Tag Archives: Endometriosis

EndoCheck Clinical Trial

EndoCheck Clinical Trial

1 out of 10 women have endometriosis, a condition that can significantly impact a person’s quality of life. As with many conditions, the earlier the diagnosis, the better the treatment outcomes. Unfortunately, laparoscopy, an invasive procedure, is currently the only definitive way to diagnose endometriosis.

If you are facing a diagnostic laparoscopy due to your endometriosis-related symptoms, you may be eligible to participate in the EndoCheck clinical trial.

What Is Endometriosis?

Endometriosis is a chronic medical condition in which tissue similar to the lining of the uterus, called the endometrium, grows outside the uterus. Normally, the endometrium remains within the uterus and simply thickens throughout the month before being shed during menstruation. With endometriosis, this tissue grows in the pelvic cavity, on the surface of the uterus, and other organs, such as the ovaries, fallopian tubes, and tissues lining the pelvis.

While the endometrium is shed during menstruation and exits via the vaginal opening, the tissue outside of the uterus has no way to leave the body. Over time, this can cause inflammation, scarring, and painful adhesions.

What Is Endometriosis

Stages of Endometriosis

Endometriosis is classified into stages based on the severity, extent, and location of the disease.

The staging system used to classify endometriosis is the Revised American Society for Reproductive Medicine (rASRM), which categorizes endometriosis into four stages.

  • Stage 1 endometriosis is considered minimal, typically with minimal adhesions or scar tissue, and generally localized within the pelvic cavity.
  • Stage 2 endometriosis is mild, with numerous or slightly larger lesions, and involves both ovaries and other pelvic structures.
  • Stage 3 endometriosis is moderate, with multiple implants or lesions and deeper infiltrating lesions affecting the ovaries, fallopian tubes, or uterus. It may distort the anatomy and organ function.
  • Stage 4 endometriosis is severe and consists of extensive implants or lesions scattered throughout the pelvic cavity. It may extend to other parts of the body, such as the bowels or bladder.

Endometriosis at a more advanced stage does not always mean you will have more severe symptoms or pain. For example, some women with stage 4 endometriosis may have few or no symptoms, whereas others with stage 1 can experience severe symptoms.

Endometriosis Evaluation and Diagnosis

In order to diagnose endometriosis, a doctor will assess medical history, perform a pelvic exam, and run diagnostic tests.

During the review of your medical history, your doctor will ask about your symptoms, whether you have any risk factors associated with endometriosis, your periods and pelvic pain,  and whether you are experiencing infertility.

During the pelvic exam, your doctor will check for tenderness or pain. Afterward, your doctor may order imaging tests to examine the tissues around your pelvic area visually. Your doctor may make a “clinical diagnosis,” but this is not currently definitive without an invasive laparoscopy procedure.

Invasive laparoscopy procedure

A laparoscopy involves a small incision made in the abdomen near the belly button. The surgeon will insert a laparoscope – a long, thin tube equipped with a light and camera – through the incision before inflating the abdominal cavity with carbon dioxide gas. This will allow the surgeon to identify and examine any endometrial implants and even take a biopsy to send for laboratory analysis.

While laparoscopies are far less invasive than open-cavity surgery, they still involve some risk and recovery time. Fortunately, research is ongoing to demonstrate the effectiveness of a new diagnostic tool, the EndoCheck clinical test.

What Is EndoCheck?

If you are scheduled to undergo diagnostic laparoscopy to be evaluated for endometriosis, you may be eligible to access a non-invasive blood test called EndoCheck. This diagnostic test for endometriosis can help your gynecological professional diagnose endometriosis and guide decisions related to your ongoing care. Help us as we work to validate this procedure, potentially eliminating the need for laparoscopy in the future.

To be eligible to participate, you must:

  • Be able to provide written and informed consent or obtain the consent of an authorized representative or guardian.
  • Be a female aged 14 to 50 years old.
  • Be scheduled to undergo laparotomy or laparoscopy for suspected endometriosis.

How the EndoScope Clinical Trial Works

If you choose to participate, the endometriosis clinical trial will last approximately three months and include two visits to the Arizona Gynecology Consultants office. Upon arrival, you will complete an informed consent form along with an Endometriosis Health Profile Questionnaire and case report forms. Afterward, a blood sample will be collected. After your laparoscopy, and if you are confirmed to have endometriosis, you will complete the Endometriosis Health Profile Questionnaire again. We will compare the results of the blood study test to the pathology reports and surgical observations obtained during your surgery.

How the EndoScope Clinical Trial Works

Why Participate?

The goal of EndoCheck is to evaluate a new investigational test that may be able to detect endometriosis without the invasive procedure. Participating in this study allows you to be a part of changing the endometriosis prognosis journey and improving women’s quality of life. It may also reveal additional information about the medical roots of endometriosis.

Endometriosis Causes

The exact cause of endometriosis is not clear, but researchers have identified some promising theories.

Retrograde Menstruation

One theory suggests that during menstruation, some of the menstrual blood containing endometrial cells flows backward through the fallopian tubes into the pelvic cavity instead of leaving the body. These cells then implant and grow on the pelvic organs, causing endometriosis.

Coelomic Metaplasia

The theory of coelomic metaplasia suggests that certain cells lining the pelvic cavity can transform into endometrial-like tissue in response to hormonal or inflammatory signals. These transformed cells then create endometriosis lesions.

Embryonic Cell Changes

Some researchers speculate that endometriosis may result from embryonic cells that retain the ability to develop into various types of tissue, including endometrial-like tissue. These cells may become misplaced during embryonic development and create endometriosis lesions later in life.

