Endometriosis FAQ: The American College of Obstetricians and Gynecologists

March: Endometrio­sis Aware­ness Month

Dr. Tanya Mero, a gyne­col­o­gist in Quin­cy Med­ical Group’s Women’s Health Cen­ter, shared infor­ma­tion about endometrio­sis and treat­ment options for it on KHQA-TV’s ​“This Morn­ing” pro­gram (March 6, 2020). For more infor­ma­tion, Dr. Mero rec­om­mends the fol­low­ing fre­quent­ly asked ques­tions (FAQ) from the Amer­i­can Col­lege of Obste­tri­cians and Gyne­col­o­gists (ACOG). Watch her inter­view at https://​youtu​.be/​O​7​t​n​9​c​Uk0vI.

What is endometriosis?

Endometrio­sis is a con­di­tion in which the type of tis­sue that forms the lin­ing of the uterus (the endometri­um) is found out­side the uterus.

How com­mon is endometriosis?

Endometrio­sis occurs in about one in 10 women of repro­duc­tive age. It is most often diag­nosed in women in the 30s and 40s.

Where does endometrio­sis occur?

Areas of endome­tri­al tis­sue (often called implants) most often occur in the fol­low­ing places:

• Peri­toneum
• Ovaries
• Fal­lop­i­an Tubes 
• Out­er sur­faces of the uterus, blad­der, ureters, intestines, and rectum
• Cul-de-sac (the space behind the uterus)

How does endometrio­sis cause problems?

Endometrio­sis implants respond to changes in estro­gen, a female hor­mone. The implants may grow and bleed like the uter­ine lin­ing dur­ing the men­stru­al cycle. Sur­round­ing tis­sue can become irri­tat­ed, inflamed, and swollen. The break­down and bleed­ing of this tis­sue each month also can cause scar tis­sue, called adhe­sions, to form. Some­times adhe­sions can cause organs to stick togeth­er. The bleed­ing, inflam­ma­tion, and scar­ring can cause pain, espe­cial­ly before and dur­ing menstruation.

What is the link between infer­til­i­ty and endometriosis?

Almost 40% of women with infer­til­i­ty have endometrio­sis. Inflam­ma­tion from endometrio­sis may dam­age the sperm or egg or inter­fere with their move­ment through the fal­lop­i­an tubes and uterus. In severe cas­es of endometrio­sis, the fal­lop­i­an tubes may be blocked by adhe­sions or scar tissue.

What are the symp­toms of endometriosis?

The most com­mon symp­tom of endometrio­sis is chron­ic (long-term) pelvic pain, espe­cial­ly just before and dur­ing the men­stru­al peri­od. Pain also may occur dur­ing sex­u­al inter­course. If endometrio­sis is present on the bow­el, pain dur­ing bow­el move­ments can occur. If it affects the blad­der, pain may be felt dur­ing uri­na­tion. Heavy men­stru­al bleed­ing is anoth­er symp­tom of endometrio­sis. Many women with endometrio­sis have no symptoms.

How is endometrio­sis diagnosed?

A health­care pro­fes­sion­al first may do a phys­i­cal exam, includ­ing a pelvic exam. How­ev­er, the only way to tell for sure that you have endometrio­sis is through a sur­gi­cal pro­ce­dure called laparoscopy. Some­times a small amount of tis­sue is removed dur­ing the pro­ce­dure. This is called a biop­sy.

How is endometrio­sis treated?

Treat­ment for endometrio­sis depends on the extent of the dis­ease, your symp­toms, and whether you want to have chil­dren. Endometrio­sis may be treat­ed with med­ica­tion, surgery, or both. When pain is the pri­ma­ry prob­lem, med­ica­tion usu­al­ly is tried first.

What med­ica­tions are used to treat endometriosis?

