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Endometriosis

Endometriosis is a common gynecologic condition that can cause pain and potentially lead to fertility problems.

Tissue that lines the inside of the uterus is called endometrium. During your regular menstrual cycle, this tissue builds up. If you don’t become pregnant, the tissue is broken down and shed from your body through your monthly flow.

Endometriosis is a disorder in which the endometrium grows outside the uterus instead, known as an endometrial implant. Each month, this misplaced tissue responds to the hormonal changes of the menstrual cycle by building up and breaking down as normal. However, because the tissue is outside the uterus, the blood from the endometrial implant has no way to leave your body. This process causes swelling that creates scar tissue and may eventually lead to growths.

When growths become too large they can trap blood in your ovaries causing cysts (fluid-filled sacs) called endometriomas to form and block your fallopian tubes. Scar tissue and adhesions can form and bind your organs together, which can result in pelvic pain and fertility issues. Endometriosis can also cause bladder and intestinal problems.

Symptoms

Symptoms associated with endometriosis can vary greatly, ranging from no symptoms to severe pain and infertility. However, the degree to which symptoms are felt doesn’t necessarily reflect the severity of the condition — a woman with a severe case of endometriosis may experience no symptoms, while a woman with a mild case may experience severe pain.

Common symptoms include:

  • Pelvic pain – Unusually painful menstrual cramps, pain during or after sex or pain during urination or bowel movements.
  • Excessive bleeding – Heavy bleeding or bleeding between periods.
  • Digestive problems – Diarrhea, constipation, bloating and nausea; usually most significant during your period. 
  • Infertility – Approximately a third to half of women with endometriosis have difficulty getting pregnant. Surgery to remove adhesions, cysts and scar tissue can help restore fertility. 

Diagnosis

The only way to confirm if you have endometriosis is through surgery. Sometimes it’s visible during the procedure, and in some cases your doctor needs to collect a sample for further testing. Before resorting to surgery, doctors generally use diagnostic tools that identify physical clues that can give a strong indication of endometriosis.

Doctors at El Camino Health use a variety of methods to diagnose endometriosis, such as:

  • Pelvic exam – A manual exam performed by your doctor to feel for cysts or other abnormalities.
  • Biopsy – A procedure to remove abnormal tissue that’s sent to a lab for further evaluation.
  • Ultrasound exam – A diagnostic imaging technique that uses high-frequency sound waves to produce images of your internal structures.
  • Computed tomography (CT scan) – A diagnostic imaging technique that uses a combination of X-rays and computer technology to produce cross-sectional images of bones and soft tissues.
  • Magnetic resonance imaging (MRI) – A diagnostic imaging technique that uses a combination of a large magnet, radio waves and a computer to produce detailed images of bone and soft tissue.
  • Laparoscopy – A surgical procedure that uses a thin tube with a lens and a light (laparoscope) to view your pelvic area. The laparoscope is inserted through a small incision in your abdominal wall. 

Treatment

Endometriosis itself cannot be cured; however, there are treatments that are effective in addressing the symptoms or complications that result from the condition. Treatment depends on the severity of complications you’re experiencing — if the symptoms aren’t severe, you may choose not to treat the condition. If you’re experiencing significant pain, infertility or other difficulties, there are a number of treatment options available.

Common nonsurgical treatments include:

  • Pain medications. Non-steroidal anti-inflammatory drugs such as ibuprofen (Advil) or naproxen (Aleve) may be enough to keep you comfortable.
  • Hormone therapy. Oral and injectable hormones can relieve symptoms by preventing ovulation or reducing or stopping your menstrual flow.

Surgery

When nonsurgical treatments aren’t effective, your doctor may recommend surgery to relieve your symptoms. At El Camino Health, our experts perform the full array of gynecologic procedures, including:

  • Laparoscopy. Using a laparoscope, your doctor can remove the endometrial growths using surgical tools inserted through a second small incision.
  • Laparotomy. A more extensive surgery than laparoscopy, this procedure is used to remove as much of the displaced tissue (endometrium) as possible without damaging healthy tissue.
  • Hysterectomy. This surgery involves removing your uterus, cervix and possibly both of your ovaries (total hysterectomy). It’s generally used as a last resort for women experiencing extreme symptoms. You cannot become pregnant after having a hysterectomy.

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