Surgical Scar Complication

Surgical procedures involving the reproductive organs or pelvic cavity can cause tissue trauma, inflammation, and scarring, which may create an environment prime for the development of endometriosis. Inflammatory processes associated with surgical healing can promote the adhesion and proliferation of endometrial cells outside of the uterus.

Immune System Condition

A potential problem with the immune system is that the body may not recognize and destroy endometriosis tissue since it is produced within the body. Endometriosis has also been associated with systemic lupus erythematosus (SLE) and Hashimoto’s thyroiditis.

Genetics

Endometriosis may affect some people more often due to a genetic trait passed down in their families. Women with a close relative who has endometriosis, such as a mother, sister, or daughter, are at an increased risk of developing the condition themselves compared to those with no family history.

Endometriosis Symptoms

The main symptom of endometriosis is pelvic pain, often linked with menstruation. This pain can be a dull ache, cramping, or even sharp stabbing sensations, depending on the person. It may even worsen over time.

Endometriosis Symptoms

Other common symptoms include:

Painful Periods

Painful periods, medically known as dysmenorrhea, are a common symptom of endometriosis. This pain can be debilitating and may interfere with daily activities and quality of life. Some people with endometriosis experience deep pelvic pain or pressure during menstruation from the presence of endometrial implants or lesions near the cervix, uterus, ovaries, or rectum. Endometriosis pain can also impact the lower back, thighs, or buttocks.

Dyspareunia

Dyspareunia occurs when endometrial or scar tissue in the pelvic region causes pain or discomfort during sexual intercourse. This can lead to difficulties with intimacy and potential strain on relationships.

Infertility

Endometriosis is the leading cause of infertility in women, affecting up to 30-50% of women who experience infertility. The disease can distort pelvic anatomy, interfere with ovulation, and damage eggs and sperm.  Alterations in the endometrial lining may also affect embryo implantation and early pregnancy development, along with changes in hormone levels, inflammation, and immune system dysfunction.

Gastrointestinal Symptoms

Endometrial growths on pelvic organs and bowels can lead to bloating, constipation, diarrhea, abdominal cramping, and nausea and vomiting. Endometrial growths or adhesions near the rectum or sigmoid colon can cause discomfort or pain during bowel movements. These can all worsen during menstruation.

Fatigue

Chronic pain and discomfort, pain management, coping with symptoms, and disrupted sleep patterns can contribute to fatigue and exhaustion. This is an often overlooked symptom, but it can significantly impact a person’s quality of life.

Urinary Symptoms

Some women may experience endometrial growths that affect the urinary tract. Endometriosis can cause interstitial cystitis (IC), which is a chronic condition that causes bladder pain, urinary urgency, frequency, and discomfort. Women with endometriosis may also be at an increased risk of urinary tract infections because of urinary retention, inflammation, or obstruction caused by endometrial growths or adhesions.

Other Symptoms

Endometriosis can also cause back pain, leg pain, heavy menstrual bleeding, and irregular menstrual cycles. The extent and severity of these symptoms will vary among each individual, and some women do not have any symptoms. As mentioned, having a more advanced stage of endometriosis, such as stage 4, does not mean more severe symptoms or pain.

Many symptoms may not be typically associated with endometriosis, which can complicate diagnosis and treatment. People may think they have irritable bowel syndrome (IBS) or uterine fibroids, but diagnostics reveal endometriosis.

Treatment Options

While endometriosis currently has no cure, there are treatment options available to help manage pain, slow tissue and implant growth, and help with potential infertility.

The first line of treatment is medication, such as nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen, combined (estrogen-progestin) contraceptives, progestin, gonadotrophin-releasing hormone (GnRH) agonists, danazol, or aromatase inhibitors are the most commonly prescribed.

Treatment Options

If medications are not working, surgery may be a choice. Surgeries may be used to remove scar tissue and endometrial implants or hysterectomy with or without bilateral scalping-oophorectomy. This involves the removal of the uterus while leaving or removing the ovaries and fallopian tubes.

What are the Risk Factors for Endometriosis?

It is possible to develop endometriosis later in life, but it usually manifests during a woman’s reproductive years.

Factors that raise the risk of endometriosis include:

  • Starting your period at an early age
  • Starting menopause at an older age
  • An abnormal uterus
  • Heavy periods that are longer than seven days
  • A menstrual cycle that is shorter than 27 days
  • Higher levels of estrogen in your body or greater exposure to estrogen than your body normally produces
  • Low body mass index
  • You have a genetic connection to family members with endometriosis.

Additionally, any health condition that prevents menstrual blood from leaving your body can increase your risk of endometriosis.

Help Reduce the Impact of Endometriosis

Endometriosis can significantly impact a woman’s life, including physical health, emotional well-being, relationships, work, and social activities, due to severe pain, fatigue, infertility, anxiety, and depression. Addressing endometriosis will help empower those experiencing it and improve women’s sexual and reproductive health, quality of life, and well-being. First, however, it’s crucial to make the process of diagnosing endometriosis as painless and stress-free as possible. We urge you to consider participating in the EndoCheck clinical trial and potentially help minimize the impact of endometriosis on others.

If you’re interested, please contact your surgeon at Arizona Gynecology Consultants for further information.

