Endometriosis is a medical condition in which uterine tissue grows outside the uterus, causing cysts and scar tissue that affect the other pelvic organs. Most commonly, this uterine tissue is found on the ovaries, Fallopian tubes, the surface of the uterus, the bowel and the membrane lining of the pelvic cavity. It affects about 5 million women nationwide, according to the Office on Women’s Health, and is most common in women in their 30s and 40s.
While many women experience pain with their periods, endometriosis tends to cause higher levels of pain, or pain that increases over time. Endometriosis can lead to generalized pelvic pain, severe cramping and pain with periods, heavy bleeding or clotting, bleeding between periods, low back pain, pain that radiates to the anterior thigh, pain with intercourse, pain with bowel movements, and fertility issues. The condition sometimes is confused with pelvic inflammatory disease, ovarian cysts or irritable bowel syndrome, and can go undiagnosed for years.
With endometriosis, the endometrial tissue has no way to exit the body, so it becomes trapped.
These misplaced areas of endometrial tissue are referred to as endometrial implants. Moderate and severe endometriosis can lead to cysts and scarring. The most severe stage can lead to infertility.
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While there is no known cause for endometriosis, risk factors include never having given birth, starting your period at an early age, low body mass index, alcohol consumption, uterine abnormalities, family history, short menstrual cycles, or higher levels of estrogen in the body.
There is no cure, though catching the condition early leads to a greater likelihood of slowing its progression. Many women don’t discover they have endometriosis until they try to get pregnant. Women with mild to moderate endometriosis often can still conceive and carry a baby to term. Pregnancy might temporarily reduce symptoms.
A tentative diagnosis for endometriosis can be made through a pelvic exam or ultrasound. Your physician will also discuss your family and medical history, symptoms and menstrual periods. However, the only definitive diagnosis method is through a minimally invasive surgical procedure, using a laparoscope, in which a small incision is made and your doctor inserts a tiny camera to examine your abdomen for endometrial tissue.
If you are diagnosed with mild endometriosis, birth control pills, progestational agents or other medications that decrease estrogen levels can help. However, more advanced cases might require surgery.
Robotic surgery is an excellent option, because surgeons can see the condition twice as well with the robotic scope than with a laparoscope. The precision of robot-assisted surgery allows the surgeon to remove even the smallest tissues and restore fertility in most patients. The recovery time for robot-assisted surgery is two or three days, depending on recovery.
Endometriosis is manageable when detected early. Contact your physician if you feel you might be at risk or are experiencing pain or other symptoms.
Mike Guiler, MD, is with KentuckyOne Health Obstetrics & Gynecology Associates.