What is Endometriosis?
Tissue called endometrium lines the inside of the uterus. When that type of tissue is present outside the uterus, the condition is called endometriosis. When a woman has endometriosis, that tissue responds to monthly hormonal changes in the body the same as the tissue inside the uterus. The inflammation, swelling, and scarring associated with this can cause women to have unbearable pain during menses. It's estimated that up to 10% of women between 25 and 40 suffer from endometriosis.
What are the symptoms of Endometriosis?
The main symptom of endometriosis is pelvic pain. Pain is typically worse before or during menses and may be associated with sex, bowel movements, or urination. Endometriosis may also eventually lead to constant, chronic pelvic pain. In fact, endometriosis is found in about three quarters of women with chronic pelvic pain.
The amount of pain someone has is not always associated with how severe the endometriosis is. Some women with slight pain may have significant endometriosis, and others with a lot of pain may have just a mild. In fact, in some cases endometriosis is found in women with no symptoms at all.
Can Endometriosis impact fertility?
Yes, in addition to causing pelvic pain, endometriosis can affect fertility. Extensive endometriosis can cause scarring and blocking of the fallopian tubes. Even mild cases can reduce the chance of getting pregnant from the normal 25% per month to around 7% per month, on average. Endometriosis is found in about one third of infertile women.
How is Endometriosis treated?
Endometriosis may be treated by medication or surgery. Medications may include nonsteroidal anti-inflammatory drugs (NSAIDs) or hormones. If hormone treatment is used, typically it will include one of these options:
- Combined hormonal (estrogen and progesterone) contraceptives
- Progestins
- Gonadotropin-releasing hormone (Gn-RH) agonists and antagonists
What surgical options are available for Endometriosis?
Dr. Arabkhazaeli, one of our minimally invasive gynecologic surgeons, explains surgical options this way:
“Surgery can be both diagnostic and therapeutic. At minimum, surgery can provide visual and histologic confirmation about the presence of endometriosis, and unfortunately is the only way to definitively diagnose the disease. Further, if endometriosis is confirmed and managed surgically, surgery can result in a therapeutic relief in symptoms.”
Who is a candidate for Endometriosis surgery?
People pursue endometriosis surgery for a variety of reasons, and there is no right answer. Some common motivations for pursuing surgery is the following:
- Persistent pain despite medical therapy
- Unable to or unwilling to take medical therapy
- Desire a confirmation of diagnosis
- Improvement in fertility
What surgeries are available for Endometriosis?
Typically, any of the surgical procedures we use for endometriosis are minimally-invasive. Endometriosis surgery can consist of excision or ablation and can be conservative or definitive. Endometriosis lesions can be destroyed through excision (removing tissue) or ablation ("burning" tissue). While outcomes are similar, excision allows for a histologic diagnosis and can address deeper lesions as compared to ablation.
Conservative Approach
Sometimes a conservative approach is preferred. This surgery involves destruction of endometriosis lesions, while preserving the uterus and ovaries. Conservative surgery is generally first line, as it preserves fertility and hormonal function, is less invasive, and has short-term efficacy. Conservative laparoscopic excision of endometriosis reduces overall pain in 73% of patients. Unfortunately, the recurrence rate can be high, with up to 58% of patients needing repeat surgery.
Definitive Approach
Definitive surgery includes hysterectomy (removing the uterus), with or without oophorectomy (removing the ovaries). This is reserved for people with persistent bothersome symptoms who do not plan on future childbearing. The main benefit is a lower long term recurrence rate.
