Endometriosis: What you need to know
Severe pain during your period can be a sign
Many women experience discomfort during their menstrual period. Sometimes the pain becomes debilitating. If pain starts shortly before your period and continues for days after, it could be due to a medical condition called endometriosis.
Endometriosis, which affects about 10 percent of women, is the most common cause of pelvic pain and infertility in women of reproductive age. Because it can be mistaken for other conditions with similar symptoms, endometriosis often goes undiagnosed and untreated. Many women suffering from endometriosis are not aware of the cause.
Doctors Shari Snow and Laura Douglass, gynecological experts in the surgical management of endometriosis at the University of Chicago Medicine, answer questions about what can be a debilitating condition and the latest treatments.
What is endometriosis?
Endometriosis occurs when tissue similar to the lining of the uterus (endometrium) is found outside of the uterus. These “endometrial implants” attach to other organs in the pelvis such as the ovaries, fallopian tubes or the bowel.
What are common symptoms of endometriosis?
Endometriosis symptoms vary from woman to woman, depending on the number, location and size of the implants. Some women have no symptoms, while others are affected significantly.
Signs and symptoms can include:
• Pelvic pain, particularly shortly before, during or right after a period.
• Heavy or abnormal vaginal bleeding during periods.
• Lower back or leg pains (“cramps”) during periods.
• Significant pain during sex.
• Inability to conceive (infertility).
Why does endometriosis cause pain?
Pain, the most common symptom of endometriosis, can be the result of:
• Implants causing inflammation, which stimulates nerves and creates a sensitive pain response in the pelvis. The pain is often constant around the time of a woman’s menstrual period and increases during intercourse.
• Scarring between the pelvic organs and tissues.
• Heavy vaginal bleeding, which increases inflammation and irritation around the pelvic organs.
How is it diagnosed?
The first step is to tell your primary care doctor or gynecologist that you are experiencing pain or struggling to conceive. Because there is no single definitive nonsurgical test for evaluating endometriosis, your doctor may perform a combination of the following interventions:
• A pelvic exam to feel for endometrial implants, identify cysts or larger areas of scar tissue, or to detect points that trigger pelvic discomfort.
• Imaging of the pelvic area with ultrasound and/or MRI. At UChicago Medicine, radiologists who specialize in diagnosing endometriosis review these images and share their findings with your doctor.
• Laparoscopic surgery to confirm the diagnosis as well as to guide, and possibly provide, treatment. Laparoscopy is a minimally invasive technique that allows the surgeon to detect implants and biopsy tissue samples for further testing. In addition, the surgeon may treat or remove endometrial implants during the surgery.
What are the treatment options?
Managing and treating endometriosis involves a combination of several different types of treatment, based on the most bothersome symptom(s).
If pain is the most prevalent symptom and is mild, over-thecounter medications may offer initial relief. For severe or chronic endometriosis pain, specialized pain management approaches may be helpful. These might involve a thoughtful combination of medication and nonpharmacologic approaches (for example, acupuncture, physical therapy, psychotherapy).
Hormone therapy is another treatment option, because it reduces ovulation and the consequent stimulation of endometrial implants. When the ovaries stop releasing eggs, pain recedes and implants shrink due to a reduction in estrogen.
Surgery may be necessary if symptoms do not respond to medication, if implants are widespread, or if implants are found on the ovaries and affect a woman’s ability to conceive within one year. UChicago Medicine surgeons are highly trained to use minimally invasive laparoscopic or robotic techniques to destroy or remove endometrial implants. Sometimes a hysterectomy is necessary.
Does endometriosis affect fertility?
Some women may have difficulty getting pregnant as a result of undiagnosed endometriosis. If you are trying to get pregnant, discuss the options for managing endometriosis with your doctor. This will optimize your chance of carrying a healthy pregnancy.