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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
What Women Should Know About Minimally Invasive Surgery - AZ Gyn

What Women Should Know About Minimally Invasive Surgery

For women who are in need of gynecological surgery, the idea of “going under the knife” or “getting cut open” (especially “down there”) can be enough to scare off even the bravest and most confident of us.

But thanks to advances in surgical procedures, women today have many minimally invasive surgical options. In fact, it’s never been safer to get the surgery you need.

What Is Minimally Invasive Surgery?

To understand what minimally invasive surgery is, let’s look at what it’s not.

Traditional, or “open,” surgery involves making an abdominal incision large enough for the surgeon to see the area well and navigate the site with surgical tools. Although surgeons do their best to make the surgical incision as small as possible, there are practical limitations with this type of surgery.

Minimally invasive surgery (MIS), meanwhile, utilizes modern advances in technology that allow a surgeon to perform procedures using very small incisions, or in some cases, no incision at all.

Types of Minimally Invasive Surgery

Any type of surgery that isn’t open surgery and that involves minimal incisions can be considered minimally invasive surgery. However, there are two main types that we will explore here. Both use technology inserted through small incisions or natural orifices to perform the operation. Which one is used depends on the specific protocol of a particular surgery.

Endoscopic Surgery

Benefits of Minimally Invasive Surgery Bulleted List - Arizona Gynecology Consultants

Endoscopic surgery involves making small incisions – often less than an inch each – and inserting a small tube equipped with a tiny camera, and other tubes with microsurgery tools as appropriate. The tube can also be inserted through a natural orifice, such as the mouth or cervix, depending on the location to be operated on and the type of surgery.

The camera allows the surgeon to see an enlarged view of the surgical area for clear viewing. The small surgical tools give the surgeon the ability to make very precise cuts and sutures.

Other terms you might hear used for this type of surgery include:

  • Laparoscopy
  • Hysteroscopy
  • Keyhole surgery

Robotic-Assisted Surgery

Like with endoscopic surgery, microscopic cameras and tools are inserted through small incisions. However, during robotic-assisted surgery, the surgeon operates from a console with controllers and a high-definition screen. When the surgeon makes a movement with the controllers, the computer makes the movement more precise.

Robotic-assisted surgery is appropriate for delicate surgeries that benefit from the computer’s ability to perform movements that are more precise than what the human hand is capable of.

With both types of MIS, the surgeon is still very much in control of the operation, regardless of the technology used.

Like all surgeries, minimally invasive surgeries require a professional surgery center and well-trained medical staff with experience performing these types of procedures. Anesthesia needs vary; your doctor will discuss your options with you.

Benefits of Minimally Invasive Surgery

MIS is generally considered safer and more effective than traditional open surgery. Benefits include:

  • Smaller incisions
  • Lower risk of infection
  • Reduced blood loss
  • Less pain
  • Minimized scarring
  • Shorter hospital stay
  • Faster recovery time

The smaller incision means less healing time for the patient, and it reduces the chance of infection. This, in turn, leads to a shorter hospital stay and reduced expenses for the patient.

Professional women, in particular, enjoy the benefit of being able to rehabilitate to full capacity as quickly as possible, while still taking enough time for a full recovery after surgery.

How to Know If Minimally Invasive Surgery Is Right for You

Gynecological conditions that improve after minimally invasive surgery include:

  • Uterine fibroids
  • Endometriosis
  • Ovarian cysts
  • Pelvic organ prolapse
  • Cervical incompetence
  • Abnormal uterine bleeding
  • Pelvic pain

Minimally Invasive Gynecological Surgery in Phoenix, Arizona

Our experienced surgeons at Arizona Gynecology Consultants are well-practiced in advanced surgery techniques like minimally invasive surgery. Dr. Kelly Roy is our in-house specialist in gynecology and advanced endoscopy.

If you’ve been putting off a surgery or aren’t sure if your situation warrants surgery, make an appointment today to meet with one of our gynecological specialists. We have offices in multiple locations in the Phoenix area.

