This is the first in a series of five blogs about common conditions that can cause abnormal uterine bleeding.
Many of our patients experience mild pain and cramping during their menstruation. But what about the patients who are forced to endure severe pain and discomfort, causing them to miss school and work on a monthly basis?
For many of these women, endometriosis is the cause.
The good news is that we are able to offer medical treatments and fertility-sparing surgical options that can alleviate endometriosis pain for most patients.
What is endometriosis?
Endometriosis is a condition in which tissue that normally grows inside the uterus grows outside it — often on the ovaries, fallopian tubes and nearby tissue. These areas, called “implants,” bleed each month, which can cause unusually high blood flow as well as pelvic pain. Endometriosis can cause fatigue and make it difficult to get pregnant. The condition is estimated to occur in up to one in every 10 women and can cause symptoms for women at any age until menopause.
Endometriosis responds to changes in estrogen, which is the female hormone that controls a woman’s monthly cycle. This is why the implants can grow and bleed like the uterine lining does during the menstrual cycle. The surrounding tissue can become irritated or swollen, and it can also cause scar tissue to form. All of these factors — bleeding, inflammation and scarring — can cause pain. In rare cases, endometriosis can lead to cancer.
Symptoms of endometriosis
Although many women with endometriosis have no symptoms, the most common symptom of endometriosis is long-term pelvic pain, especially just before and during your period. Depending on where the implants are located, there can be pain during sex, during bowel movements or during urination. The other main symptom is heavy or abnormal menstrual bleeding.
How does endometriosis affect pregnancy?
When scar tissue or inflammation occurs around the reproductive organs, they can damage the sperm or egg or interfere with their movement through the fallopian tubes and uterus. This condition is pretty common: Almost 40% of all women with infertility have endometriosis.
Endometriosis diagnosis and treatment options
The good news is that there are a few ways to get relief from endometriosis pain, or at least to slow the condition’s progress. Hormones such as those in birth control pills and the levonorgestrel IUD may relieve pain, help slow endometrial tissue growth, and may keep new implants from forming. Additional pain relief can come from nonsteroidal anti-inflammatory drugs such as ibuprofen. Some women gain relief from pain and fatigue through dietary or lifestyle changes. Conservative, minimally invasive surgery with removal of endometriotic implants but not removing the uterus or ovaries can relieve pain, usually for about three years. Relief of pain from endometriosis after surgery can be extended for up to five or six years with hormonal therapy, pregnancy and breastfeeding.
Lifecycle endometriosis management and severe cases
In our practice, we support the approach of “lifecycle” endometriosis management. The three goals of this approach are:
- to maximize pain relief with effective medical treatments,
- to minimize the number of surgeries needed for recurrences of severe pain, and
- to preserve the ability to have children.
In severe cases that do not respond to medical treatment or conservative surgery, surgical removal of the uterus and all adjacent endometriosis will permanently relieve pain in up to 97% of patients.
What to do if you think you may have endometriosis
If you think you may have endometriosis, contact your healthcare provider and ask to be tested. There are a few ways that your healthcare provider can find out. These include a pelvic pain questionnaire review, pelvic examinations, ultrasound procedures and some blood tests. The only way to diagnosis endometriosis with certainty is to surgically visualize the implants, usually by minimally invasive laparoscopic surgical procedures, and to send tissue for biopsy.
Above all, remember that there are options for treatment, and that you’re not alone.
If you have any questions about abnormal uterine bleeding or endometriosis, feel free to contact us for more information and to discuss your particular situation. More information can be found below.
Dr. John M. Garofalo, M.D.: Endometriosis
American Congress of Obstetricians and Gynecologists: frequently asked questions on endometriosis
About the practice
Dr. John Garofalo, MD, is an ob-gyn located in Fairfield County, Connecticut. He has more than 20 years of practice and surgical experience covering many facets of obstetrics and gynecology.
Laury Berkwitt, APRN, is a nurse practitioner specializing in women’s health in Fairfield County, Connecticut. Nurse Berkwitt has a passion for providing quality women’s health care in a safe and comfortable manner by creating a trusting patient-practitioner relationship. She has been in practice for more than 10 years, caring for women of all ages.
For more information, go to www.garofaloobgyn.com. Dr. Garofalo and Nurse Berkwitt can be reached for personal consultations by calling 203.803.1098.