Endometriosis is a condition in which tissue resembling the lining of the uterus grows outside of your uterus. Endometriosis is a chronic disease causing severe pelvic pain, pain during or after sex, and infertility, which in turn can all significantly affect your ability to enjoy life.

While there is no cure for endometriosis, it can be treated and symptoms can be managed with medicine and in some cases, surgery. Endometriosis may affect more than 11 percent of women between the ages of 15 and 44, according to the Office on Women’s Heath of the U.S. Department of Health and Human Services.

In this Q&A, Tamara Kolev, MD, explains some of the common misconceptions, why patients find their symptoms may be dismissed, and how patients can talk with their doctors about this condition.

What prevents early diagnosis of endometriosis?

Endometriosis is a very complex disease, and its diagnosis is often delayed due to a combination of factors. One of these factors is the presentation of variable, non-specific symptoms.

What does that mean?

Endometriosis can vary in intensity and type. Sometimes symptoms may overlap with gastrointestinal and genitourinary symptoms, which may make it harder to diagnose. We also do not have definitive diagnostic tools. Imaging can be helpful, but the standard diagnosis for endometriosis is histological diagnosis with surgery. Histological diagnosis is made by a pathologist after examining tissue samples after a biopsy or surgical removal of tissue. Often, endometriosis will not appear on an ultrasound, and small endometriosis implants may not even appear on an MRI. Patients may present with pain and receive imaging, but we cannot give them confirmatory diagnosis.

Are patients’ symptoms often dismissed before being correctly diagnosed with endometriosis?

Yes. Patients are dismissed all the time. One of the big issues patients face is societal normalization of menstrual pain, and the misconception that painful periods are normal. When these patients complain of painful periods, they’re told by providers that this is normal. This leads to a lack of awareness in some providers, when it comes to educating patients on what’s normal and what’s normal, not normal.

How long does it typically take before the condition is diagnosed?

Very often, providers and specialists experienced in this area of medicine can make a diagnosis in a matter of weeks or months. But it can take some patients several years or more to receive a proper diagnosis if their providers are not as familiar with endometriosis and its complex presentations.

How does a delay in diagnosis of endometriosis affect a patient’s fertility or overall quality of life?

Endometriosis can be a significant factor in fertility. Some studies have shown that between 30 to 50 percent of women with infertility ultimately receive an endometriosis diagnosis. Endometriosis can cause scar tissue or adhesions and can cause inflammation in the pelvic area. This can make it difficult for eggs to be fertilized or implant. Endometriosis can also affect ovarian reserve, which is the number of healthy, immature eggs in the ovaries. The longer that it takes for women to be diagnosed, the more it affects their fertility options for the future. Endometriosis is an extreme social and emotional burden. Endometriosis symptoms of chronic pelvic pain, painful intercourse, problems with bowel movement and urination can all significantly affect a patient’s ability to enjoy life.

How can early detection of endometriosis be improved?

Promoting health literacy among providers and patients is important. Patients need to be aware of endometriosis symptoms and when to seek help. Health care providers need to aware of symptoms of endometriosis and when it is appropriate to refer a patient to a specialist. There are also new developments in trying to identify more non-invasive testing, certain biomarkers, and improving our imaging technology to properly diagnose endometriosis.

What are some common misconceptions about endometriosis symptoms?

A common misconception is that painful periods are normal.  A certain degree of cramping can be common, however severe, debilitating pain that is affecting your daily life could be related to endometriosis. Another misconception is that endometriosis only causes pelvic pain. Other symptoms include:

• Pain with urination
• Diarrhea, constipation, nausea, vomiting
• Pain with defecation

What should I do if my doctor dismisses my symptoms?

It’s very important to speak up and advocate for yourself. Document your symptoms. Keep a pain diary, so that when you go to your doctor, you can show them what you’re experiencing. Don’t be afraid to talk to your doctor. If you feel like your doctor is not listening to you, ask for a referral to a specialist or get a second opinion. There are other providers out there who will listen.

Nearly everyone will experience elbow pain at some point in their lives. Tennis and golf enthusiasts are especially prone to such injuries. Baseball players, both professionals and little leaguers, often develop pain through over use of their arms.

But you don’t have to play sports to get elbow pain. Even office workers can cause damage to their elbow joints just by frequently resting their arms on the hard surface of a desk.

Given the number of bones, nerves, tendons, and ligaments that comprise the elbow joint, it’s easy to understand why your elbow can be prone to injury.

In this Q&A, Dave Shukla, MD, an orthopedic surgeon at Mount Sinai Brooklyn, explains some of the most common causes of elbow pain and non-surgical and surgical treatment options, including recent advances in implant design and surgical techniquethat have improved the success rate of elbow replacements.

Why is the elbow such a complex joint?

The elbow is composed of the ulna and radius (bones of the forearm), the humorous (the bone in your upper arm); cartilage; and ligaments and muscles that surround the joint and keep the elbow stable. The elbow has two main nerves that signal pain: the ulnar nerve, which wraps around the exterior corner of the elbow, and the radial nerve, which runs on the front outside of the forearm.

What are the most common causes of elbow pain?

