Menstruation can be uncomfortable. But, for some, “that time of the month” is also a period of extreme pain accompanied with heavy bleeding and pelvic discomfort. Affecting 2 to 10 percent of premenopausal women, endometriosis is often difficult to diagnose and can hamper the day-to-day living of those with the condition.
In this Q & A, endometriosis specialist Susan S. Khalil, MD, Assistant Professor of Obstetrics, Gynecology and Reproductive Science at the Icahn School of Medicine at Mount Sinai, explains the condition, its symptoms, and why early diagnosis and treatment is important.
What is endometriosis?
Endometriosis is a condition in which there is an ectopic implantation of the endometrium. In layman’s terms, the lining of the uterus is implanted in sites outside of the uterus. Implantation can be in the fallopian tubes, the ovaries, or inside the belly. It can also be in areas of the body very distant from the reproductive organs, such as the lungs or even the brain. The condition typically effects women who are still having their period.
What causes the condition, and can it be prevented?
The cause of endometriosis is largely unknown, but there are a few different theories. One is that, in some women, blood from menstruation flows backward into the belly instead of flowing downward, causing incorrect implantation. Another is “de novo” formation, meaning that it just happens on its own. Yet another theory is that local cell changes can lead to endometriosis.
There is no cure for endometriosis, but there are treatments. And early diagnosis leads to less invasive methods of managing the condition.
I think I have endometriosis. What are the symptoms?
The most common symptoms of endometriosis are pelvic pain and painful periods.
If you are wondering how much period pain is too much, remember that your period should not routinely interfere with your ability to go to work or school, or to go about the activities of daily living. If you are missing out on these activities due to your period, please see a gynecologist.
Patients with endometriosis may also experience unexplained painful urination, painful bowel movements, and painful intercourse. Occasionally, women will get evaluated for the condition if they are having difficulty getting pregnant. Based on your symptoms, endometriosis can be suspected, but the condition is confirmed through laparoscopy.
I was diagnosed with endometriosis. Can I still get pregnant?
Yes, you can get pregnant. However, you may require some assistance. For instance, some people with the condition may need to undergo minimally invasive surgery to remove endometrial tissue.
There is a wide spectrum of severity with endometriosis. While many women actively pursue treatment or diagnosis because they are having difficulty conceiving, there are also pregnant women whose diagnosis is only discovered during routine examination.
What are the treatment options for the condition? Will I need surgery?
Generally, the treatment for endometriosis includes medication and, for some, a surgical option.
Common medications prescribed for the condition depend on the patient’s primary goals, which may include pain control or suppression, or pain control while trying to conceive. The medications include hormonal agents with progesterone only, a combination of estrogen and progesterone, and gonadotropin-releasing hormone (GNRH) agonists or antagonists. The treatments are tailored to the patient when they are evaluated.
If patients need surgical intervention, laparoscopy is one option. It can be used to diagnose endometriosis and to remove growths and scar tissue from the reproductive area. The procedure is often regarded as a fertility-sparing operation that also helps to reduce the pain associated with endometriosis and improve quality of life.
How important is early treatment, and diagnosis, of endometriosis?
Early treatment and diagnosis is important to maintain fertility and manage pain symptoms. It also helps with identifying patients who have endometriosis, and patterns in their family history.
At Mount Sinai, we offer a team-based approach that includes various services, such as pelvic floor therapy, acupuncture, dietary management, and pain management. All of these services are intended to make endometriosis a more livable condition for patients as well as to provide them with a good framework for support.