organs.

Endometriosis growths can cause pain, scarring, and sometimes infertility. Pain from endometriosis is usually the result of menstrual bleeding from the tissues. Unlike the endometrium inside your uterus, blood that comes from endo tissue outside this organ has no means of escaping the body. This blood causes increased pressure and inflammation, which can result in pain that’s often debilitating. If you would like to learn more information about endometriosis, please read our introduction article, “Endometriosis 101: Covering the Basics.”

Why is it Difficult to Diagnose endometriosis?

Studies show that it can take an average of seven years or more for a woman to get an endometriosis diagnosis. Why is this? Endometriosis signs and symptoms are often similar to other conditions, such as irritable bowel syndrome or pelvic inflammatory disease (PID). Therefore, it’s often mistaken for another illness. Furthermore, the myths and misconceptions we discuss below also prevent a lot of women from seeking help. For this reason, it’s crucial to get the endometriosis facts clear. Keep reading as we debunk the myths and state the facts.

Myth #1: Severe Period Pain is Normal

Nineteenth-century doctors were often perplexed by “women’s problems.” As a result, women were often discounted as being unstable mentally. While the attitudes and thoughts have improved since, some of those old beliefs persist, including those regarding period pain.

Many patients with endometriosis hear that their severe period pain is “normal.” Pain and cramping are normal during menstruation. However, the pain should not be so intense that it interferes with functioning or impacts the quality of life. If your period pain is so severe that you cannot carry out daily activities, you should seek an endometriosis expert.

Myth #2: A Hysterectomy Cures Endometriosis

Endometriosis growths are tissues “similar” to those inside of the uterus. It is not the same tissue. Simply removing the uterus and/or ovaries without excising any endometriotic implants growing outside the uterus will not cure it. 

Myth #3: Endometriosis Only Affects the Pelvic Area

Locations within the pelvis, such as the surface of the uterus, bladder, or fallopian tubes, are the most common locations where endometriosis growths occur. However, endo can occur elsewhere in the body. In some cases, endometriosis growths have been present in distant organs, such as the lungs

Myth #4: Endometriosis Symptoms are Simply a “Heavy Period”

Bleeding during menstruation can be heavy at times. However, it should not exceed the saturation of a pad or tampon in one hour. If you experience that degree of bleeding, you should bring this up with your healthcare provider. The fact is that many women with endometriosis experience abnormally heavy flow due to the excess tissue.

Myth #5: Douching Causes Endometriosis

No scientific evidence links douching with the development of endometriosis.

Myth #6: Having an Abortion Can Cause Endometriosis

No scientific evidence demonstrates that having an abortion causes endometriosis. Those who claim otherwise might be confusing endometritis and endometriosis.

Myth #7: You’re Too Young to Have Endometriosis

A common misconception is that endometriosis is rare or doesn’t occur in young women and teenagers. As a result, many doctors do not consider an endometriosis diagnosis in young women with typical symptoms. Endometriosis facts demonstrate that teenagers and women in their early 20s can have the disorder. Most people with endometriosis state they experienced endo symptoms during adolescence. 

Myth #8: Endometriosis Can Be Prevented

It’s not clearly understood what causes endometriosis. Therefore, there are no proven ways to prevent this inflammatory condition. Anything else is purely speculation at this point.

Myth #9: Endometriosis is Always Painful

Not all women with endometriosis experience pain. Studies show that some women with advanced stages of endometriosis do not experience pain as a symptom.

Myth #10: Pregnancy is a Cure for Endometriosis

This misconception about endometriosis is slowly beginning to fade. However, not quickly enough! Pregnancy fluctuates hormones in the female body, which can temporarily suppress some symptoms of endometriosis. However, these symptoms usually recur for most patients following the pregnancy. Therefore, it’s not a cure.

