What options do I have for treating my endometriosis?

Endometriosis is an often-painful condition in which the tissue that normally lines the uterus, endometrial tissue, is found in places other than where it belongs. Most frequently it is found in the pelvic area and on the ovaries, but it can also travel into other parts of the body, sometimes as far as the thoracic cavity (chest) and on rare occasion, the nose and spinal column.

We don’t know exactly what causes endometriosis, but the leading theory is that it is the result of retrograde menstruation — when a woman’s menstrual flow doesn’t follow the normal path to exit the body but instead flows back up through the fallopian tubes into the pelvic cavity.

Symptoms can vary; sometimes large amounts of endometriosis can be virtually symptomless while in another woman a very small amount causes significant discomfort. This tissue responds to the same hormones that surge around the time of a woman’s period; often this is when symptoms are worst. The main symptom is pelvic pain, especially during menstruation. Other symptoms may include pain during bowel movements or urination, pain during intercourse, very heavy periods or bleeding between periods, bloating, nausea, fatigue and either constipation or diarrhea.

Endometriosis does not equal infertility; however, some patients will experience fertility problems, even after proper treatment. If you have symptoms of endometriosis, you should see your physician for diagnosis and treatment as soon as possible. Pelvic pain can be caused by a variety of conditions that must be ruled out, including pelvic inflammatory disease, interstitial cystitis, ovarian cysts, irritable bowel syndrome, or even adenomyosis, a condition in which the uterine lining gets inside the muscular wall of the uterus.

For diagnosis, I conduct an exam and review of symptoms and ask about any family history. Having first-degree relatives with the condition greatly increases the odds of developing it yourself. Sometimes imaging (usually via ultrasound) will show endometrioma (cysts) or scarring, but the only definitive way to confirm the diagnosis is through biopsy.

To treat endometriosis, we usually begin with non-surgical management. Medication based interventions include hormone treatments such as contraceptives with estrogen and progestin (oral, patch or ring) or progestin-only (intrauterine devices or shots); Gonadotropin-releasing hormone (Gn-RH) agonists or antagonists; or danazol, a steroid that decreases hormones. Your doctor will consider your personal situation and discuss which medications may make the most sense for you.

Non-steroidal anti-inflammatory medications (NSAIDs) are preferred for pain management, along with heating pads and warm baths. In some instances, pelvic physical therapy may help.

If the problem persists, surgery may be necessary. If you’re planning on future pregnancies, lesions can be removed laparoscopically; if not, removal of the ovaries with or without removal of the uterus and cervix might be your best treatment option. Removal of the ovaries will cease production of the hormones that aggravate the problem, but removal of those ovarian hormones will also induce menopause. It’s a big decision.

One of my most important recommendations for anyone dealing with any chronic pain is to find a provider who will take time to listen to you and with whom you feel confident taking this journey. There is an emotional aspect to chronic pain that needs care just as much as the physical, and you want a provider who is going to work with you to figure out what’s going to get you where YOU need to be.

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Dr. Nita Landry is a board certified OB/GYN and co-host on the Emmy®-winning TV series The Doctors. She also practices medicine in understaffed hospitals in need across the country as a locum tenens physician. Visit thedoctorstv.com for more information.