March is National Endometriosis Month, and we sat down with Dr. Kelly Wright, assistant professor of Obstetrics and Gynecology at Cedars-Sinai to chat about this often-misunderstood condition.
Q: What is endometriosis and who gets it?
Dr. Wright: Endometriosis is a condition where the inside lining of the uterus (the endometrium) gets outside the uterus and attaches to other organs. Even though it’s outside the uterus, the endometrial tissue still behaves like it does when it’s inside the uterus, which means it responds to hormones and bleeds every time you have a period. This causes a lot of inflammation in the abdomen, which can lead to pain.
Any woman who is having periods can have endometriosis, but we don’t know exactly why it occurs. Because the symptoms and types vary, it’s also very difficult to study.
“To reduce inflammation and prevent endometrial tissue from becoming stimulated and inflamed, many patients use hormonal birth control.”
Q: What are some common symptoms?
Dr. Wright: Common symptoms, which range from mild to severe, include painful or heavy periods, pain during sex, problems with bowel movements, or trouble getting pregnant.
Q: How do I get diagnosed?
Dr. Wright: Endometriosis can be hard to diagnose and treat, and some patients experience years of pain and frustration before they find good care.
Typically, a doctor will suspect endometriosis based on a detailed history, pelvic exam, and a pelvic ultrasound. To get diagnosed, patients undergo a laparoscopic procedure where a doctor looks inside the abdomen with a small camera to see if there are any spots that look like endometrial tissue outside of the uterus.
If needed, tissue is removed or biopsied and sent to a pathologist to confirm the diagnosis.
Read: Demystifying Mammograms
Q: Is there a cure for endometriosis?
Dr. Wright: Endometriosis does not have a cure. After menopause, most women find relief due to a lack of periods.
Q: I’ve been diagnosed. What’s next?
Dr. Wright: For women who are still having periods, treatment depends on symptoms and goals. Most treatment plans involve surgical and non-surgical options, and patients may try different approaches before finding what works for them.
During the laparoscopy, all endometrial tissue that is found outside the uterus is removed. Even after surgery, endometriosis can come back every time a woman has a period. Therefore, we typically add other types of treatment after surgery.
“Most women with endometriosis can become pregnant on their own.”
To reduce inflammation and prevent endometrial tissue from becoming stimulated and inflamed, many patients use hormonal birth control. Successful treatments include birth control pills, hormonal IUDs, a hormonal implant, or a shot.
Many patients will also use NSAIDs like ibuprofen to treat pain. These medications come in prescription-strength doses, and when taken at the very onset of a period, can prevent inflammation from building.
Pelvic floor physical therapy may also be recommended because endometriosis can cause the pelvic floor muscles to tense up, which can result in pain even after endometriosis is treated.
Patients will often be referred to a gastrointestinal specialist, as symptoms including gastritis (upper abdominal pain), constipation, and bowel pain are common.
Q: Is there a link between fertility and endometriosis?
Dr. Wright: Yes. However, most women with endometriosis can become pregnant on their own. Fertility rates increase in the year following laparoscopic surgery.
Severe endometriosis that causes scarring can block the tubes and prevent the egg and sperm from reaching each other. Some women with severe endometriosis need to pursue options like in-vitro fertilization (IVF) if they wish to become pregnant.
Q: Should I have a hysterectomy?
Dr. Wright: Women who do not wish to become pregnant or are past their childbearing years may choose to have a hysterectomy.
This may be particularly effective for women who have adenomyosis, a specific type of endometriosis where the endometrial tissue is trapped between the muscle layers of the uterus. Women with adenomyosis are very likely to experience relief from a hysterectomy.
However, women who have leftover endometrial tissue in their abdomen may continue to need hormonal suppression after a hysterectomy to prevent the tissue from being stimulated by the ovaries.
Q: Is there anything else I should know?
Dr. Wright: Because many doctors have a hard time diagnosing and treating endometriosis and pelvic pain in general, patients should look for a specialist who practices minimally invasive gynecologic surgery (MIGS) and has extra training in treating endometriosis. Look for a physician who takes your symptoms seriously and offers a treatment plan composed of different treatment options.
At Cedars-Sinai, we have two faculty physicians—Dr. Matthew Siedhoff and me—who are fellowship trained in MIGS and routinely treat women with endometriosis.