 

Resources:

  1. Endometriosis. (2021, February). Www.acog.org. https://www.acog.org/womens-health/faqs/endometriosis
  2. World Health Organization. (2023, March 24). Endometriosis. World Health Organization; World Health Organization. https://www.who.int/news-room/fact-sheets/detail/endometriosis
  3. ?Matsuura, K., Ohtake, H., Katabuchi, H., & Okamura, H. (1999). Coelomic metaplasia theory of endometriosis: evidence from in vivo studies and an in vitro experimental model. Gynecologic and Obstetric Investigation, 47 Suppl 1, 18–20; discussion 20-2. https://doi.org/10.1159/000052855
  4. ?John Hopkins Medicine. (2024). Endometriosis. John Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/endometriosis
  5. ?Endometriosis. (n.d.). Yale Medicine. https://www.yalemedicine.org/conditions/endometriosis
  6. ?Mayo Clinic. (2023, October 12). Endometriosis – Symptoms and Causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/endometriosis/symptoms-causes/syc-20354656
  7. ?Bafort, C., Beebeejaun, Y., Tomassetti, C., Bosteels, J., & Duffy, J. M. (2020). Laparoscopic surgery for endometriosis. Cochrane Database of Systematic Reviews, 10(10). https://doi.org/10.1002/14651858.cd011031.pub3
  8. ?Endometriosis: Does It Cause Infertility? (n.d.). Www.reproductivefacts.org. https://www.reproductivefacts.org/news-and-publications/fact-sheets-and-infographics/endometriosis-does-it-cause-infertility/
  9. ?American Society for Reproductive. (1997). Revised American Society for Reproductive Medicine classification of endometriosis: 1996. Fertility and Sterility, 67(5), 817–821. https://doi.org/10.1016/s0015-0282(97)81391-x
Endometriosis

Navigating Endometriosis: Symptoms, Diagnosis, and Treatment Options

As women, it is never easy to hear that our physical health is compromised, especially when it comes to our reproductive system. For those who have been diagnosed with endometriosis, uncertainty about what comes next can feel overwhelming. Whether you’ve been diagnosed with endometriosis or you know someone who has, accurate information is key. The more informed you are on the topic, the more supported you will feel. In fact, understanding the causes, symptoms, and treatment options can provide you with a clear path forward.

What Is Endometriosis?

Endometriosis Diagram

Endometriosis is a disorder in which tissue very much like the tissue that creates the lining of your uterus, known as the endometrium, develops in areas other than the uterus. Tissue growth can occur in areas it should not, including reproductive organs like the fallopian tubes and ovaries, as well as other pelvic tissue. Though uncommon, this tissue can even be found in areas outside the pelvic organs.

During endometriosis, the endometrial-like tissue takes on the functions and characteristics of your true endometrial tissue. As a result, the tissue will thicken, break down, and bleed during the menstrual cycle. The problem this presents is that there is no way for the tissue to exit your body. Normal pelvic tissue surrounding this foreign, trapped tissue can get inflamed and create scar tissue. Adhesions, which are bands of fibrous tissue, can develop and cause endometrial tissue that develops on organs to stick together. In addition, if tissue grows on the ovaries, cysts can form called endometriomas. Women with endometriosis can also experience severe pain during their menstrual cycle and could develop fertility issues.

Women with endometriosis may not notice the condition for some time, especially if they are prone to painful menstrual cramps or other discomforts. Eventually, however, most women do notice a significant difference in the severity of their menstrual pain, usually leading to a visit to their gynecologist. The good news is that once endometriosis is diagnosed, there are effective treatments available.

Endometriosis: Symptoms and Causes

Endometriosis Symptoms
Unfortunately, many women hesitate to explore medical concerns until they start to impact daily life, especially as they pertain to the reproductive system. A primary reason endometriosis so often goes undiagnosed is due to a delay in reaching out for healthcare. Fortunately, regular visits with your gynecologist can help you feel more comfortable opening up to your doctor and seeking treatment for any minor or major concerns.

If you’re concerned about a potential issue with your reproductive health, knowing the symptoms and causes of endometriosis can help you make the decision to seek treatment, understand the condition, and explore your treatment options.

Symptoms

There are a variety of symptoms associated with endometriosis, the most common of which is pelvic pain that heightens during the menstrual cycle. The pain can be worse than usual and can also increase over time.

Other symptoms to look for include:

  • Excessive Bleeding – Occasional heavy menstrual periods could occur, as well as bleeding between periods.
  • Painful Periods – Also known as dysmenorrhea, pelvic pain and cramping could begin days before a menstrual cycle and continue to last for as long as 1-2 weeks. In addition to pelvic pain, you may also experience abdominal pain and lower back pain.
  • Urinary and Bowel Pain – If you experience unusual pain while urinating or having a bowel movement, especially during a menstrual period, this could be an indicator of endometriosis.
  • Pain with intercourse – A common symptom of endometriosis is pain during or after sex.
  • Infertility – Endometriosis-related infertility is often detected when a woman seeks infertility treatment.
  • Additional Symptoms – Endometriosis can also cause fatigue, nausea, constipation, bloating, or diarrhea.

It is beneficial to look for these additional symptoms beyond pelvic pain because while pelvic pain is often the reason many women discover their diagnosis, this symptom presents itself differently from case to case. Some women have mild endometriosis and experience severe pain, while others have advanced endometriosis with little to no pain. Everyone has a different pain tolerance, and the way endometriosis affects you can be drastically different compared to someone else.

Causes

There is still some uncertainty when it comes to the exact cause of endometriosis, and researchers have not identified a single cause that can trigger the condition. However, while the root cause is still uncertain, scientists have developed several theories.

Some possible explanations for endometriosis include:

  • Transformation of peritoneal cells. Also known as “induction theory,” experts believe that hormones or immune factors may support the transformation of peritoneal cells into endometrial-like cells.
  • Retrograde menstruation. In some cases, menstrual blood with endometrial tissue may continue on into the abdominal cavity via the fallopian tubes instead of being eliminated from the body. The cells may stick to the internal cavity walls and the associated organs, and with nowhere to go, this tissue could continue to build layers, thicken, and cause pain.
  • Transformation of embryonic cells. Estrogen and other hormones can transform embryonic cells into endometrial-type cells during puberty, which can then implant into the abdominal cavity.
  • Endometrial cell transport. Endometrial cells are transported to other parts of the body through blood vessels or tissue fluid and may wind up in the abdominal cavity.
  • Surgical scar implantation. Endometrial cells may attach to a surgical incision, especially after surgeries involving the pelvic organs.
  • Immune system issues. Immune disorders could also cause endometriosis. The body may be unable to identify and eliminate endometrial tissue developing in places it should not.
  • Genetics. Family history may also play a role in your likelihood of developing this condition. Women who have a close relative with this condition are more prone to having it themselves.

