Endometriosis: What You Should Know

Catholic Health Minimally Invasive Gynecologic Surgeon Peter Sticco, MD, shares helpful information about endometriosis, a significant underlying cause of abdominal and pelvic pain.

Are painful periods normal? Aren’t I supposed to have some pain with my periods?

While pain associated with a menstrual period is common, it is certainly not normal. There can be several underlying causes, each with their own treatment options, but by far the most common is endometriosis.

What is endometriosis?

Tissue known as the “endometrium” is the inner lining of the uterus. When this tissue is present outside the uterus, such as in the abdomen and pelvis, it is called endometriosis.

Endometriosis is a significant underlying cause of abdominal and pelvic pain affecting at least 10 percent of reproductive-age women globally. For women and adolescents with pelvic pain, 70 percent are found to have endometriosis. And 70 percent of women experiencing infertility without any pain symptoms are also discovered to have endometriosis. 

Why is this problematic?

This is problematic because endometriosis causes significant inflammation and can affect surrounding structures including the fallopian tubes, ovary, bowel and bladder. Many women experience abdominal bloating around their menstrual period because of this inflammation. Additionally, nerves deep within the pelvis can signal pain.

What are the common symptoms of endometriosis?

• Pain or pelvic cramping before or during menstrual periods
• Pelvic pain during or after sex
• Pain or irritation with urination during menstrual period
• Pain, irritation, or loose bowel movements during menstrual period
• Difficulty achieving a pregnancy

How do I check for endometriosis?

A formal diagnosis of endometriosis is made during surgery. There is no specific test to definitively diagnose endometriosis. The most important first step is a thorough and detailed history and physical examination with a physician experienced in diagnosing and treating endometriosis.

Imaging studies, such as ultrasound or MRI, are frequently used to help identify if there are any large endometriosis collections, known as an endometrioma. If present or discovered on imaging, there is expected to be endometriosis elsewhere in the abdomen and pelvis.

What should I do if I think I have endometriosis?

Speaking with your physician about any type of pelvic pain is an important first step.  A consultation with a pelvic pain and endometriosis specialist, such as a minimally invasive gynecologic surgeon, may help uncover underlying causes and provide appropriate treatment options.

Can endometriosis be treated?

Treatment plans are designed based on a patient’s age, desire for future fertility, and taking into account individual wishes and goals.

Medications

Medications are available to help manage the pain and inflammation caused by endometriosis but do not target endometriosis directly. These are generally referred to as NSAIDs or non-steroidal anti-inflammatory drugs. Some are over-the-counter and others require a prescription.

There are also a wide variety of hormone-based medications that help suppress endometriosis, thereby limiting its activity. These medications interfere with the usual hormones in a woman’s menstrual cycle, and so are not appropriate if trying to achieve a pregnancy. Although the medications reduce the activity of endometriosis, they are unable to remove endometriosis that is already present.

Surgery

Surgery is used to formally diagnose endometriosis by direct visualization and biopsy. This is performed with either laparoscopy or robotic-assisted surgery. Several small incisions are made on the abdomen to look inside with a camera known as a laparoscope. Any endometriosis or endometriomas identified should be removed completely. Depending on the extent of endometriosis, the appendix may also be affected, and may need to be removed at the same time.

The goal of surgery is to remove all endometriosis while restoring normal anatomy. This can be especially useful in women trying to achieve a pregnancy. Surgical excision of endometriosis currently achieves the most significant resolution in symptoms and patient satisfaction as compared to medical management options.

Call 866-MY-LI-DOC (866-695-4362) to find a Catholic Health physician near you.