Tag Archives: Endometriosis

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

This entry was posted in Procedures and tagged , on by .

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.