What Are the Four Stages of Endometriosis?

Endometriosis Symptoms

If you or a loved one have recently received an endometriosis diagnosis, it is important to understand the four stages of endometriosis: minimal, mild, moderate, and severe. Understanding these stages can help you understand what to expect as you and your physician discuss treatment. There are a variety of factors used to determine the stage, including the location, number, size, and depth of the endometrial implants. It is beneficial to keep in mind that the pain you may experience during your menstrual cycle does not determine your endometriosis stage.

Stage One: Minimal

When a person is diagnosed with stage one or minimal endometriosis, the lesions caused by endometriosis are small, and the implants are shallow. Individuals with stage one may experience inflammation in the area.

Stage Two: Mild

Individuals with stage two endometriosis have mild lesions and endometrial tissue is implanted fairly shallow. This stage is considered mild endometriosis.

Stage Three: Moderate

Individuals who are in the moderate stage may have more lesions than seen in the previous stages. The endometriosis implants are typically deeper within both the pelvic lining and the ovaries.

Stage Four: Severe

Individuals in this stage likely have deep implants on both the ovaries and the pelvic lining. In many cases, there are lesions that could extend to the fallopian tubes and portions of the bowel region. There could also be cysts on one or both of the ovaries due to repetitive cycles of the endometriosis cells thickening, shedding, and becoming trapped.

The Diagnosis Process

Endometriosis can have similar symptoms to other conditions, including ovarian cysts, pelvic inflammatory disease, and even irritable bowel syndrome. This can prolong diagnosis and often requires a variety of tests to ensure accuracy. These delays can be significant; it can take some cases 4 to 11 years for a diagnosis from the onset of symptoms. Ongoing research and support are needed to ensure this timeframe can be significantly reduced so that accurate diagnosis can be given and the right treatment implemented. It can be frustrating, but patience and open communication with your healthcare team can help minimize the delay in proper diagnosis.

Things that are likely to occur during the diagnosis process include:

  • A detailed medical history. Your doctor will likely explore any personal or family history of endometriosis, as there is an increased risk of developing endometriosis if a close family member also has the condition. Your doctor will complete a general health assessment to ensure your signs and symptoms aren’t connected to a different long-term disorder.
  • A physical exam. Your doctor will complete a detailed pelvic examination to search for cysts or scars behind the uterus. A speculum and light will be used to see inside the vagina and cervix, helping the doctor determine the severity of your condition, as well as possibly rule out other conditions that may share other symptoms.
  • Ultrasound imaging. A transvaginal or abdominal ultrasound can be used to provide clear images of your reproductive organs. An ultrasound helps identify cysts and lesions.
  • Laparoscopic imaging. This is a minor surgical procedure that provides an opportunity to directly view endometriosis. Once a person is diagnosed with this condition, the same procedure can be used to remove the tissue.

Treatment Options

Female hormone therapy

The main goal of endometriosis treatment is to alleviate pain and help you learn to cope with the physical and emotional challenges that can be associated with this condition. Which treatment is best for you will depend on your age, the severity of your symptoms, the severity of the condition itself, and any plans for future pregnancies. There are medications, alternative therapies, and surgeries that can be considered.

Medications

Medications can help you control the symptoms of endometriosis.

Hormonal options and medications include:

  • Birth Control – Hormonal suppression can help reduce the symptoms associated with this condition, which can include using estrogen and progesterone birth control options such as oral birth control pills, patches, Nexplanon, IUD, a vaginal ring, or the birth control shot. These medications can help you experience less painful periods.
  • GnRH Medications – Gonadotropin-releasing hormone medications stop the hormones associated with your menstrual cycle. This essentially puts your reproductive system on hold to help relieve pain.
  • Danazol – Also known as Danocrine, this medication stops the production of hormones that cause a period. Individuals on this medication may have an occasional menstrual period, or they may stop entirely.

It is important to note that these medications are not recommended for those who are trying to get pregnant. In addition, if the medication is stopped in an attempt to become pregnant, endometriosis symptoms can come back. Your medical professional will discuss the details of these options with you. For pain relief, doctors commonly prescribe over-the-counter pain relief and non-steroidal anti-inflammatory drugs (NSAIDs) like acetaminophen and ibuprofen.

Surgery

Endometriosis Surgery

Surgery can be an effective way to help relieve endometriosis pain and improve your ability to become pregnant. There are always risks associated with any form of surgery, so it is beneficial to discuss this treatment option with your provider. Endometriosis is a chronic disease, so surgery is not often the final solution. Symptoms may return within a few years, or they may not.

Surgical treatments include:

  • Laparoscopy – This procedure can be used to diagnose and treat endometriosis. A surgeon makes a small cut into the abdomen and inserts a thin tube-like tool called a laparoscope into your body, which uses a high-definition camera to identify lesions so they can be accurately removed through the tube.
  • Hysterectomy – In severe cases, removing the uterus may be suggested due to scar tissue and the extent of endometriosis in the pelvic area.

Alternative Therapies

Not everyone wants to turn to medications or surgery to experience relief. Some patients may experience symptom relief through holistic treatments and delay surgical procedures for a time.

These treatments may include:

  • Acupuncture
  • Herbal medication
  • Dietary changes
  • Pelvic floor muscle therapy
  • Heat therapy

Endometriosis FAQs

Whether you have just received an endometriosis diagnosis or believe you may be experiencing symptoms of endometriosis, the answers to these common questions could shed some light on what to expect.

