Endometriosis is a chronic disorder where tissue similar to the lining of the uterus grows outside of the uterus, causing inflammation and scar tissue. The condition can be difficult to diagnose and occurs in about 1 in 10 women of reproductive age. We recently sat down with Andrea Twomey, PA-C at Essex County OB/GYN, to discuss some frequently asked questions about endometriosis.
How do you explain endometriosis to someone who is newly diagnosed?
I usually start by explaining that endometriosis is a complex disease and it is often misdiagnosed for years because the symptoms can mimic other things. Most patients have pelvic pain, but they can also have other symptoms like heavy menstrual bleeding, back pain, bowel symptoms, urinary symptoms, etc., that contribute to misdiagnosis.
When a person has endometriosis, they can have endometrial implants anywhere in the pelvis, and sometimes even outside the pelvis, that are hormonally activated. As you go through your normal cycle, hormones trigger inflammation in the spots where you have these endometrial implants. This causes pain, urinary frequency, bowel complaints, and more, so it can be really tricky to diagnose.
For years, the gold standard for diagnosis has been laparoscopy because we can see the endometrial implants and accurately assess the stage of endometriosis. ACOG recently released new guidelines, though, which say laparoscopy to examine and confirm endometriosis is still a valid option, but not required. A clinical diagnosis based on symptoms and physical exam is sufficient to start treatment.
When should someone with painful periods or pelvic pain seek evaluation?
We don’t want anyone to suffer from painful periods! Yes, it can be normal to have cramps with your periods. However, if it’s affecting your ability to go to school or work, you should make an appointment to be evaluated. It could be endometriosis, and there are things that can be done to manage your pain.
What are the first-line treatments for endometriosis?
We always try to start with non-invasive treatments. Combined estrogen-progesterone contraceptive pills, NSAIDs (ibuprofen or naproxen), and progesterone-only treatments can help. There are also other medications called GnRH antagonists, like elagolic or relugolix, that can be used to treat moderate to severe endometriosis pain. Also, medications called GnRH agonists, like nafarelin, leuprolide, buserelin, goserelin, and triptorelin, are used to help treat the pain associated with endometriosis.
When medical management is not helping, and a patient is still having symptoms affecting their life, we recommend minimally invasive gynecologic surgery (MIGS).
What is MIGS, and how does it benefit patients with endometriosis?
Minimally invasive gynecologic surgery, or MIGS, is an approach which uses advanced laparoscopic, hysteroscopy, or robotic techniques to treat conditions like endometriosis, fibroids, and abnormal bleeding through small incisions. These procedures offer reduced pain, shorter hospital stays, and faster recovery compared to traditional open surgery.
MIGS at Essex County OB/GYN
Essex County OB/GYN is proud to have Dr. Courtney Fox on our team of physicians. Dr. Fox is a fellowship-trained minimally invasive gynecologic surgeon, meaning she completed two additional years of surgical training in a high-volume center to gain complex gynecologic surgery skills. In addition to being board-certified in obstetrics and gynecology, she utilizes minimally invasive surgery techniques with laparoscopy, robotics, and hysteroscopy, as well as conventional vaginal surgery to manage complex pathologies.
Common pathologies that can be managed with minimally invasive surgery are endometriosis excision surgery, management of fibroids, fertility surgery, and pelvic organ prolapse repair.
What do you wish more patients knew about endometriosis?
There are treatment options, and you don’t have to suffer. The important thing is seeing a specialist, like Dr. Fox, and working together to figure out which treatment option is best for you. There are also 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 us today to schedule an appointment and see how we can help. The entire Essex County OB/GYN team is here to support you through every step of your reproductive healthcare journey.