The endometrium is the tissue that lines the inside of your uterus. Each month, as part of your menstrual cycle, these tissues thicken, break down and then bleed out of your body. When you have endometriosis, these tissues do not grow as they should — in fact, they appear outside of the uterus or on your ovaries, fallopian tubes or pelvic lining.
Your doctor may find endometrial tissues in your vagina, cervix or vulva. But they can also appear completely outside your reproductive system, in places such as your intestines, rectum or bladder. They can even be found, although rarely, in abdominal surgery scars. The endometrial tissue — regardless of their location and the fact that the tissue has no way to exit your body — continue their normal cycle of thickening, breaking down and bleeding. Signs and symptoms of endometriosis should always be evaluated with a thorough consultation and examination by a physician for an accurate diagnosis, treatment plan can well as follow up.
The initial signs of endometriosis are abnormally painful menstrual cramps that get worse over time. Endometriosis pain also can occur before you get your period or while having sex. However, while pain is the best-known symptom of endometriosis, you may not always recognize it. Instead, other symptoms may present, such as:
- Urination that’s painful during your menstrual cycle
- Bowel movements that are painful only during your period
- Other gastrointestinal issues, such as diarrhea, constipation, bloating or nausea, especially during your period
- Heavy or excessive bleeding during your period, as well as breakthrough bleeding from your uterus in between your menstrual cycles
Because so many different diagnoses may include pelvic pain as a symptom, endometriosis can be hard to differentiate initially from diagnoses such as pelvic inflammatory disease, ovarian cysts or irritable bowel syndrome.
It’s important not to let pelvic pain go unchecked. See your doctor. Some women don’t discover they have endometriosis until they seek assistance in getting pregnant. Certain factors may also put you at higher risk for endometriosis, such as:
- If you’ve never given birth
- If your period started at a younger than usual age
- If menopause started later than usual
- If your menstrual cycle is less than the standard 28 days
- If your body produces higher levels of estrogen
- If you have a low body mass index or BMI
- If you consume alcohol
- If you have one or more relatives who have been diagnosed with endometriosis
- If you’ve already been diagnosed with a medical condition that disrupts your menstrual cycle
- If you have any uterine abnormalities
- If you are Caucasian
As with all female reproductive issues, your doctor first performs a pelvic exam. The best way to be sure of a correct diagnosis is to order a test so the doctor can better see what’s happening with your reproductive organs. Unlike other diagnoses that may need several tests to be sure, endometriosis is generally confirmed using only two tests:
- Ultrasound can be done either with a wand on the outside of your abdomen or with a transvaginal ultrasound using a wand inserted into your vagina. Both methods produce pictures of your internal reproductive organs. Growths like cysts or tumors show up on the image, although the test won’t show endometriosis definitively.
- Laparoscopy for endometriosis is a common procedure used to get a better picture of your organs. In fact, this is the only test that definitely shows whether you have endometriosis. For this test, your doctor puts you under general anesthesia, makes a small incision in your abdomen and inserts a small scope with a light (a laparoscope). With the scope, your doctor can examine the exterior of your uterus to any endometriosis and its extent. A biopsy may be taken at this time, especially if there are tissues that look suspicious in any way.
Steps After Diagnosis
Once you’ve been diagnosed with endometriosis, your doctor will explain the stages of the condition, which are based on several factors:
- How far and deep the endometrial tissues have spread
- Whether the tissues have attached to organs, such as your ovaries, and if those organs have been compromised in any way
- If you have any fallopian tube blockages as a result
- The presence and severity of pelvic adhesions
Your case will fall into one of four endometriosis stages:
- Stage 1: Minimal
- Stage 2: Mild
- Stage 3: Moderate
- Stage 4: Severe
Which stage of endometriosis you fall into relates directly to your physical factors: the presence of adhesions or cysts, how many, how deep or severe, and so on.
Complications of Endometriosis
- Endometriosis cancer, which begins in the lining of your uterus when endometrial cells begin to grow out of control. The types of endometrial cancer include:
- Adenocarcinoma, the most common of the endometrial cancers
- Squamous cell carcinoma
- Undifferentiated carcinoma
- Small cell carcinoma
- Transitional carcinoma
- Endometriosis cyst
- Ovarian cancer
A variety of treatments exist for endometriosis, depending on what stage you’re in and what your pain levels are. As a general rule, surgery is a last resort; your doctor will probably start with pain medications to help with your painful cramps. Diagnosis and treatment plans should always be carefully performed in conjunction with your gynecologist.
- Hormonal contraceptives and progestin therapy lighten your period.
- Estrogen-lowering hormones like the gonadotropin-releasing hormone (Gn-RH) agonists and antagonists lessen the effects of menopause.
- Danazol is a drug that blocks menstruation.
- The endometriosis diet is not standard treatment yet, but studies have shown that women who eat a diet low in red meat and high in fruits and vegetables lower their chance of getting endometriosis.
- Physical activity has been shown to help with several estrogen-dependent conditions, including fibroids, menopause and severe periods.
- If nothing else works, your doctor may encourage you to get a complete hysterectomy to relieve your years of painful symptoms. The hysterectomy must be complete — that is, it must include the uterus, ovaries, fallopian tubes and cervix — to remove estrogen-producing organs. Endometriosis after hysterectomy is no longer possible, and there’s total relief of symptoms.
Endometriosis and infertility are often linked. Women who have failed to get pregnant often discover their endometriosis when going for fertility treatments. Patients already diagnosed who now want to avoid surgery but still try to get pregnant can be directed to infertility treatments such as in vitro fertilization.
Endometriosis doesn’t have to mean painful periods for the rest of your life, nor does it mean you can’t become pregnant. In fact, while pregnant, endometriosis meets a temporary end, and a permanent one with the onset of menopause.
Important Reminder: This information is only intended to provide gynecology guidance, not a definitive medical advice. Please consult obgyn doctor about your specific condition. Only a trained, experienced board certified gynecologist or certified gynecology specialist can determine an accurate diagnosis and proper treatment.
Do you have questions about Endometriosis treatment? Would like to schedule an appointment with the best Gynecologist in Manhattan, Dr. Pedram Bral, please contact our office.
Dr. Pedram Bral, Gynecologist (Gynecologist NYC, Midtown OB GYN)
New York, NY10010
(Between Madison Ave & Park Ave)
☎ (212) 533-4575