Can I Get Pregnant if I Have Endometriosis?

Endometriosis can make it more difficult to become pregnant, but pregnancy is not impossible. Your chances of becoming pregnant largely depend on the severity of your condition, as well as your treatment options. It may be recommended to try to conceive sooner than later, as this condition often worsens over time.

What Are the Risk Factors Associated with Endometriosis?

Common risk factors include a family history of endometriosis, when you started having your period, the length of your menstrual cycle, and any defects in your uterus or fallopian tubes. Having a close family member with the condition or menstruating before the age of 11 can increase your chances of developing endometriosis. Long menstrual cycles and uterine or fallopian tube defects can increase the chances that excess tissue will develop in the abdominal cavity.

Can Endometriosis Go Away on its Own?

Yes, in some cases. Lesions can get smaller, and you may only have a few of them. Menopause can also help alleviate or eliminate endometriosis since the body no longer produces estrogen. However, for most, this condition needs ongoing treatment to relieve pain and prevent the condition from worsening.

Let Us Support You

Endometriosis awareness can help individuals and their families better prepare and face this diagnosis. Currently, it can take years for an accurate endometriosis diagnosis, which can mean years of pain and discomfort that can only worsen over time. At Arizona Gynecology Consultants, women’s health is our top priority. We continue to strive for advancements in the diagnosis and treatment of this condition. View our Arizona gynecology services and book an appointment.

Editor’s Note: This article was originally published April 12, 2020 and was updated October 2, 2023.

References :

  1. Agarwal, S. K., Chapron, C., Giudice, L. C., Laufer, M. R., Leyland, N., Missmer, S. A., Singh, S. S., & Taylor, H. S. (2019). Clinical diagnosis of endometriosis: A call to action. American Journal of Obstetrics and Gynecology, 220(4), 354.e1–354.e12. https://doi.org/10.1016/j.ajog.2018.12.039
  2. ?Mayo Clinic. (2018, July 24). Endometriosis – Symptoms and Causes. Mayo Clinic; Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/endometriosis/symptoms-causes/syc-20354656
  3. Wadood, A. (2019, July 2). Endometriosis. Healthline; Healthline Media. https://www.healthline.com/health/endometriosis
  4. ?What are the symptoms of endometriosis? (n.d.). Https://Www.nichd.nih.gov/. https://www.nichd.nih.gov/health/topics/endometri/conditioninfo/symptoms
  5. ?Heitmann, R. J., Langan, K. L., Huang, R. R., Chow, G. E., & Burney, R. O. (2014). Premenstrual spotting of ?2 days is strongly associated with histologically confirmed endometriosis in women with infertility. American Journal of Obstetrics and Gynecology, 211(4), 358.e1–358.e6. https://doi.org/10.1016/j.ajog.2014.04.041
  6. ?Surrey, E. S., Soliman, A. M., Johnson, S. J., Davis, M., Castelli-Haley, J., & Snabes, M. C. (2018). Risk of Developing Comorbidities Among Women with Endometriosis: A Retrospective Matched Cohort Study. Journal of Women’s Health, 27(9), 1114–1123. https://doi.org/10.1089/jwh.2017.6432
Laparoscopy for Endometriosis

Common Questions About Laparoscopy for Endometriosis

By Dr. Tom Waliser

Endometriosis is a difficult disease. Many patients who are diagnosed with endometriosis experience significant amounts of pain and discomfort on a regular basis. Though modern medicine is beginning to develop solutions to endometriosis, science has a long way to go.

Fortunately, there are options for patients who live with endometriosis. Laparoscopies are one such option. Though surgery of any kind can be intimidating, laparoscopies provide an immense amount of relief. What’s more, they provide patients with much-needed answers about their condition.

What Is a Laparoscopy?

A laparoscopy is a minimally invasive surgery that allows a surgeon to look inside a patient’s abdomen to determine the cause of their pain. Though they can be used as a solution for endometriosis pain, laparoscopy procedures primarily provide diagnostic information about a patient’s condition.

What Are the Reasons to Get a Laparoscopy?

There are many scenarios in which a laparoscopy may be necessary. Though doctors may try other methods first, there are situations in which a laparoscopy is the best way to obtain a diagnosis. These situations include:

  • Pain
  • Ovarian cysts
  • Endometriosis
  • Fibroids

Medical professionals will be able to assess whether a patient is a good candidate for a laparoscopy, and if the procedure may be able to help their condition.

How Is a Laparoscopy Done?

How Is a Laparoscopy Done?

In an operating room, an anesthesia care provider will give the patient general anesthesia. After the patient is asleep, the surgeon will make 2–4 very small “incisions” (cuts in the skin) about ¼ of an inch long in the abdomen. The first incision is placed just inside the belly button.

After the first incision, the surgeon will put carbon dioxide gas into the patient’s abdomen through this incision. The gas makes room inside the abdomen so that the internal organs can be seen.

When the carbon dioxide is inserted, the surgeon will put a surgical telescope into the first incision. This is a long instrument that looks like a thick straw and at the tip of the telescope is a small lens. The lens projects an image of the inside of the patient’s abdomen through a fiber optic cable on a small screen (like a television).

The other incisions (1–3) are made just above the patient’s pubic bone. Special laparoscopic instruments are placed into the lower incision sites. The surgery is done through the small incisions in the lower belly.

What Can the Surgeon See?

During the procedure, the surgeon will be able to see the outside of the pelvic area organs. This includes the uterus, ovaries, fallopian tubes, bowel, bladder, appendix, and the area behind the uterus.

