Although March is Endometriosis Awareness Month, it is always important to raise awareness of the condition to promote early diagnosis and treatment. Andrea Twomey, a Physician Assistant at Essex County OB/GYN, recently sat down to answer some common questions about the disorder.
What is endometriosis, and how common is it among the patients you see at Essex County OB/GYN?
Endometriosis is a chronic disorder in which tissue similar to the lining of the uterus grows outside of the uterus (commonly on the ovaries, fallopian tubes, and pelvic tissue), leading to the formation of inflammation and scar tissue. It can start at a person’s first menstrual period and last through menopause.
The condition occurs in about 1 in 10 women of reproductive age and is most often diagnosed in women in their 30s and 40s.
What are the most common symptoms that lead patients to seek care?
The most common symptoms of endometriosis are heavy menstrual bleeding and chronic, long-term pelvic pain, especially just before and during the menstrual period. Pain may also occur during sexual intercourse, during bowel movements, or urination.
It is also common to have no symptoms. Many women do not learn they have endometriosis until they cannot get pregnant or until they are having surgery for something else.
How is endometriosis typically diagnosed, and how has the process of diagnosis changed over the years?
The only way to definitively diagnose endometriosis is through a minimally invasive surgical procedure called a laparoscopy. A small amount of tissue may be removed during the procedure and tested in a lab, which is called a biopsy.
Accurate and timely diagnosis is crucial to effectively manage symptoms associated with endometriosis, including infertility. While laparoscopy with histology remains the gold standard, the potential for a range of non-invasive imaging methods to shorten the time to diagnosis and to inform the next steps in treatment has resulted in their inclusion in clinical guidelines and clinical trials. Transvaginal ultrasound (TVS) and magnetic resonance imaging (MRI) are already widely used to diagnose other conditions such as ovarian and deep disease.
What treatment options do you offer?
Endometriosis may be treated with medication, surgery, or both. The best option for you will depend on the extent of the disease, your symptoms, and whether you want to have children. If pain is the primary problem, we usually try medication first. Significant advancements in treatment methods have occurred in recent years, including new drugs and robotic surgery!
Hormonal medications, including birth control pills, progestin-only medications, and gonadotropin-releasing hormone (GnRH) agonists, often play a role in managing endometriosis. These medications do not typically get rid of existing endometriosis tissues, but they help slow the growth of the endometrial tissues and may prevent new adhesions from forming.
Surgical options are available for patients with severe cases. If your severe pain does not improve or go away after treatment, a hysterectomy may be an option. Endometriosis is less likely to lead to future pain if your ovaries are removed at the time of the hysterectomy. Regardless, the goal of surgical treatment is to remove as much of the endometriosis tissue that is found outside of the uterus as possible.
What advice do you give patients who are trying to conceive but are affected by endometriosis?
Reach out to your provider! Almost 40% of women experiencing infertility have endometriosis. The inflammation caused by the condition can damage the sperm or egg or interfere with their movement through the fallopian tubes and uterus. In more severe cases, the fallopian tubes may be blocked by adhesions or scar tissue. We can help connect you with a reproductive specialist!
What do you wish more people knew about endometriosis and its impact on overall health?
Endometriosis can decrease quality of life due to severe pain, fatigue, depression, anxiety, and infertility, and therefore has significant social, public health, and economic implications. The debilitating pain can prevent some individuals from going to work or school. The condition can also cause painful sex, leading to interruption or avoidance of intercourse, and affecting the overall sexual health of the affected individuals and their partners.
Addressing and raising awareness of endometriosis can help empower those affected by it by supporting their human right to the highest standard of sexual and reproductive health, quality of life, and overall well-being. Over the past few years, we have noticed more patients seeking care for endometriosis and thus achieving a better quality of life through available treatments.
Resources
There are many resources available, including:
- Endometriosis Foundation of America
- Endometriosis Association
- Endometriosis Toolkit from the Society for Women’s Health Research
- Office on Women’s Health
If you are experiencing symptoms of endometriosis, contact Essex County OB/GYN today. We are here to support you through every step of your reproductive healthcare journey.