Myth #11: Menopause Cures Endometriosis

Endometriosis symptoms often occur during menstruation, but many women experience them long after periods stop. Following menopause, the body still produces small amounts of hormones, and the endometriosis tissue still responds to them, thus causing pain. For many women, the symptoms of endometriosis may improve after menopause, but that does not mean it’s a cure. Depending on the case, it might be necessary to remove endometriosis implants or adhesions even after menopause. 

Myth #12: Hormonal Therapy Cures Endometriosis

Doctors have been treating endometriosis for years using hormonal therapy drugs. However, these medications do not have long-term effects on the disease itself. Hormones can help relieve the symptoms temporarily and even shrink the growths, but they do not cure endometriosis.

Myth #13: Endometriosis is Cancer

Endometriosis growths are not cancerous. To date, there is little evidence that shows endometriosis directly causes cancer. However, some types of cancers are more common in women who have endometriosis. Endometrial cancer is also known as uterine cancer. Many studies have examined the relationship between the two, and one showed that merely 0.7 percent of patients with endometriosis had endometrial cancer at the 10-year follow-up. Therefore, endometriosis does not equal cancer, but it may increase the risk of cancer.

Myth #14: Tubal Endometriosis Always Causes Infertility

Tubal endometriosis is not very common, and it does not always cause infertility. Does endometriosis cause infertility? It can be in many cases, but the mechanisms of infertility in endometriosis remain multifactorial. Can you get pregnant with endometriosis? It is possible, and many women do – especially with proper treatment early on.

Myth #15: Endometriosis Symptoms Are the Results of Emotional Distress (It Is All in Your Head)

Yes. People have heard many times that emotional distress could be the cause of their endometriosis and pain. This statement is false. The fact is, endometriosis is a highly complex disorder with many underpinnings. Those with endometriosis often experience emotional distress as an impact of the symptoms such as pain and infertility. But emotional distress it’s not the cause of endometriosis symptoms.

Endometriosis quick facts:

1- There is no blood test available for the diagnosis of endometriosis.

Mehedintu C, J Med Life, 2014

2- The diagnosis of endometriosis starts by taking a good history from patients, and performing a detailed physical exam including pelvic exam. In some cases, a doctor might ask for MRI and Ultrasound to have a more thorough picture. But the ultimate diagnosis is only possible with laparoscopic /robotic surgery and taking a biopsy for histopathology. There is no blood test that can tell if you have endometriosis.

3- Studies show that those with endometriosis have an increased risk of developing depression and anxiety disorders.

Chen LC, et al, J Affect Disord, 2016

4- Pelvic pain due to endo occurs a day part of an inflammatory cycle which can affect the pelvic organs and functions such as sitting, sex, bowel movements and even urination. Pelvic floor physical therapy can help with restoring balance to the pelvic floor muscles.

Dr. Juan Michelle Martin,  Endometriosis Physical Therapist.

5- “The most common clinical signs of endometriosis are menstrual irregularities, chronic pelvic pain, dysmenorrhea (painful periods), dyspareunia (painful sex), and infertility.”

Lagana AS, et al, Int J Womens Health. 2017

We Want Your Input

Are there any endometriosis myths or misconceptions we did not list here? Let us know in the comments below!

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How Do I Know If I Have Endometriosis? Endometriosis Signs

Learn Endometriosis Signs & Symptoms & What to Tell Your Dr.

Pelvic pain is common for most women during their period. However, for some – this time of the month comes with excruciating pain due to the medical condition – endometriosis (also known as endo for short). Believe it or not, endometriosis signs extend beyond just the debilitating pain, although, that’s the hallmark symptom of this inflammatory disorder.

If you think you might have endometriosis, it’s important to have a solid foundation of information before you see your doctor for a possible endo diagnosis. Keep reading to learn what endometriosis is and what are the most common signs and symptoms of this condition.

What Is Endometriosis?

Pronounced (en-doe-me-tree-O-sis), endometriosis is a chronic inflammatory disorder of the pelvis where tissue similar to that normally grows inside your uterus, grows elsewhere instead, usually on the outside of it. The endometriosis tissue can block fallopian tubes, cover your ovaries, and even line the organs of your pelvis. 

