Endometriosis is an often painful disease that can be challenging to diagnose. Endometriosis affects 1 in 10 women, most commonly affecting women and girls in their reproductive years between ages 15 and 49. It has also been reported to affect girls at the beginning of their first period and due to scar tissue and adhesions, symptoms don’t always stop at menopause.
A nationwide survey conducted by the independent health network Healthy Women found that “42 percent of the women with endometriosis were told by their doctor that the pain they were experiencing was “part of being a woman.” Endometriosis is difficult to diagnose, which the survey proved true as 72% of women with endometriosis had to visit two or more doctors before being diagnosed” (National Women’s Health Network, 2017). On average it takes 10 years for a woman to receive the proper diagnosis of endometriosis, likely attributed to a lack of awareness for both the patient and the physician.
According to the Endometriosis Foundation of America, endometriosis occurs when the tissue lining normally found in the uterus begins to grow in areas it shouldn’t outside of the uterus, such as the pelvic region, fallopian tubes, ovaries, spaces between the bladder and vagina. In some cases, endometriosis also affects the large and small bowel, lungs, diaphragm, appendix and rectum. The growth of the endometrium lining outside of the uterus causes inflammation, often debilitating pain and scarring. If left untreated it can lead to infertility.
A 2011 worldwide study by the Global Study of Women’s Health on endometriosis and its impact found that 65% of women in the study presented with pain and that one-third were also infertile. Additionally, 14% of women with endometriosis reported no pain and were infertile.
Endometriosis can significantly impact the quality of life. The 2011 study found that endometriosis accounts for approximately 11 hours of loss in productivity per woman per week. It was estimated that individuals with endometriosis had a 38% greater loss of productivity at work than their counterparts. Outside of work, the pain proved debilitating and interfered with common everyday activities such as childcare, shopping and housework. The increase in pain severity was directly associated with a decrease in quality of life.
Endometriosis is more than just painful menstrual cramps.
The following are common signs of endometriosis and are NOT normal symptoms of menstruation:
Chronic pelvic pain
Pelvic pain that gets worse after sex or a pelvic exam
Abdominopelvic pain apart from menses
Chronically heavy or long periods
Bowel or urinary disorders, often associated with periods
Painful sexual activity, particularly with penetration
Significant lower back pain with menses
Allergies, migraines or fatigue that tends to worsen around menses
Crippling menstrual pain causing missed school, work, activities
Catamenial pneumothorax (with lung endometriosis)
The research is still not definitive on the exact cause of endometriosis. Some of the potential causes include:
Retrograde menstruation: The process where menstrual blood carrying endometrial cells flows backward up the fallopian tube versus out of the body. Endometrial cells are deposited in the pelvic cavity where they begin to grow every menstrual cycle.
Transformation of peritoneal cells: Peritoneal cells line the inside of the abdomen, it is proposed that hormones and immune factors may transform these cells into endometrial cells, therefore, causing the disease.
Embryonic cell transformation: During puberty, estrogen hormones transform cells during their early development stage into endometrial cell implants.
Surgical scar implantation: Where endometrial cells attach to the surgical incision following surgeries such as C-sections and hysterectomies.
Endometrial cell transport: Where endometrial cells are transported through the blood vessels to other parts of the body.
Immune system disorder: An immune system not functioning properly may not recognize and destroy endometrial-like cells that are growing in areas of the body outside the uterus.
Genetics: Having a family member who has endometriosis makes you more prone to developing the disease.
There’s no definitive cure for endometriosis and researchers are still trying to ascertain the factors that cause endometriosis. However, there are treatments available including:
Symptom management with the use of medication, birth control, hormone therapy, physical and alternative therapies
Diet and nutrition
Surgical options include hysterectomy and less invasive options that might improve fertility chances such as surgical excision, which can be performed laparoscopically or robotically.
Regardless of the treatment, early and proper diagnosis is key to managing the disease and reducing risks of infertility and prolonged quality of life interference. It is essential to find a competent doctor who understands that pelvic pain is more than “just cramps” and can perform the necessary examinations to identify and diagnose endometriosis early on as well as provide minimally invasive treatment options.
Dr. Melissa Delgado at the Chronic Pelvic Pain Center of Northern Virginia specializes in minimally invasive treatments including hysterectomies and surgical excision that may be necessary to treat endometriosis. Dr. Delgado has been accredited by SRC as a Surgeon of Excellence in Minimally Invasive Gynecology with Reston Hospital Center since 2016. SRC is an internationally recognized nonprofit patient safety organization that accredits medical professionals who meet proven standards. Independently vetted, SRC-accredited providers are dedicated to safe and superior patient care, continuous education and optimal outcomes.
If you are experiencing pelvic pain or other symptoms and are unsure whether it is endometriosis, make an appointment at the Chronic Pelvic Pain Center of Northern Virginia by calling 571-261-6260.
Want to learn more about what an SRC accreditation means for your care? Visit www.surgicalreview.org.