Whatever your surgical or reproductive needs, we’ll help you feel safe and well-cared for when you join the Arizona Gynecology Consultants family!

What Are Uterine Fibroids - Arizona Gynecology Consultants

What Are Uterine Fibroids?

Uterine fibroids are small, benign tumors that grow in the uterus. They are made of the same type of cells found in the walls and connective tissues of the uterus.

In some cases, they embed in the walls of the uterus, but some fibroids will project from the outer surface of the uterus into the abdominal cavity. Others can cluster inside the uterus and project into the interior space of the uterus. [1]Farris, M., Bastianelli, C., Rosato, E., Brosens, I., & Benagiano, G. (2019). Uterine fibroids: an update on current and emerging medical treatment options. Therapeutics and Clinical Risk … Continue reading

The cause of uterine fibroids is not known, but some women are at higher risk of developing them than others. Black women receive uterine fibroid diagnosis 2 to 3 times as often as other women, [2]Stewart, E. A., Nicholson, W. K., Bradley, L., & Borah, B. J. (2013). The burden of uterine fibroids for African-American women: results of a national survey. Journal of Women’s Health, … Continue reading and uterine fibroids only rarely appear in young women who have not started menstruating.

Uterine fibroids will stop growing and dissolve over time after menopause.

What Does My Uterine Fibroid Diagnosis Mean?

Uterine fibroid diagnoses are incredibly common, [3]Zimmermann, A., Bernuit, D., Gerlinger, C. et al. Prevalence, symptoms and management of uterine fibroids: an international internet-based survey of 21,746 women. BMC Women’s Health 12, 6 … Continue reading and about 70 to 80 percent of women will receive a uterine fibroid diagnosis before age 50. If your doctor recently diagnosed you as having uterine fibroids, don’t be alarmed: Uterine fibroids are not cancerous, and the worst symptoms they cause are manageable. While this condition can cause some unpleasant symptoms, many women with uterine fibroids do not have any symptoms at all, and the condition is not medically threatening.

Possible Symptoms of Uterine Fibroids

Most uterine fibroids do not cause any noticeable symptoms. If a doctor discovers uterine fibroids that are asymptomatic during a routine gynecological exam, he or she will likely suggest a wait-and-see approach for monitoring the fibroids in the future. The doctor may wish to confirm the uterine fibroid diagnosis with imaging scans like an ultrasound or pelvic MRI.

Women who experience negative symptoms from uterine fibroids typically report painful or excessive bleeding during periods, or bleeding between periods. Uterine fibroids may also cause abdominal swelling or a feeling of fullness. [4]Viva, W., Juhi, D., Kristin, A. et al. Massive uterine fibroid: a diagnostic dilemma: a case report and review of the literature. J Med Case Reports 15, 344 (2021). … Continue reading

If fibroids compress the bladder, the woman may experience a frequent need to urinate or may have difficulty urinating. Uterine fibroids can also cause lower back pain and pain during sexual intercourse.

Excessive bleeding during periods is a common issue, and some women develop anemia from the blood loss and can suffer other medical complications as well. If these symptoms are severe enough, the woman’s doctor may recommend one of several possible treatment options.

What Are Uterine Fibroids: Treatment Options

A doctor will only treat a case of uterine fibroids if they are causing the patient significant discomfort. The type of symptoms the patient displays, and the severity of those symptoms, typically determines the best course of treatment.

Women who experience only mild pelvic pain may benefit from over-the-counter anti-inflammatory and painkiller medications like ibuprofen. If the pain is too severe for these drugs to handle, the woman’s doctor can prescribe a stronger medication.

Hormone Treatment

While doctors have yet to pinpoint the causes of uterine fibroids, they do believe that uterine fibroids have an easier time developing in an estrogen-rich system. Some doctors may wish to treat uterine fibroids with hormonal medication to limit estrogen production, but it’s important that women understand the effects of hormonal medications.