Endometriosis can cause intense pain and fatigue, which makes it a disabling inflammatory condition for many women. Pain from endometriosis can be so intense that sometimes even medication cannot touch it. Other organs commonly involved include the fallopian tubes, bowels, cervix, ovaries, vagina, and pelvic tissue. Rarely, endo may also affect distant organs. Learn more about the disorder in our previous article, “Endometriosis 101: Covering the Basics”.

What Are Endometriosis Signs and Symptoms?

Sadly, endometriosis is an inflammatory disorder that often goes undiagnosed for years because the hallmark symptoms are things that some women take for granted as “normal”: heavy bleeding and pain during periods. If you think you might have endometriosis, it’s important that you know what to look for and when you should notify a doctor. The following are seven common signs of endometriosis:

Dysmenorrhea (painful periods)

Intense pelvic or abdominal pain is one of the most common symptoms of endometriosis. Endometriosis pain is often described as a sharp or stabbing sensation. During menstruation, women with endo may experience very painful periods because the endometrial tissue swells and bleeds every month, just like the uterine lining would. However, because this process is occurring outside the uterus, blood is not easily shed, and this pressure can cause extreme cramping that is much more intense than typical period cramps. Period pain should not disrupt your daily life, so if it does, you need to let your doctor know or find a qualified endo specialist.

Menorrhagia (heavy menstrual bleeding): 

While many women bleed heavily during their period, endometriosis can cause significant blood loss. How do you know if your amount of bleeding is excessive? Watch for these signs:

  1. Passing large clots
  2. Period goes on longer than a week
  3. Bleeding through a pad or tampon in an hour
  4. Too fatigued to carry out daily activities

If you have these symptoms, you may have menorrhagia and should contact a gynecologist. Menorrhagia is sometimes caused by endometriosis, and it can cause anemia and severe fatigue.

Dyspareunia (pain during or after intercourse): 

When endometriosis is the cause of painful intercourse, the woman may not experience the pain upon entry, only upon deep penetration. There can be physical and psychological causes of this condition, and endometriosis may be the culprit, as tissue builds up on the other side of the lower uterus or vagina – and sexual intercourse can stretch the tissue. You should talk to an experienced physician if you have pain during or after intercourse.

Chronic Pelvic Pain: 

While the inflammatory condition usually involves pain during menstruation, endometriosis pain can occur at any time of the month. Endometriosis causes an increase in pressure due to the excessive tissue in the pelvic cavity. This can cause a chronic pain condition that might be felt exclusively in the pelvis or manifest as abdominal or back pain. 

Ovarian Cysts: 

There is a type of endometriosis that causes endometriomas (also known as chocolate cysts) to grow on your ovaries. These cysts are non-cancerous but may become large and painful. Also, women who have these may also have other endometrial growths in the abdominal or pelvic areas. 

Infertility: 

Up to about half of women who have problems with fertility also have endometriosis. Furthermore, up to 50 percent of women who have endometriosis are unable to get or stay pregnant. The relationship between these conditions isn’t always clear as many factors can impact fertility. However, in the event that the endometriosis tissue blocks the reproductive organs, there is a clear connection. Treating the condition can increase your odds of having a baby. If these fertility issues are affecting you, contact an endometriosis specialist. 

Bowel/Bladder Problems: 

Bathroom visits may be problematic if you have endometriosis lesions growing near your bladder or bowels. And if you are experiencing difficulty with urination or bowel movements or bleeding in the bowel – these may be signs of endometriosis. Also, if you have painful urination, blood in your stool, nausea, or hyper urgency to urinate – you should tell your medical provider immediately. 

