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Endometriosis occurs when tissue that is normally supposed to reside inside of the uterus somehow makes it outside and starts growing in places where it does not belong. This can be anywhere, such as the ovaries, fallopian tubes, pelvic sidewalls, rectum, bladder, etc.
Endometriosis growths are not cancer, but they can be very painful and cause infertility. Endometriosis symptoms sometimes can mimic other disorders, such as pelvic inflammatory disease, fibroids, ovarian cysts, irritable bowel syndrome and urinary tract infections, which is why it can be difficult to obtain a precise diagnosis.
The three most notable symptoms of endometriosis are pelvic pain, which can be particularly severe during menstrual cycles, pain during sex, and difficulty becoming pregnant. The condition can range in severity, and it can be disabling to the point where it has a negative impact on a patient’s quality of life. Recognizing the signs of endometriosis early and seeking appropriate medical care are key to effectively treating the condition.
When a reproductive-aged patient is experiencing severe pelvic pain, endometriosis is found to be the culprit in approximately 70% of cases, especially if no other obvious causes are seen on imaging or blood tests.
A patient is considered to have advanced or severe endometriosis when the lesions cover a large percentage of the pelvic cavity, or the endometriosis implants are located on organs such as the bladder, ureters, intestines or diaphragm.
Your OB/GYN can treat endometriosis with consideration for your symptoms, age and plans for pregnancy. In many patients, medical management with anti-inflammatory medications or hormones can help keep the symptoms under control. If your primary OB/GYN suspects that you have advanced or complex endometriosis, you may be referred to one of our minimally invasive gynecologic surgeons. They specialize in using a combination of medications and surgery to maximize the chances of obtaining relief from endometriosis while decreasing the probability of recurrence.
Norton Women’s Care offers comprehensive gynecologic care. Our OB/GYNs, including urogynecology specialists and minimally invasive gynecologic surgeons, have offices across the Louisville and Southern Indiana region. Fellowship trained and board certified, they have the experience and expertise to provide a precise diagnosis and work with you to create a customized treatment plan for your condition.
While medical researchers are still working on finding out exactly what causes endometriosis, we now know there are complex interactions between the immune system and endometrial cells that contribute to the development of the disease. Furthermore, risk factors for developing endometriosis have been identified.
Typically, the first step for mild endometriosis is providing pain relief via anti-inflammatory drugs and prescribing medications to try to suppress the growth of suspected endometriosis implants.
Since endometriosis is highly sensitive to hormonal fluctuations like the ones that occur naturally during menstrual cycles, taking medicines to maintain stable hormonal levels may help reduce the number and intensity of flare-ups. The most common approach to this is through the use of birth control pills.
It is also believed that high doses of progesterone have an inhibiting effect on certain types of endometriosis and may help shrink the lesions. This can be administered either via pill form, injections or an intrauterine device (IUD).
Gonadotropin-releasing hormone (GnRH) analogues are another class of medications that essentially put the body into temporary menopause while taking them. This causes estrogen levels to drop significantly. Most endometriosis implants are dependent on estrogen to survive, so when levels decrease, the lesions may regress, and symptoms of pain improve. Although the medication is highly effective, endometriosis tends to come back if you stop taking it.
Medical therapy should be discussed with your physician to determine the appropriate treatment plan based on your condition.
Surgery is an option if patients are not responding well to medical management, if they are interested in fertility within a short period of time, if they wish to avoid taking any kind of hormonal medications, or simply if they want a definitive answer as to what is causing their pain.
During minimally invasive endometriosis surgery, the patient is asleep under anesthesia and tiny incisions are made in the abdomen. These allow the surgeon to insert a small camera and perform a thorough examination to visually confirm if endometriosis is present. If it is found, miniature tools are used to strip away the affected tissues while minimizing the effect on other organs. At the same time, your surgeon can also make sure the fallopian tubes are open.
If you no longer wish to have children, a hysterectomy combined with endometriosis surgery will significantly decrease the risk of endometriosis returning.
The type of surgery your physician will recommend depends on factors such as age, severity of symptoms and whether you want children in the future.
Reviewed by Steven J. Radtke, M.D., FACOG, FMIGS, gynecologic surgeon with Norton Women’s Care.
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