As an OB/GYN, I often meet patients who have been silently suffering with pain for years. They may have painful periods from chronic pelvic pain, or trouble getting pregnant. One of the most common reasons behind these problems is endometriosis. This condition affects an estimated 1 in 10 women of reproductive age in the United States.
Even though it’s common, endometriosis can be hard to diagnose and is often misunderstood. Let’s explore what endometriosis is, how we diagnose it and what treatment options are available.
What Is Endometriosis?
Endometriosis happens when tissue similar to the kind that lines the inside of the uterus (called the endometrium) grows outside the uterus. These growths can show up on the bladder, ovaries, fallopian tubes, bowel, and other structures in the pelvic area. This tissue responds to hormonal changes, resulting in inflammation, scarring, and pain.
Why Is Diagnosis So Challenging?
It often takes years for someone to find out they have endometriosis. According to the National Institute of Child Health and Human Development, on average, it takes 7 to 10 years from the start of symptoms for a woman to receive a proper diagnosis.
This delay is because:
- Symptoms look like other health problems (e.g., IBS, pelvic inflammatory disease)
- Period pain is assumed to be normal
- There isn’t a simple, noninvasive test to confirm diagnosis without surgery
Step-by-Step: How We Diagnose Endometriosis
There isn’t a single test for diagnosing endometriosis, but here are the steps we take to confirm diagnosis:
Medical History & Symptom Review
We begin by asking about your symptoms, for example:
- Do you have painful periods (dysmenorrhea)?
- Do you experience chronic pelvic pain?
- Do you feel pain during sex (dyspareunia)?
- Are you having difficulty getting pregnant?
- Do you feel pain when you urinate or have bowel movements?
We also ask if you have a family history of endometriosis.
Pelvic Exam
Next, we’ll perform a pelvic exam and check for tenderness, nodules, or masses. Although it isn’t definitive, this can suggest endometriosis may be the cause of the symptoms and help point us in the right direction.
Imaging Tests
We may order imaging to help identify growths in the pelvic region:
- Transvaginal ultrasound: Useful for seeing cysts (chocolate cysts) on the ovaries, known as ovarian endometriomas.
- MRI: In some cases, we may use an MRI to get a better look and identify deep-infiltrating endometriosis and mapping the disease before surgery.
However, many forms of endometriosis, especially smaller, superficial lesions, are difficult to spot in imaging.
Laparoscopy
The only way to be sure someone has endometriosis is by doing a minimally invasive procedure called a laparoscopy. This is a small surgery where:
- A camera is inserted through a small incision in the abdomen.
- We can directly see the suspicious areas and take a small biopsy for testing.
- During the same procedure, some lesions can often be removed or ablated.
Treatment Options
There are many ways to manage symptoms, slow the progression of the condition, and improve quality of life. Treatment depends on the severity of symptoms, age, and fertility goals. Options include:
Medications
- Hormonal therapies: Different forms of birth control, including birth control pills, Depo Provera (the birth control shot), hormonal IUDs, and progestins are used to help stop periods and relieve symptoms. These are typically prescribed to people not planning to become pregnant in the near future. These medications lower estrogen levels, which help shrink the endometriosis growths and keep the new ones from growing
We may use other medicines like gonadotropin-releasing hormone (GnRH) agonists to shrink the growths and improve fertility - Pain relievers: Non-steroidal anti-inflammatory drugs like ibuprofen can help manage pain. They don’t stop the growth, but they can make you feel more comfortable.
Surgical Treatment
- Laparoscopic Excision or Ablation
As previously mentioned, this minimally invasive procedure involves using small incisions and a camera (laparoscope) to locate and either remove (excision) or destroy (ablation) endometrial tissue. By directly targeting these areas, the procedure can help with pain, reduce endometriosis symptoms, and potentially improve fertility. - Hysterectomy
For more severe cases of endometriosis, particularly when adenomyosis (a condition where endometrial tissue grows into the muscular wall of the uterus) is also present, a hysterectomy may be recommended. This surgical procedure involves the removal of the uterus and, in some cases, the ovaries and fallopian tubes. This is usually the last option if other treatments fail to offer relief, and symptoms are more serious.
Final Thoughts
Endometriosis is a serious and common condition that can significantly impact a person’s quality of life. It is important to understand that it is treatable, and various options are available depending on the severity of the symptoms and individual health circumstances.
Early diagnosis and a personalized treatment plan are essential in managing endometriosis effectively and enhancing your overall well-being.
You deserve to be heard and helped. Speak with your OB/GYN about your concerns, and if you don’t have one, schedule an appointment with a compassionate provider in your community, now.