This view allows the surgeon to see problems such as appendicitis, ovarian, or tubal cysts, as well as signs of endometriosis and fibroids. The surgeon can also tell if the patient is severely constipated or has any tumors or growths.

It may be possible for the surgeon to remove or destroy the endometriosis that is found. Additionally, they may drain, remove, or destroy any ovarian or tubal cysts.

How Is Endometriosis Destroyed?

Surgical treatment using different methods is aimed at removing and/or destroying any visible endometriosis lesions. Superficial lesions (lesions that are just on the surface and don’t go deep into the tissues) are treated at the time of laparoscopy by surgical excision (cutting them out) or burning them off. This is also known as “fulguration.”

Surgical excision is the most common and effective treatment for endometriosis of the ovary (endometrioma cyst). Surgical removal at the time of laparoscopy has been shown to improve pain without damaging the ovaries.

How Long Does the Surgery Take?

Laparoscopy usually takes one to two hours, but it depends on the extent and severity of what the surgeon finds. Patients under anesthesia will not notice that time has passed when they wake up.

What Type of Scar or Stitches Result From the Surgery?

Modern surgeries, including laparoscopies, often use stitches that dissolve into the body. This means that the patient does not need to have them removed.

This can occasionally be alarming. These stitches sometimes come out of the skin, which causes concern in many patients. However, this is normal. Most incisions look red or dark pink after the stitches dissolve, but they fade over time. The scars will be hardly visible since the incisions themselves are small.

How Common Is Endometriosis?

Depending on which clinical study is referenced, women with chronic pelvic pain (pain that has been going on for longer than three months), who did not respond to hormonal suppression or birth control pills, have about a 70-80% chance of having endometriosis. Depending on the patient, the doctor may need to eliminate other diagnoses before settling on endometriosis.

How Long Is the Recovery After a Laparoscopy?

Recovery time is different for every patient. However, the median recovery for a laparoscopy is 3-4 days. If the patient has significant endometriosis or adhesions (pelvic scar tissue) then the recovery can be up to two weeks.

What If the Patient Is Menstruating?

Patients who are experiencing a period on surgery day can still go through with the procedure. However, tampons cannot be worn in the operating room. The patient will be given a pad instead.

What Do Patients Feel Directly After the Surgery?

Most patients do not stay overnight after a laparoscopy procedure, because it is minimally invasive. However, abdominal tenderness and bloating are common.

To make themselves more comfortable, patients are encouraged to wear or bring stretchy, comfortable clothes to wear home after the procedure. This can help to minimize pain and tenderness in the abdomen. Patients are also encouraged to bring a book or other form of entertainment for the pre-op waiting area, as surgeries often require some wait time.

Pain Management After a Laparoscopy

Pain Management After a Laparoscopy

Everyone’s experience following laparoscopies is different. The recovery room nurse will discuss which medications to take and how often once the patient returns home. In some situations, prescription pain medications are required, while other individuals can take over-the-counter NSAIDs, such as ibuprofen and acetaminophen. Since most prescription pain medications cause constipation, it’s important that the patient drinks plenty of water, eats foods that contain fiber, such as fruits and vegetables, and stays active. Some patients may also opt to take 1 capful of MiraLAX® (over the counter) in 8 ounces of fluid twice a day to relieve constipation.

For more information about laparoscopies, endometriosis, or other gynecological topics, contact AZGYN. We can answer any additional questions or concerns you have. 

 

Adenomyosis: Symptoms, Causes and Risk Factors

Adenomyosis: Symptoms, Causes and Risk Factors

We’ve all heard about endometriosis, a condition in which the uterine lining (endometrium) develops outside the uterus and grows on other organs within the abdomen, including the ovaries. There is another condition that can take place with the endometrium, known as uterine adenomyosis. This condition affects women, mostly in child-bearing years, and can be quite painful. Although most women have never heard about it, near 20 percent of them are affected by it.

History and Definition of Adenomyosis

Whereas it was described as early as 1860, adenomyosis was not properly diagnosed or named until the early part of the 20th century. In 1908, Thomas Cullen investigated its causes and named it, determining it was not an inflammation of the uterus, because it did not present any signs.

Not until 1972 did a proper definition come about, made by Dr. Charles C Bird, MD. At that time, adenomysis was described a “benign invasion of endometrium into the myometrium, producing a diffusely enlarged uterus which microscopically exhibits ectopic non-neoplastic, endometrial glands and stroma, surrounded by the hypertrophic and hyperplastic myometrium”.

What Is Adenomyosis?

What Is AdenomyosisAdenomyosis is a condition in which the endometrium, instead of growing out into the uterus, grows into the uterine wall (myometrium). Each time the lining (endometrium) is stimulated, during the menstrual cycle, the trapped lining in the myometrium is also stimulated and can make menstrual cramps and pain worse. This can disrupt the quality of life for the women who have to deal with it. And because adenomyosis symptoms vary due to he flux of estrogen levels going up and down, the menstrual cycle brings more discomfort than usual.

The condition can either be generalized adenomyosis, spread out over a large area of the uterine wall, or localized a small area or spot, also known as adenomyoma. The area that is affected by adenomyosis is called the endometrial-myometrial junction, where the endometrium and myometrium meet. It is the disruption of this junction – adenomyosis – that is considered a contributing factor in the failure of eggs to settle and stay in the uterus, thus preventing women from becoming pregnant.

Symptoms and Treatment

In spite of it being a benign condition, adenomyosis symptoms run the gamut and include:

  • Painful periods (dysmenorrhea)
  • Heavy periods (menorrhagia)
  • Bloody discharge or spotting between periods (metrorrhagia)
  • Bloating during pre-menstruation
  • Pain during or after sex (dyspareunia)
  • Chronic pelvic pain
  • Tender uterus and larger than normal in size

Women may also suffer from depression, irritability and reduced fertility or infertility. However, when women go into menopause and their estrogen levels drop, so do the symptoms of adenomyosis.

