Approximately six and a half million American women have endometriosis, according to the Office on Women’s Health, and many suffer with chronic pelvic pain, severe menstrual cramps and the physical and emotional toll of infertility.
“Endometriosis is a condition where tissue similar to the lining of the uterus grows outside of the uterus, typically located on the walls of the pelvis and/or the ovaries and tubes,” says Jessica Putman, M.D., a minimally invasive gynecologic surgeon with OU Health in Oklahoma City. “It can sometimes affect other organs in the abdomen. There are certain symptoms that can raise suspicion for endometriosis, but definitive diagnosis is surgical with visualization of the lesions and pathological confirmation.”
While there’s no known cause for endometriosis, Putman says the most common theory is retrograde menstruation, where menstrual blood flows back through the fallopian tubes and into the pelvis.
“The blood may contain endometrial cells from the uterine lining that can then stick to the pelvic walls or organs,” she says. “Estrogen stimulates the growth and spread of endometriosis. Family history, particularly in mom or a sister, is a major risk factor. The majority of patients are diagnosed after the age of 25, however, most patients develop symptoms long before that. It can take months up to 10 years to get a diagnosis depending on symptoms and discussions with your doctor.”
The difficulty in diagnosing endometriosis often stems from symptoms being so similar to other conditions, and the varying degrees of severity and presentation of symptoms among individuals. Endometriosis symptoms can mimic conditions such as pelvic inflammatory disease, irritable bowel syndrome and uterine fibroids.
“The most common symptoms are painful periods, pelvic pain, pain with sex, pain with bowel movements or urination, heavy periods, bloating and infertility,” says Putman. “Most of the symptoms can be managed with appropriate treatment, but patients will often experience ‘flares’ where symptoms are worse for a period of time.”
She says up to half of patients with endometriosis will struggle with infertility, however, many with mild to moderate disease can still conceive.
“Some patients, particularly those with more advanced disease, may need reproductive assistance,” she says. “Any patients with known endometriosis who are trying to conceive should reach out to their doctor for further workup if unable to achieve pregnancy within six months.”
Regarding treatment for endometriosis, Putman says symptoms are often managed with hormonal suppression medications.
“This not only improves symptoms but also decreases the risk of progression or recurrence of disease,” she says. “When medical management does not control symptoms, then surgical management may be needed. This can be anywhere from a surgery for removal of endometriosis lesions up to hysterectomy. It is important to know that endometriosis is a chronic condition and there is no cure, although patients typically have significant improvement in symptoms after menopause due to the drop in estrogen.”
For women navigating the journey of endometriosis, there are several organizations that offer resources and support groups, such as SpeakEndo.com, the Endometriosis Coalition Patient Support Group, the Endometriosis Foundation and a variety of apps that can help women track symptoms, medications and gain more knowledge about their condition.
