What is endometriosis?
The inside lining of the uterus that produces a monthly period is called the endometrium. Endometriosis is when this type of tissue grows on the outside of the uterus in the pelvis or abdomen. It can be anywhere such as the ovaries, fallopian tubes, bladder or bowel. Your hormones each month will stimulate the endometriosis just like the endometrium. Your body was not made to handle this tissue and stimulation outside of the uterus.
What are the symptoms and how do I know if I have endometriosis?
The most common symptoms are painful periods, pelvic pain, painful intercourse, abnormal bleeding, and infertility. Having any of these symptoms doesn’t necessarily mean you have endometriosis, and you could have endometriosis without any symptoms at all. A normal ultrasound of the uterus and ovaries does not rule out endometriosis since it is usually flat like a freckle or mole. Sometimes, a large amount can build up and be seen by ultrasound. Most of the time, you and your doctor may suspect you have endometriosis but an accurate diagnosis can only come after seeing it in your pelvis during surgery.
How is endometriosis treated?
If you do not want to get pregnant, the first line treatment is birth control pills. Taking them continuously to avoid a menstrual cycle will be best. Other options include progesterone agents such as Depot Provera, Implanon, and progesterone pills. The best medical therapy is Depot Lupron, an injectable medication given for about 6 months at a time. This temporarily stops your monthly cycles to allow the endometriosis to heal. Some physicians will give a progesterone pill daily during this treatment to prevent side effects. Surgery is an option to remove endometrial implants using laser or cautery. This can improve symptoms dramatically, but without further medical therapy, it will likely come back. This may be a good option if you are trying to get pregnant. For severe, refractory cases, a hysterectomy with removal of the ovaries may be necessary. Menopause is generally a cure since the hormonal stimulation ceases.
If you think you may have endometriosis, discuss your symptoms and fertility desires with your personal ob/gyn. A personalized treatment plan will be tailored to your individual symptoms, needs and desires.
Jo Choudhry, MD
Cornerstone Ob/Gyn