Med­ica­tions that are used to treat endometrio­sis include pain reliev­ers, such as non­s­teroidal anti-inflam­ma­to­ry drugs (NSAIDs), and hor­mon­al med­ica­tions, includ­ing birth con­trol pills, prog­estin-only med­ica­tions, and gonadotropin-releas­ing hor­mone ago­nists. Hor­mon­al med­ica­tions help slow the growth of the endome­tri­al tis­sue and may keep new adhe­sions from form­ing. These drugs typ­i­cal­ly do not get rid of endometrio­sis tis­sue that is already there.

How can surgery treat endometriosis?

Surgery can be done to relieve pain and improve fer­til­i­ty. Dur­ing surgery, endometrio­sis implants can be removed.

Does surgery cure endometriosis?

After surgery, most women have relief from pain. But there is a chance the pain will come back. About 40 – 80% of women have pain again with­in two years of surgery. This may be due to endometrio­sis that was not vis­i­ble or could not be removed at the time of surgery. The more severe the dis­ease, the more like­ly it is to return. Tak­ing birth con­trol pills or oth­er med­ica­tions after hav­ing surgery may help extend the pain-free period.

What if I still have severe pain that does not go away after I have had treatment?

If pain is severe and does no go away after treat­ment, a hys­terec­to­my may be a ​“last resort” option. endometrio­sis is less like­ly to led to future pain if your ovaries are removed at the time of hys­terec­to­my. Either way, the goal of sur­gi­cal treat­ment is to remove as much as pos­si­ble of the endometrio­sis that is found out­side the uterus.

Glos­sary

Adhe­sions: Scars that can make tis­sue sur­faces stick together.

Biop­sy: A minor sur­gi­cal pro­ce­dure to remove a small piece of tis­sue. This tis­sue is exam­ined under a micro­scope in a laboratory.

Blad­der: A hol­low mus­cu­lar organ in which urine is stored.

Endometrio­sis: A con­di­tion in which tis­sue that lines the uterus is found out­side of the uterus, usu­al­ly on the ovaries, fal­lop­i­an tubes, and oth­er pelvic structures.

Endometri­um: The lin­ing of the uterus.

Estro­gen: A female hor­mone pro­duced in the ovaries.

Fal­lop­i­an tubes: Tubes through which an egg trav­els from the ovary to the uterus.

Gonadotropin-releas­ing hor­mone ago­nists: Med­ical ther­a­py used to block the effects of cer­tain hormones.

Hor­mone: A sub­stance made in the body that con­trols the func­tion of cells or organs.

Hys­terec­to­my: Surgery to remove the uterus.

Infer­til­i­ty: The inabil­i­ty to get preg­nant after one year of hav­ing reg­u­lar sex­u­al inter­course with­out the use of birth control.

Inflam­ma­tion: Pain, swelling, red­ness, and irri­ta­tion of tis­sues in the body.

Laparoscopy: A sur­gi­cal pro­ce­dure in which a thin, light­ed tele­scope called a laparo­scope is insert­ed through a small inci­sion (cut) in the abdomen. The laparo­scope is used to view the pelvic organs. Oth­er instru­ments can be used with it to per­form surgery.

Ovaries: Organs in women that con­tain eggs nec­es­sary to get preg­nant and make impor­tant hor­mones, such as estro­gen, prog­es­terone, and testosterone.

Pelvic exam: A phys­i­cal exam­i­na­tion of woman’s pelvic organs.

Peri­toneum: The mem­brane that lines the abdom­i­nal cav­i­ty and sur­rounds the inter­nal organs.

Prog­estin: A syn­thet­ic form of prog­es­terone that is sim­i­lar to the hor­mone made nat­u­ral­ly by the body.

Rec­tum: The last part of the diges­tive tract.

Ureters: A pair of tubes, each lead­ing from one of the kid­neys to the bladder.

Uterus: A mus­cu­lar organ locat­ed in the female pelvis. Dur­ing preg­nan­cy this organ holds and nour­ished the fetus.

Note: This infor­ma­tion is from the Amer­i­can Col­lege of Obste­tri­cians and Gyne­col­o­gists. Please see https://​www​.acog​.org/​-​/​m​e​d​i​a​/​F​o​r​-​P​a​t​i​e​n​t​s​/​f​a​q​0​1​3.pdf.