Many women have unexplained chronic pelvic pain for years before they are diagnosed with endometriosis. Traditional endometriosis treatments often involve the removal of the ovaries to minimize pain. At Sara Saudi Medical Group, our expert physicians use minimally-invasive techniques to help her manage endometriosis pain and also potentially save her ovaries, increasing the chances of conceiving her own child if she wishes.
What is endometriosis?
Endometriosis is a benign disorder characterized by the presence of endometrial tissue (the tissue that lines the uterus) outside the uterine cavity where it grows on the surface of reproductive, chest, abdominal and/or pelvic organs.
Endometriosis implants are often superficial (coating the surface) but can invade surrounding structures or even grow into a mass, such as an ovarian cyst or tumor, within the uterus or abdominal wall. It is associated with inflammation which results in adhesions, scar tissue, and distorted anatomy. Cysts may range from the size of a pinhead to the size of a grapefruit; cysts, scars, and adhesions may all lead to infertility.
Endometriosis is a common disorder, most prevalent between the ages of 25 and 40. Symptoms vary and are not strictly correlated with the severity of the disease; they may worsen with time, but tend to diminish during pregnancy and cease with menopause. Many women have no symptoms at all. Treatment depends on the severity of symptoms, the age of the woman, and whether she wishes to have children.
Causes of endometriosis
The cause of endometriosis is unknown. Hereditary factors may be involved. Hormonal changes or recent pelvic surgery may promote endometriosis.
Symptoms of endometriosis include:
- Pain in the pelvis, lower abdomen, and lower back. Pain often begins just prior to monthly periods, continues during menses, and worsens just after the cessation of blood flow.
- Abnormal or heavy menstrual bleeding
- Vaginal pain during sexual intercourse
- Diarrhea, constipation, or pain during bowel movements
- Bleeding from the rectum or blood in the urine during menses
- Nausea and vomiting just prior to monthly periods
- Pressure related symptoms impacting the bladder or bowels due to a large mass of endometriosis
- Infertility or subfertility: Endometriosis is one of the most common causes of infertility.
A pelvic examination may reveal a suspicion of endometriosis. The doctor presses upon the uterus and ovaries to feel for any abnormalities. A definitive diagnosis requires:
- Direct visualization of endometrial tissue
- Biopsy or sampling of the extrauterine endometrial tissue. This is usually done by laparoscopy (the insertion of a thin, lighted camera into the abdomen through a small incision at the belly button).
- If you are diagnosed with endometriosis while undergoing laparoscopy, your doctor may remove the endometrial tissue during the procedure.
Treatment options include:
- Your doctor may prescribe low-dose oral contraceptive pills. They work by suppressing ovulation and menstruation, thereby keeping symptoms under control. Evidence also suggests that this treatment may reduce the endometriotic implants. Over-the-counter pain relievers may be taken for mild menstrual pain.
- Danazol, progestins, or Gn-RH (gonadotropin-releasing hormone) agonists may be administered to halt menstruation for three to six months in an effort to shrink endometrial tissue.
- Surgical removal of the tissue may be required to relieve severe symptoms or to allow impregnation. Tissue may be destroyed by heat (electrocautery) or removed with lasers during laparoscopy (usually done on an outpatient basis under general anesthesia). A hysterectomy, the surgical removal of the uterus (and sometimes other reproductive organs), may be advised in severe cases. Hormone replacement is required if both ovaries are removed.
- Minimally-invasive or robotic surgery is available at Sara Saudi Medical Group for treatment of endometriosis. Advantages of a minimally invasive approach include less bleeding, infection, less pain, faster recovery and return to normal function.