When to Call Your Healthcare Provider

Share with your healthcare provider any of the following endometriosis signs and symptoms:

  • Pain. Pain is the most common sign of endometriosis, and it can be present:
    • During or after sex
    • With bowel movements
    • When urinating during your period
    • As chronic abdominal, lower back, or intestinal pain
    • Similar to menstrual cramps that get worse gradually
  • Bleeding or spotting between periods
  • Difficulty getting pregnant or infertility
  • Digestive issues or stomach problems such as diarrhea, constipation, bloating, or nausea—especially during your periods

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What are the First Signs of Endometriosis and Symptoms: Everything You Need to Know

Sharp. Stabbing. Burning. Throbbing. Aching. All these adjectives have been used to describe endometriosis pain. Endometriosis is a condition that, for some women, can cause excruciating uterus pain. Some describe it as feeling like their insides are being pulled out of their bodies. Even worse – pain medication doesn’t cut through or provide relief for many patients with this condition. Therefore, an endometriosis diagnosis can be very serious and life-changing news.

Our commitment to our patients runs deep, and our mission is to help patients with endometriosis pain and other complications find the skilled doctors they need.

Read more: How to Find an Endometriosis Specialist for Diagnosis

As our first introduction to the disorder, we will give you a brief overview of the signs and symptoms of endometriosis, its causes, complications, and treatment options (or, as we like to call it – hope). First, we will give you general information on the disease and cover what endometriosis is.

Table of contents

1- What is the Endometrium?

2- What is Endometriosis?

3- Signs and Symptoms of Endometriosis

4- Causes of Endometriosis

5- Complications of Endometriosis

6- Diagnosis of Endometriosis

7- Treatment for Endometriosis

8- Surgical Treatment Options for Endometriosis:

9- Multidisciplinary care

10- Find a Vetted Endometriosis Expert

What is the Endometrium?

The endometrium, also known as the endometrial lining, is the tissue that comprises the “wallpaper”, or lining of the uterus. The uterus is the pear-shaped organ that houses a growing baby. During pregnancy and menstruation, the endometrium plays vital functions.

What is Endometriosis?

Endometriosis is pronounced (en-doe-me-tree-O-sis). Endometriosis is a medical condition in which tissue similar to what normally lines the inner walls of the uterus, also known as the endometrium, grows outside the uterus. It is often a very painful, even debilitating disorder. It may involve the ovaries, fallopian tubes, bowels, vagina, cervix, and the tissues that line the pelvis. In rare cases, it can also affect other organs, such as the bladder, kidneys, or lungs.

Signs and Symptoms of Endometriosis

Signs and Symptoms of Endometriosis
signs of endometriosis
endometriosis symptoms

Not all women will experience the same symptoms of endometriosis or degree of intensity/severity. Some women may not experience any symptoms at all. 

endometriosis does not always have symptoms. It can show itself by complications such as infertility.
signs you have endometriosis

20 Signs and Symptoms of Endometriosis

It is also important to keep in mind that the severity of symptoms is not a solid indicator of the progress of the disease. There are women with advanced stages of endometriosis who experience no symptoms at all and others with mild cases who endure many. Common endometriosis symptoms include: 

  • Painful periods, or dysmenorrhea
  • Infertility
  • Diarrhea during period
  • Pain during intercourse
  • Heavy or abnormal menstrual flow
  • Abdominal or pelvic pain after vaginal sex
  • Painful urination during or between menstrual periods
  • Painful bowel movements during or between menstrual periods
  • Gastrointestinal problems, including bloating, diarrhea, constipation, and/or nausea

Mechanisms of signs and symptoms of endometriosis:

Painful periods (dysmenorrhea)

Cyclic release of multiple inflammatory factors activates nerve fiber growth, leads to cell damage and fibrosis, and exacerbates pain during periods

Infertility

The overall mechanisms can include tubal blockage, local inflammation, uterine muscle dysfunction, local hormonal alterations, and much more.

Diarrhea during menstrual periods

Diarrhea may result from endometriosis growing directly on the rectal muscle or endometriosis inflammatory substances. Local production of inflammatory molecules can lead to hyper-motility of the sigmoid and rectum muscles, which can manifest as cramping and diarrhea.