While a birth control pill may contain hormones that reduce excessive bleeding and decrease a woman’s pain during menstruation, birth control pills that contain estrogen can cause uterine fibroids to grow. This treatment would effectively only manage the symptoms while making the cause of those symptoms worse.

Uterine Fibroids and Pregnancy

Some women may wonder if uterine fibroids interfere with pregnancy. Since estrogen encourages fibroid growth, [5]Borahay, M. A., Asoglu, M. R., Mas, A., Adam, S., Kilic, G. S., & Al-Hendy, A. (2017). Estrogen Receptors and Signaling in Fibroids: Role in Pathobiology and Therapeutic Implications. … Continue reading a woman’s existing uterine fibroids may enlarge during the first trimester when estrogen levels are highest. However, the tumors will later shrink after birth.

Surgical Options

Advanced cases of uterine fibroids that cause significant pain and discomfort may require surgery. The two types of surgery that can solve a uterine fibroid problem are:

  • Hysterectomy
  • Myomectomy

If a woman undergoes a hysterectomy during her childbearing years, she will no longer be able to have children. Some women may not wish to have children, or any more children, and find this acceptable if it stops the unpleasant symptoms of the fibroids.

Women who wish to remove their uterine fibroids but still want to be able to bear children may opt for a myomectomy instead. A myomectomy procedure removes the uterine fibroid tumors while leaving the uterus intact.

Doctors perform myomectomies in three different ways:

  • Laparotomy: The doctor enters the uterus through a small incision in the abdomen to remove the uterine fibroids.
  • Laparoscopic myomectomy: The doctor uses a small, thin telescopic instrument through a small incision in the navel to reach the uterine fibroids.
  • Hysteroscopic myomectomy: A procedure which involves inserting a hysteroscope through the cervix to extract the uterine fibroids through the vaginal opening.

Finally, if a woman does not wish to undergo surgery and wants to keep her fertility intact, she can opt for a fibroid embolization procedure. This is a minimally invasive outpatient procedure during which an interventional radiologist shrinks the uterine fibroids by cutting off their blood supply. The patient will often be able to go home the same day as the procedure after a short recovery period.

Know Your Options

Uterine fibroids can be unpleasant and cause a host of problematic symptoms, so women should always refer to their gynecologists for their recommendations for treatment and handling symptoms. Arizona Gynecology Consultants works with a large network of trusted medical providers, so reach out to us if you have questions about managing your uterine fibroids.

References

References
1 Farris, M., Bastianelli, C., Rosato, E., Brosens, I., & Benagiano, G. (2019). Uterine fibroids: an update on current and emerging medical treatment options. Therapeutics and Clinical Risk Management, 15, 157–178. https://doi.org/10.2147/TCRM.S147318
2 Stewart, E. A., Nicholson, W. K., Bradley, L., & Borah, B. J. (2013). The burden of uterine fibroids for African-American women: results of a national survey. Journal of Women’s Health, 22(10), 807–816. https://doi.org/10.1089/jwh.2013.4334
3 Zimmermann, A., Bernuit, D., Gerlinger, C. et al. Prevalence, symptoms and management of uterine fibroids: an international internet-based survey of 21,746 women. BMC Women’s Health 12, 6 (2012). https://doi.org/10.1186/1472-6874-12-6
4 Viva, W., Juhi, D., Kristin, A. et al. Massive uterine fibroid: a diagnostic dilemma: a case report and review of the literature. J Med Case Reports 15, 344 (2021). https://doi.org/10.1186/s13256-021-02959-3
5 Borahay, M. A., Asoglu, M. R., Mas, A., Adam, S., Kilic, G. S., & Al-Hendy, A. (2017). Estrogen Receptors and Signaling in Fibroids: Role in Pathobiology and Therapeutic Implications. Reproductive Sciences (Thousand Oaks, Calif.), 24(9), 1235–1244. https://doi.org/10.1177/1933719116678686