Many different issues can lead to pain in your elbow, ranging from repetitive conditions and overuse to injuries. This includes arthritis-related conditions, sprains and strains, and fractures. However, sports-related activities, notably tennis, golf, and baseball, are among the most common causes.

The pain from these sports activities can come on suddenly or gradually and may worsen with certain movements.

• Tennis Elbow (lateral epicondylitis)

Tennis elbow results from overuse or injury. However, you do not need to be a tennis player to wind up with tennis elbow.  Any repetitive gripping or grasping activity can cause this problem including using a kitchen knife to cut meat; using hand-held tools (screwdriver or hammer); painting or drawing; and knitting or crocheting. Plumbers, carpenters, butchers, and painters are among those whose jobs require the types of motion that can lead to tennis elbow. Tennis elbow pain mostly occurs where the tendons of your forearm muscles attach to the bony bump on the outside of your elbow and possibly spreading into your forearm and wrist.

• Golfer’s Elbow and Baseball Player’s Elbow (medial epicondylitis)

Any repetitive or forceful activities involving the wrist or fingers can result in this condition. The cause of golfer’s elbow is primarily damage to the muscles and tendons that control your wrist and fingers. The symptoms of golfer’s or baseball player’s elbow include pain on the inside of your elbow, or the “funny bone,” when you clench your hand into a fist.  Symptoms can also include weakness, stiffness, numbness, and tingling in the hand and wrist.

What treatments are available for tennis elbow, golfer’s elbow and baseball player’s elbow ?

Rest and physical therapy exercises are common treatments. Consult your health care provider before using any form of treatment. Simple stretches of the hand, wrist and arm, as well as grip strengthening, can often help repair the damage. Non-surgical treatments might include over-the-counter pain and anti-inflammatory medications.

How can I prevent elbow overuse injuries?

There are a number of simple things you can do.

• For playing sports, ensure you have done the proper conditions and use warm-up exercises
• Minimize the repeated impact on your elbow, such as avoiding resting your elbow on hard surfaces, especially at your desk.
• Always use proper form and gear, pace yourself, gradually increase activity levels and mix up routines with other physical activities.

When should someone experiencing elbow pain see an orthopedic surgeon?

You should follow a simple rule that if conservative measures fail after six weeks, it’s time to see an orthopedic surgeon for further evaluation. Before seeking medical help, using home remedies can help. This includes basic things like:

• Wrapping a towel around your elbow so that you don’t sleep with your elbow bent up all night.
• Wear a baseball elbow pad and place it in the front of your elbow so that you don’t bend it.

If the pain does not subside after you have taken anti-inflammatory medications and used heat or ice or any other home remedy, you should see an orthopedic surgeon.

How is elbow pain diagnosed?

First an orthopedic surgeon will conduct a physical examination and take a medical history. The surgeon will also use radiological exams to determine best courses of treatment. At Mount Sinai Brooklyn, we commonly rely on a magnetic resonance imaging (MRI), a non-invasive test, because it  provides the most information.

Will my elbow pain resolve on its own?

Sometimes, elbow pain can go away on its own, especially if it’s due to a strain or sprain. These issues are usually minor, and with home care they can subside within a few weeks. However, many of the other more serious causes usually require some kind of treatment, especially if they don’t get better after a six weeks of conservative care at home.  

What non-surgical treatment options are available?

In most cases, mild elbow soreness can be treated by icing the area, refraining from pain-causing activities, and taking over-the-counter medications.  Persistent, worsening, or severe pain may need more formal treatment and should be evaluated by an orthopedic surgeon. In the case of sprains, strains, golf or tennis elbow, therapy is often used. Physical therapy will lead to a reduction in pain and add stability to the affected joints especially in people with osteoarthritis and rheumatoid arthritis. Oral anti-inflammatory medications can help alleviate pain and swelling. If needed, a cortisone injection maybe given to provide short-term pain relief for conditions such as osteoarthritis and tennis elbow.

What are the surgical options available for elbow pain?

Surgery may be needed if symptoms don’t improve after a few months of non-surgical, conservative therapies. At Mount Sinai Brooklyn, we use minimally invasive and/or arthroscopic surgery with most procedures performed as same day outpatient surgery. This approach allows patients to immediately begin their recovery at home. Surgical options include:

• Arthroscopy—a minimally invasive procedure that uses small instruments to remove bone fragments, damaged cartilage, and bone spurs from the joint
• Arthroplasty—a minimally invasive procedure used to replace damaged joints with an artificial one
• Osteotomy—a procedure involving the removal of sections of the bone to ease symptoms and reduce any bone-on-bone contact
• Synovectomy—a procedure involving the removal of the synovium, which is a thin layer of tissue surrounding each joint

Can my elbow joint be replaced like my knee or hip?

Orthopedic surgeons can replace the elbow joint just as they do with knee and hip joints. This surgery is called elbow arthroplasty. The surgery involves replacing one or more bones that meet in the elbow with parts made of metal and plastic (implants). In the past, elbow replacement surgery had a higher rate of complications than hip or knee joint replacement surgeries. However, recent advances in implant design and surgical techniques have improved the success rate of elbow replacements. 

How long will it take to recover from surgery?

After elbow surgery, most patients usually recover within two weeks, even patients undergoing elbow replacement surgery. A complete recovery that restores full range of motion might take up to three months.