Your Endometriosis Questions Answered
March is Endometriosis Awareness Month, a reminder and an opportunity to understand just what endometriosis is; its effects on women; and how it is diagnosed and treated.
Dr. Rohan Hattiangadi, EvergreenHealth Women's Specialty Care, Gynecology, answers your frequently asked questions about endometriosis symptoms, diagnosis and treatment.
What is endometriosis?
Endometriosis is a chronic inflammatory condition in which endometrial tissue (similar to the lining of the uterus) grows outside the uterus. This condition impacts one in 10 women – or about 200 million women worldwide.
What are the symptoms of endometriosis?
While the typical presentation involves painful periods and pain with sexual intercourse, endometriosis can also be associated with infertility, heavy menstrual bleeding, depression and anxiety, irritable bowel syndrome, painful bladder syndrome, and a variety of other chronic pain conditions that can dramatically reduce a woman's quality of life. Endometriosis may also be asymptomatic and only diagnosed incidentally during imaging or surgery for another medical condition.
Can endometriosis cause infertility?
Approximately 40% of women with unexplained infertility may have a diagnosis of endometriosis. Pelvic inflammation caused by endometriosis can be toxic to the egg and sperm and prevent fertilization and implantation. Severe endometriosis can cause scar tissue and adhesions that block the fallopian tubes.
How is endometriosis diagnosed?
There is no simple urine, blood or saliva test to diagnose endometriosis. The only way to arrive at a definitive diagnosis is through laparoscopic surgery. During the procedure, areas of endometriosis are identified and excised (removed). The tissue is analyzed by a pathologist who can confirm the diagnosis.
Alternatively, a high clinical suspicion of endometriosis is sufficient to start treatment and does not require surgery. It's important to listen to your body and recognize that painful periods can be treated and are an appropriate reason to visit your doctor.
Studies show that the average delay in diagnosis of endometriosis can be as many as eight to 12 years, much longer than is necessary. This is often because pain from endometriosis is normalized and dismissed as "period pain" by friends, family and even health care practitioners. Also, cultural norms may prevent discussing menstrual pain, preventing some women from seeking evaluation and care.
How is endometriosis treated?
Endometriosis is hormonally sensitive: It grows under the influence of estrogen. Therefore, treatment of endometriosis is most effective with medications that can suppress ovarian production of estrogen. This includes oral contraceptive pills, progestin-only pills, hormone-releasing implants and IUDs, hormone-releasing vaginal rings, etc. Symptomatic treatment with NSAIDS (e.g., Ibuprofen), heating pads, meditation/yoga and mindfulness is also helpful. Finally, if pain persists despite these interventions, it may be time to consider surgery.
Does surgery cure endometriosis?
There is no cure for endometriosis. Surgical excision of endometriosis, performed by a well-trained minimally-invasive surgeon, may result in as much as a 60 to 80% improvement in pain symptoms, welcome relief for many women. Unfortunately, endometriosis can return. (There is a 25 to 50% risk of recurrence in the first five years after surgery.) Some people may need definitive surgery with hysterectomy (removal of the uterus).
If you or someone you know might have endometriosis, we encourage you to seek care with an endometriosis specialist, like Dr. Hattiangadi, for a consultation. Consultation begins with a review of symptoms and thorough counseling to determine the best way to reduce pain and improve quality of life, whether through medication or surgery.
EvergreenHealth's expert, Dr. Rohan Hattiangadi, is a board-certified OB/GYN who has completed specialized fellowship-training in minimally invasive gynecologic surgery. He has performed more than 1,500 minimally invasive gynecologic surgeries, many using the da Vinci robotic surgery system, a minimally invasive procedure resulting in a faster recovery time.
To learn more about Dr. Hattiangadi and the EvergreenHealth Women's Specialty Care, Gynecology, please visit www.evergreenhealth.com/gyn-surgery or call (425) 899-4692.