Drugs and Hormones

Adenomyosis treatments vary with the severity of the symptoms that present themselves. If the symptoms are mild enough, doctors can treat them with anti-inflammatory drugs and hormonal treatments. Usually they include contraceptive pills and IUDs. Certain surgeries can be performed that will treat the condition as well.

Uterine Artery Embolization

This procedure is usually used for uterine fibroids, but if the adenomyosis is just a small area or spots, this surgery could take care of it. The blood supply to the affected area is cut off and the adenomyosis shrinks. A 2007 study showed that after three to five years, the symptomatic pain was reduced by half and the success of the procedure was about 60 percent. This minimally invasive procedure leaves no scars.

Endometrial Ablation

Considered as a last resort procedure, endometrial ablation is conducted when other options have failed to relieve the symptoms. Because it destroys the endometrium, this is a permanent solution, like a hysterectomy and will only be done if the woman no longer wishes to become pregnant. It does, however, relieve the symptoms of adenomyosis, and the woman either has no more periods or has reduced bleeding. This may not work if the endometrium has infiltrated too far into the myometrium (uterine muscle wall).

MRI Surgery

MRI guided focused ultrasound surgery (MRgFUS) uses an MRI in real time to monitor focused high-intensity waves that create heat and destroy the targeted tissue. This is an early stage, non-invasive procedure that requires an overnight stay in a hospital or surgicenter setting. Because the uterus remains, this procedure allows a woman to still have children. The side effects are few and the prognosis is good, but it is not recommended for a woman who also has endometriosis.

Hysterectomy

Hysterectomy is the only treatment that will eliminate all adenomyosis symptoms effectively and permanently. Hysterectomies have been the treatment for years, but are only done in severe cases of the condition and if the woman no longer wants to get pregnant. To prevent early menopause, the ovaries may be left in, if they are not affected by endometriosis, which can be a co-occurring condition.

Risk Factors and Causes

Middle-aged women who already have had children (the more children, the greater the risk) or who have had uterine surgery, such as a cesarean, or an inflammation after childbirth are more at risk for adenomyosis, however it can affect any woman before menopause. But a root cause has still not been found.

One of the risks of having adenomyosis is anemia from the blood loss each month. Anemia is a condition caused by an iron deficiency. This means the body cannot make enough red blood cells to carry oxygen to the various parts of the body. Dizziness, fatigue, and irritability ensue and can lead to depression and anxiety.

Adenomyosis Diagnosis

In the past, the only way to diagnose adenomyosis was postoperatively and it had never been fully characterized nor any epidemiological studies made, mostly due to the fact that surgical removal was also the only way to get rid of the symptoms. Adenomyosis was severely understudied and understood until recently, when better diagnostic tools became available. However, doctors have done extensive studies in recent years and have discovered much from the information.

A 2008 study determined that adenomyosis was just a variant and not a disease on its own. The symptoms that are associated with this condition, are also symptomatic of endometriosis and uterine fibroids, thus the recommendation for a hysterectomy to get rid of all the symptoms has continued to be the best solution.

A paper written in 2010 cited several studies on adenomyosis, one of which was done in Italy in 2009, that concluded women who had had induced abortions, dysmenorrhea or chronic pelvic pain were more likely to have adenomyosis. A different study corroborated that dysmenorrhea and chronic pelvic pain were symptomatic of adenomyosis, adding depression as another factor. A third study determined that women who are diagnosed with adenomyosis most likely also have endometriosis.

Biopsy

One of the preoperative diagnostic tools used are biopsies, using keyhole surgery or laparoscopy in order to take a tissue sample. With the addition of a camera, it has been easier to get a sample, but still no guarantee to get the “right” sample, because adenomyosis doesn’t always present itself readily, like endometriosis. As in the past, several samples would have to be taken to get a good diagnosis. The best way is through the vagina, however that may damage the uterus and may make it more difficult to have children in the future, and going through the abdomen is still only good for endometriosis diagnoses.

Better Methods

With the advent of MRI’s, diagnoses have been easier to make. With the MRI, the endometrium and myometrium are clearly defined and the endometrial-myometrial junction is also clearly distinguishable. The thickening of the affected area of the uterine wall is now also considered confirmation of adenomyosis. An adenomyosis ultrasound or more specifically, a Transvaginal ultrasound (TVU) is another way to diagnose possible adenomyosis. TVU is able to identify myometrial cysts but most importantly, disparities of myometrial texture and composition, which signal the presence of adenomyosis.

Medical Care for Adenomyosis

Adenomyosis is one of two endometrium-related conditions that are fairly common to have. It can cause painful and heavy periods, as well as chronic pelvic pain, bloating and an enlarged, tender uterus. The causes are mostly unknown, however women who have had uterine surgery or trauma, are more at risk than others. Diagnosis can be done more accurately nowadays with MRIs and TVUs, although the best way to get rid of all symptoms, especially if they are extremely painful and risk quality of life, is getting a hysterectomy.

That may not be the best answer for someone with only minor symptoms or who wishes to still have children. There are less invasive and permanent treatments, such as hormonal treatment or minor surgery to excise the involved portion of the uterus.

If you have any of the symptoms and suspect you may have adenomyosis, it’s best to check with your doctor as soon as possible. Following a pelvic exam, he or she may schedule you for an MRI or TVU to get a better look.

Arizona Gynecology Consultants is located in the Phoenix and Mesa metropolitan areas. We provide expert and individualized health and medical services for women of every age, treating each patient as a unique person. Our team specializes in all aspects of women’s health and we are dedicated to practicing excellence in women’s care.

SCHEDULE A CONSULTATION TO SEE IF ADENOMYOSIS IS THE ROOT CAUSE OF YOUR DISCOMFORT.

