Finding Relief From Endometriosis

You’ve heard about endometriosis. But what does that mean? The condition gets its name from the word endometrium – the tissue that lines the uterus, or womb.

Endometriosis occurs when the tissue — instead of leaving the body during a menstrual period — is retained and abnormally implants and grows outside of the uterus. More than 5 million teenage girls and women in the United States have endometriosis, according to the U.S. Department of Health and Human Services.

“Endometriosis is one of the most under-diagnosed problems in the U.S.,” says robotic gynecologic surgeon Ricardo Estape, M.D., of Baptist Health’s Center for Robotic Surgery.

And it’s one of the causes of female infertility, according to the Centers for Disease Control and Prevention. In many cases, women continue to suffer from the effects of endometriosis, because it is misdiagnosed.

“The disease can be mistaken for conditions such as pelvic congestion, pelvic inflammatory disease, urinary tract infection or irritable bowel syndrome,” says Emerita Rafaela Castillo, M.D., an obstetrician and gynecologist affiliated with Homestead Hospital.

Each month, endometriosis responds to the hormones produced during the menstrual cycle by building up, breaking down and shedding. When the uterus contracts to push out blood and tissue, a problem can develop when some of the tissue goes upward into the pelvic region, Dr. Estape says.

Most often, endometriosis is found on the ovaries, fallopian tubes, lining of the pelvic cavity and outer surface and supporting tissues of the uterus. Other possible growth sites include the vagina, cervix, vulva, bowel, bladder or rectum. Once implanted outside the uterus, the endometriosis growths may expand with monthly menstrual cycles, causing symptoms to worsen. In some cases, endometriosis travels through the bloodstream to the lungs, brain and middle ear, Dr. Estape says.

Who is at risk?

You may be at higher risk of endometriosis if you have a family history of the disease. Delaying pregnancy until an older age also is believed to increase the risk.

What are the symptoms?

The amount of pain a teen or woman experiences does not depend on the level of endometriosis.

“Some women have no pain, even though their disease affects large areas,” Dr. Castillo says. “Others have severe pain despite the fact that they have only a few small growths.” 

Symptoms can include:

• Very painful menstrual cramps.

• Chronic pain in the lower back and pelvis.

• Pain during or after sexual intercourse.

• Fatigue.

• Painful bowel movements or urination during menstrual periods.

• Spotting or bleeding between menstrual periods.

• Diarrhea, constipation, bloating or nausea, especially during menstrual periods

• Infertility.

What is the impact?

Studies show that teens and women who suffer from endometriosis pain often miss school, work and social events. This  can affect relationships with spouses, children, friends and coworkers, and it also can lead to depression, says Dr. Castillo.

How is endometriosis detected?

Getting a proper diagnosis if you have endometriosis is the first step in taking back your life. A confirmation of endometriosis requires surgical biopsy, which is commonly achieved through a minimally invasive procedure called laparoscopy. During the procedure,  a camera is used to inspect your abdominal and pelvic regions to detect and remove growths and scar tissue without harming healthy tissue.

“Laparoscopy is the gold standard for detection of endometriosis,” Dr. Estape says, adding that other imaging or scanning methods are not as accurate.

What other treatments can help control and treat the symptoms:

• Medications can relieve pain.

• Hormone treatments may be a good option for women with small growths who do not have debilitating pain and do not wish to become pregnant.

• Laparotomy, or major abdominal surgery, allows your surgeon to reach and remove growths of endometriosis in the pelvis or abdomen.

• Hysterectomy is usually considered as a last resort. You and your surgeon may choose the option to remove your uterus and sometimes your ovaries when endometriosis has severely damaged these organs.

“It’s important that a patient partners with her physician to identify a treatment plan that works for her,” Dr. Castillo says.