Endometriosis. The gynecological equivalent of preeclampsia as far as I’m concerned. In other words. I despise them both.
Seems I have been running a special on endometriosis of late. Literally, I have seen an influx of women with endometriosis. Management has been both medical as well as surgical. I had a pretty impressive case a week or two ago where we removed two large endometriomas and ablated quite a bit of endometrial implants. The pre and post surgery pictures were pretty impressive. I scored that particular case a point for team Dr. Angela. And though there are small victories such as the one previously mentioned, endometriosis is an on-going battle. Who knows, the next round may not be so favorable for me.
Endometriosis is a disease that affects lots of women. It can be minor, severe. Symptomatic, asymptomatic. Here are five things you need to know.
Top 5 Facts About Endometriosis:
Endometriosis is a disease process that occurs when the lining of the uterus, the endometrium, which is normally shed monthly as your period, gets shot out of the fallopian tubes and implants on various aspects of the pelvis; i.e., the tubes, ovaries, cul-de-sac, etc. Endometriosis can also implant on the bowels, appendix, scars…..
The hallmark symptom of endometriosis is cyclical, painful, periods. Other symptoms may include things such as pelvic pain, pain during sex, bowel issues such as constipation/diarrhea(most commonly during your period), infertility, painful bowel movements, pain with urination.
Causes of endometriosis. No one knows for sure what causes endometriosis. There are, however, several theories. A few of the more popular ones are:
- Retrograde Menstruation: when menstrual blood containing endometrial tissue gets shot out of the fallopian tubes and implants on various aspects of the pelvis.
- Induction theory: peritoneal cells(cells that typically line the abdomen)are transformed into endometrial cells by hormones or immune factors.
- Endometrial cell transport: endometrial cells are transported to various aspects of the body via blood vessels.
- Surgical Scar Implantation: Endometrial cells attach to incisions made at the time of hysterectomy, c-section, etc.
Risk factors. Family history is a BIG one. Early onset of periods. Uterine anomalies. Short menstrual cycles; i.e., <28 days between periods. Alcohol consumption. Any medical condition that prevents the passage of menstrual blood flow out of the body; imperforate hymen comes to mind.
Diagnosis and Treatment. Diagnosis involves a thorough history and exam. We’ve already mentioned signs/symptoms of endometriosis. An ultrasound might reveal a characteristic finding such as an endometrioma, a cyst that is commonly associated with endometriosis. Endometriomas are also known as chocolate cysts. Other than an endometrioma, endometriosis doesn’t really have significant findings on ultrasound.
A diagnostic laparoscopy can be performed if conservative measures fail. Conservative measures are medicinal; i.e., pain control, hormonal suppression, etc. A laparoscopy will allow endometriosis to be visualized. At the time of surgery, endometriosis can be ablated, excised. Cysts can be removed. Medical therapy can range from medications aimed at treating pain(non-steroidals, hormonal options)to hormonal therapy(birth control, gnrh agonists, etc)which aims to suppress hormonal fluctuations(largely responsible for endometrial growth, tissue breakdown, bleeding, pain)associated with monthly menstrual cycles.
Endometriosis can range from mild to debilitating. Emotionally, it can take a HUGE toll on women; whether it’s the daily pain, or heartache that may be associated with infertility resulting from endometriosis. Ultimately, the last ditch option for treating endometriosis involves a complete hysterectomy with removal of the ovaries and tubes. Leaving the ovaries is typically not recommended. As noted above, the hormones produced by the ovaries can result in remaining endometrial tissue growing and causing pain. Of note, not all endometriosis is visible to the naked eye.
Endometriosis. It’s a wrap! Hoping this blog post has informed. Would love to hear from you. If you happen to struggle with endometriosis, what has/hasn’t worked for you? I wanna know.
Until next time,
Look Better. Feel Better. Be Better.
Wife, mother, Midwesterner, and award-winning OB/GYN, Dr. Angela is equal parts best girlfriend and bold professional, supporting women’s health with innovative approaches to care and heavy doses of humor. Dr. Angela has done more than launch a successful practice, she has defined herself as a voice for a new generation of womanhood, established her ASK DR. ANGELA brand committed to authenticity, and built a community rooted in trust, candor, and compassion.