The Importance in Raising Awareness of Endometriosis

The Importance in Raising Awareness of Endometriosis

This entry was posted in Ask An Expert and tagged on by .

March is Endometriosis Awareness Month, and everyone should understand the value of raising awareness of this medical condition. Although a large number of women develop this condition and it often entails severe adverse symptoms, endometriosis does not seem to receive as much public attention as other medical conditions. This March, take some time to understand this condition and do your part to raise awareness any way you can.

What Is Endometriosis?

EndometriosisEndometriosis is a complex condition that often results in serious and painful symptoms. Endometrium typically grows on the interior of the uterine walls and thickens, breaks down, and then bleeds with each menstrual cycle. When endometrium forms on the outside of the uterine walls, it can affect the ovaries, fallopian tubes, and other pelvic organs in rare cases.

During each menstrual cycle, displaced endometrium tissue acts just like normal endometrium tissue. It breaks down and bleeds, but may not have anywhere to go. Thus, endometrium tissue on the ovaries can cause endometriomas or cysts to form, eventually leading to scar tissue. The surrounding tissues may become irritated and grow fibrous adhesive tissues that bond nearby pelvic organs together. This condition commonly causes severely painful menstrual periods and other symptoms. If left unchecked, it may cause fertility problems.

Risk Factors and Symptoms

There are several indicators that may increase a woman’s risk of developing endometriosis:

  • Never having children
  • An early menarche or first period
  • Late menopause
  • Menstrual cycles less than 27days
  • Exposure to or natural development of excess levels of estrogen
  • Low body mass index
  • Uterine structuralabnormalities
  • Alcohol consumption
  • Family history of endometriosis

Symptoms usually appear within a few years of a woman’s menarche, can pause during pregnancy and then disappear with menopause. The most commonly reported symptom of endometriosis is unduly painful periods, usually starting a few days prior to menstruation and lasting for several days. Women with endometriosis may also experience excessive bleeding, painful urination, bloating, or pain during intercourse.

Treatments

The first line of treatment for endometriosis typically includes medication. Certain types of hormonal birth control medications can help regulate the growth and processing of endometrium tissue and ease symptoms. Hormonal intrauterine devices can prevent pregnancy for up to seven years, but they rarely treat endometriosis symptoms for this long.

If hormonal treatment does not appear effective, surgery is the next line of treatment for severe endometriosis. A surgeon will attempt to remove endometrium tissue deposits and then continue with hormonal treatment following surgery. Over-the-counter pain medicines, holistic treatments, and lifestyle changes can also improve symptoms.

Common Problems Facing Women with Endometriosis

One of the most challenging aspects of endometriosis treatment is the difficulty in obtaining an accurate diagnosis. Pain is subjective, and everyone experiences pain differently. A woman may complain of excessive menstrual pain during her periods, but her gynecologist may simply interpret this as the typical cramping and discomfort associated with menstrual periods.

According to an article published in Endometriosis News, some women have gone through 10 or more doctor visits before finally receiving referrals to specialists. Even more unfortunate is the typical wait time for an accurate endometriosis diagnosis — eight years or longer.

About 10 percent of women of childbearing age develop endometriosis, and while some manage their symptoms relatively effectively, this condition can cause a host of serious medical issues if left unchecked for too long. The most common of these related conditions is infertility. Endometrium tissue may prevent sperm from reaching eggs or even damage reproductive cells. Endometriosis can potentially interfere with any part of the fertilization and implantation process.

Failure to Address Symptoms

One of the most important reasons for raising awareness of endometriosis is to encourage gynecologists and other physicians to take patient complaints of related symptoms more seriously. From there, conduct more comprehensive screening procedures to catch endometriosis as early as possible and eliminate pain sooner than later. While this is by no means a rare or obscure condition, the symptoms are variable and often subjective, making it easy for a gynecologist to overlook or mistake for another condition.

Misdiagnosis and Delayed Diagnosis

Gynecologists’ not taking patients seriously is just one obstacle facing women in need of accurate endometriosis diagnoses; it is also very difficult to detect with imaging procedures. In many cases, a physician must perform a laparoscopic surgical inspection to confirm an endometriosis diagnosis, and the thought of undergoing this procedure deters some women from reporting their endometriosis symptoms.

Since endometriosis can be very difficult to accurately diagnose and shares symptoms with other common uterine medical issues, some women must contend with misdiagnoses for ovarian cysts or pelvic inflammatory disease. Irritable bowel syndrome can also accompany endometriosis, potentially misleading an attending physician to a misdiagnosis for a gastrointestinal issue rather than endometriosis.

How to Raise Endometriosis Awareness

There are many ways you can contribute to the public discussion on endometriosis and expand awareness of this condition. Women who have suffered from the symptoms of endometriosis should consider sharing their stories with others to potentially encourage other women in similar circumstances to seek treatment as soon as possible.

Local events are also great opportunities to increase awareness. Consider taking part in endometriosis advocacy events, such as the Worldwide March for Endometriosis or EndoMarch, at the end of March or any of the events for Endometriosis Awareness Week during the first week of March. Check your local community events guide to see if there is anything planned.

Social media is another great way to share advocacy materials, personal stories, and helpful resources for women struggling with endometriosis. Viral trends and hashtag campaigns can get a lot of people interested in an important topic in a relatively short amount of time. There are also countless petitions you could sign aimed at reducing diagnostic times for endometriosis patients and increasing the availability of care.

Endometriosis Awareness Month is a great opportunity to engage in meaningful advocacy for a condition affecting millions of women all over the world. Considering the significant diagnostic challenges facing women with endometriosis, increasing awareness could potentially help women seek treatment before their symptoms cause serious long-term medical complications.