Pain during intercourse (dyspareunia)

Endometriosis implants have more nerve endings than usual (hyperinnervated) and can produce pain with pressure. The act of intercourse can apply this pressure on the upper vaginal area and uterosacral ligaments, which are common locations of endo implants. Once this pain occurs and local inflammation further causes tension in the pelvic floor, the muscles surrounding the vagina can contract, which worsens the problem.

Heavy or abnormal menstrual flow

Endometriosis can impact your bleeding by increasing stress from pain or damage to the ovaries, which can change local hormonal function.

Abdominal or pelvic pain after vaginal sex

Uterine and pelvic floor spasms are part of regular orgasms. When these areas are hypersensitive due to endometriosis, spasms lead to continued contractions and pain that lasts for a while. In addition, rectal fusion to the posterior vaginal wall will also cause more direct pain and inflammation by the vaginal area pulling on the rectal wall. Also, as you probably recognize, any event that stirs up the pelvis and causes some trauma leads to increased molecular signaling, further amplifying the problem. 

Painful urination during or between menstrual periods (dysuria)

Painful and frequent urination is a prevalent symptom of endometriosis. Endo cells and responding inflammatory cells produce inflammatory molecular signals that aggregate in the area of injury. These molecular signals affect all pelvic organs, including the bladder, leading to bladder wall spasms. Moreover, interstitial cystitis is common in endometriosis patients and can also be a factor. In the worst-case scenario, endo lesions implant inside the bladder, which can also cause cyclic bleeding from the bladder (hematuria). 

Painful bowel movements during or between menstrual periods (dyschezia)

Endometriosis causes inflammation and fibrosis or scarring as your body attempts to heal. This inflammation and fibrosis can severely alter the anatomy in the pelvis and distort the rectal course, gluing it to the uterus, cervix, and posterior vaginal wall. This angulation can cause constipation and trouble evacuating stool, while the inflammatory signals cause the rectal muscles to hyper-contract. These mechanisms lead to painful bowel movements, which worsen during the cyclic increases in inflammatory molecules. In the worst-case scenario, the endo will grow through the rectum wall over time, causing cyclic rectal bleeding.

Gastrointestinal problems, including bloating, diarrhea, constipation, and nausea

Generally, intestinal symptoms of endometriosis can be direct or indirect or related to conditions like small intestinal bacterial overgrowth (SIBO). Even if there are no direct implants on the bowel, the endo inside the abdomen and pelvis can cause enough inflammation to irritate the intestine and cause symptoms. In addition, endometriosis implants directly on the bowel can worsen the symptoms.

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Causes of Endometriosis

One cause of endometriosis is the direct transplantation of endometrial cells into the abdominal wall during a medical procedure, such as a cesarean section. Besides this known cause of endometriosis, other theories exist as to how it develops:

1. One theory is that during the menstrual cycle, a reverse process takes place where the tissue backs up through the fallopian tubes and into the abdominal cavity, where it attaches and grows.

2. Another theory is a genetic link. This is based on studies that show if someone has a family member with endometriosis, they are more likely to have it as well.

3. Some also suggest that the endometrial tissues travel and implant in other body parts via blood or lymphatic channels, like cancer cells spread.

4. A fourth theory suggests that all cells throughout the body have the ability to transform into endometrial cells. 

Complications of Endometriosis

The following are complications of endometriosis if left untreated or in advanced stages of the disorder:

  • Infertility/subfertility
  • Chronic pelvic pain that can result in disability
  • Anatomic disruption of involved organ systems (i.e., adhesions, ruptured cysts, renal failure)

Diagnosis of Endometriosis

The diagnosis starts with assessing signs and symptoms and then performing imaging studies such as MRI and ultrasonography. But the confirmation or exclusion of the endometriosis diagnosis is only possible with surgical biopsy and histopathology. Laparoscopy is the gold-standard surgical modality for diagnosis in all cases.

