Endometriosis – The Inside Story

Aside from an annual wellness check, painful, heavy periods and infertility are two of the most common reasons women seek medical attention from their OB/GYN. While there are several factors which can cause these problems, endometriosis is often at the top of the list. Endometriosis is the condition in which the normal tissue of the uterine lining (endometrium) is found growing in other areas of the pelvic cavity or body.

According to The American College of Obstetricians and Gynecologists, while no one is certain what causes endometriosis, the amount of associated pain is not necessarily a good indicator of the severity of the condition. Likewise, treatment plans vary – from medications to surgery – and will depend on the extent of the disease, symptoms, and whether the patient wants to have children.

Jennifer Demos-Bertrand, DO, https://www.thechristhospital.com/physician-details?Provider=K4D60U2ZX3 who practices Obstetrics and Gynecology at The Christ Hospital https://www.thechristhospital.com/physician-search-results?Type=AdvancedSearch&Specialty=Obstetrics%20-AMP-%20Gynecology&Apps=Yes&TCHPOnly=No . answers questions below.

Diagnosis and Treatment

Endometriosis often presents with painful periods (but not necessarily heavier periods) and pain during intercourse.  When a patient presents with these symptoms, endometriosis is often in the back of our minds. The only way to truly diagnose endometriosis is getting a biopsy from the inside of the abdomen during surgery. This is done laparoscopically where a small incision(s) is made in the abdomen to view the pelvic organs and retrieve tissue using a slender, lighted instrument. However, since such an invasive procedure is needed to make the diagnosis, we often treat the symptoms, since the outcome of the biopsy doesn’t change the plan.

The first-line treatment to help relieve the pain of endometriosis is some type of birth control, which helps by reducing the severity, duration and intensity of the menstrual period. Birth control pills are sometimes prescribed continuously so the woman does not have a period, and therefore does not experience pain.

Other treatments include

·         Depo-Provera, a brand name for medroxprogesterone acetate, a contraceptive injection for women that contains the hormone progestin, and typically given every three months.

·         Gonadotropin, a GnRH agonist which “turns off” the ovaries, ceasing menstruation. The downside to using GnRH agonists is that the woman can experience extensive menopausal symptoms that cause extreme discomfort (hot flashes, vaginal dryness, headaches, decrease in bone density.

·         Orilissa – a specific medication for endometriosis but is not a method of birth control (unlike other treatment options) and can’t be taken while the patient is using birth control pills. Most women who struggle with endometriosis are child-bearing age and need a reliable form of birth control, whether it’s condoms, an IUD, or sterilization.  It is also difficult to get this medication covered by insurance.

·         Surgery – removing the unwanted endometrial tissue, or definitive management which removes the affected female organs and tissue.

If I have a lot of pain with endometriosis, does that mean a large portion of my pelvis is affected?

No, in fact, one little-known truth about endometriosis is that the level of discomfort and pain is not directly related to what the physician might find in the abdomen (during laparoscopic evaluation or surgery). It isn’t possible to correlate how bad the endometriosis is involved in the pelvis to how severe the symptoms.

What about infertility, I understand endometrioses is often a concern with ability to conceive?

One of the biggest myths is that a woman won’t be able to get pregnant if she has endometriosis. I can’t tell you how many times a newly pregnant patient has said to me, “but I didn’t think I could get pregnant, I have endometriosis!” Or, “I was told I could never get pregnant.” Neither are true.

If a woman has been trying to conceive for a year or longer, she will sometimes seek out the help of an infertility physician. It may be then that she has her first conversation about endometriosis, especially if she did not have any prior symptoms. Typically, a myriad of possible infertility factors is investigated during infertility treatment, including the definitive tissue biopsy mentioned earlier. To this end, there is a correlation that 38% of women who have tried to get pregnant for a year or more and are unsuccessful are found to have endometriosis. But with that said, it might be more difficult to get pregnant, but not impossible.

If endometriomas (ovarian cysts that are filled with endometrial tissue) form, your OBGYN may remove these in the operating room. My recommendations and treatment plan depend on how long the patient has been trying to conceive, and other factors.

What if I have endometriosis and do not want to go on birth control or have surgery?

I suggest scheduled NSAIDS (ibuprofen such as Advil), starting the minute their period starts, or even the night before, to help with the pain.  While some people may want to avoid hormones and look for alternative ways to deal with the pain, I don’t hear that too much from patients who are dealing with severe pain of endometriosis.

If you would like to review your symptoms, further information, or want to schedule with an OB/GYN, please call The Christ Hospital Nurse Navigator at 513-261-8007 or visit https://www.thechristhospital.com/services/womens-health/ezcare-concierge