Treatment for Endometriosis

Endometriosis needs a multidisciplinary team approach for effective and holistic treatment. This team should include the following medical professionals:

  • Nutritionist
  • Physical therapist
  • Endometriosis surgeon
  • Mental health therapist
  • Pain management specialist

Pain is often the biggest complaint from patients with endometriosis. Therefore, many treatment options are aimed at pain control. So first, here are some options for women to help temporarily ease the pain of endometriosis:

  • Exercise
  • Meditation
  • Breath work
  • Heating pads
  • Rest and relaxation
  • Prevention of constipation

These therapies may be used in combination with medical and/or surgical options to lessen the pelvic pain associated with this disorder. Furthermore, alternative therapies exist that may be used in conjunction with other interventions, and those include but are not limited to:

  • Homeopathy
  • Immune therapy
  • Allergy management
  • Nutritional approached
  • Traditional Chinese medicine

*Be sure to discuss any of these treatment options with a physician before implementing them.

The Right Medical Treatment For You:

Options for medical and/or surgical treatments for endometriosis are going to depend on several factors, including: 

  • Desire for pregnancy
  • The extent of the disease
  • Type and severity of symptoms
  • Patient opinions and preferences
  • Overall health and medical history
  • Expectations of the course of the disease
  • Patients’ tolerance level for medications, therapies, and/or procedures

In some cases, management of pain might be the only treatment. In others, medical options may be considered. The following are typical non-surgical, medical treatments for endometriosis:

  • “Watch and Wait” approach, where the course of the disease is monitored and treated accordingly
  • Pain medication (anything from non-steroidal anti-inflammatory drugs [NSAIDs] to other over-the-counter and/or prescription analgesics)
  • Hormonal therapy, such as:
    • Progestins
    • Oral contraceptives with both estrogen and progestin to reduce menstrual flow and block ovulation
    • Danazol (a synthetic derivative of the male hormone testosterone)
  • Gonadotropin-releasing hormone antagonist, which stops ovarian hormone production

Surgical Treatment Options for Endometriosis:

Despite their effectiveness in symptom control, pain medications can have significant side effects. Moreover, these medications do not stop the progression of the disease, and symptoms might return once stopped. But on the other side, surgery can lead to long-term relief and can prevent further damage to tissues. Your treatment plan should be a shared decision based on your desires, goals, and abilities. 

Almost all endometriosis surgical procedures are laparoscopic or robotic. These are minimally invasive surgeries in which small tubes with lights and cameras are inserted into the abdominal wall. It allows the doctor to see the internal organs and remove endometriosis.

Common procedures include: 

Excision of endometriosis:

In this technique, a surgeon cuts out much or all of the endometriosis lesions from the body. Therefore, surgeons avoid leaving any endometriosis lesions behind while preserving normal tissues. This technique is widely adopted by highly skilled endometriosis surgeons who are world leaders.

Ablation of endometriosis:

In this technique, a surgeon burns the surface of the endometriosis lesions and leaves them in the body. Most top experts highly criticize this ablation method. Ablation is most popular with surgeons who have not received enough training to do excision. As a result, these surgeons are not comfortable performing excision, and they do the ablation.

Hysterectomy:

this is a surgery in which surgeons remove the uterus and sometimes ovaries. But, many surgeons consider hysterectomy an outdated and ineffective treatment for endometriosis. Almost all top endometriosis surgeons reject doing it unless there is a clear indication for hysterectomy such as adenomyosis.

Laparotomy:

this surgical procedure cuts and opens the abdomen and does not use thin tubes. Therefore it is more extensive than a laparoscopy. Very few surgeons still do laparotomy because of its complications. Almost none of the top endometriosis surgeons do laparotomy for endometriosis.

Multidisciplinary care

Along with effective surgical treatment, the patient should start working with endometriosis experts in physical therapy, mental health, nutrition, and pain management to achieve the best possible outcome.

Get in touch with Dr. Steve Vasilev

More articles from Dr. Steve Vasilev:

Endometriosis And Menopause: Everything You Need To Know

Understanding the Connection between Endometriosis and Cancer

What would happen to the signs and symptoms of endometriosis after menopause?

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