Understanding endometriosis

Many women have not heard of endometriosis unless a loved one has it. It is a chronic condition caused when the endometrial tissue, also known as the endometrium, starts to grow in areas outside of the uterus. The endometrium is a layer of cells that line the inside of the uterine cavity that grows each month to prepare of the possibility of implantation of a fertilized egg. When menstruation occurs, that endometrium is shed and a new layer grows back the following month.

When endometriosis is present, endometrial tissue is usually found growing on the pelvic wall, fallopian tubes, ovaries, and other nearby organs.  This causes significant pain and discomfort, often interfering with quality of life. According to the American College of Obstetricians and Gynecologists, endometriosis can be found in one of ten women.

Logan Kracht, MD, FACOG

“Very often people’s pain is brushed off as normal period cramping. This can lead to feeling not heard or helpless,” said Logan Kracht, MD, FACOG, an OB-GYN with Lawrence OB-GYN Specialists. “Unfortunately endometriosis earned the reputation of being a commonly dismissed issue.”

Endometriosis is thought to be caused by retrograde menstruation, which occurs when a small amount of the uterus’s lining floats outside the fallopian tubes and implants somewhere outside of the uterus. The problem is that it continues to try to function outside of the uterus as it would if it were inside.

“When retrograde menstruation happens, the endometrial tissue is a lot like a dandelion seed floating around, looking for a place to sprout,” said Kracht. “Once it finds a spot, its goal is to shed, which causes problems.”

Endometriosis looks different from person to person. Even women with very little disease can present with a lot of pain.  Common symptoms of endometriosis are:

• Pelvic pain
• Pain before and during menstruation
• Pain with intercourse
• Infertility
• Heavy bleeding during menstruation
• Pain with bowel movements and urination

“A lot of the problem is that the tissue tries to shed like it normally does, but it doesn’t have anywhere to go, so it flares up,” said Kracht. “This inflammation angers the nerves. When it happens over and over again, it creates scar tissue which causes long term problems.”

One of the most prevalent long-term issues of endometriosis is infertility, which is usually the result of scarring that surrounds and distorts the fallopian tubes. The blockage does not allow for normal fertilization to occur.

“Endometriosis affects 6-10% of women of reproductive age and almost 1 in 4 women with infertility have it,” said Kracht.

Women with endometriosis are also at a higher risk for depression and struggles with intimacy.

Diagnosis

Knowing when or what to look for can be hard. If you have multiple symptoms of endometriosis or symptoms and a family history, talk to an OB-GYN provider about your concerns.

“You can definitely catch it early enough so that it will not cause as many problems,” explained Kracht.

It is important to identify whether an ovary is involved. The ovary has the ability to form follicles and cysts. However, when endometriosis is present, the ovary can be damaged in a way that produces an endometrioma, a painful cyst filled with blood. Endometriomas are often identified by visualizing the enlarged ovarian cyst on an ultrasound or during surgery.

“The most important features are size of the cyst and severity of pain - these things are what drive whether or not to treat,” said Kracht. “There are no definite size cut-offs that necessitate surgery, but if someone has a 5 cm endometrioma and pelvic pain interfering with quality of life, that would be an example of someone who could benefit from surgery.”

While physical exams, ultrasounds and endometrial biopsies are great ways to assess the likelihood of endometriosis, they don’t provide a definitive diagnosis.

“The only definitive way to diagnose endometriosis is to visualize it during surgery through a laparoscopy,” said Kracht. “It is a surgical technique where through the use of incisions less than an inch long, we use a camera to visualize operating with small instruments inside the abdomen. This way recovery is shortened, pain is less, and the risks of complications are reduced.”

Laparoscopy allows your provider to identify and visualize the location, size, and severity of disease, which can guide treatment.

Treatment

“Treatment options depend on severity of the endometriosis and goals of the person,” said Kracht.

First-line treatments are medications: anti-inflammatories, progesterone only medications such as pills, injections, implants, birth control pills, and even intrauterine devices.  These methods can help decrease the effects of the body’s natural estrogen, which is the main catalyst of endometriosis. There are some other very effective medications that work on the pituitary gland to stop estrogen at its source, which are great at halting the growth of endometriosis.

Surgery is a mainstay of diagnosis and treatment. During surgery, the tissue can be removed or cauterized, making the tissue inactive, thus improving pain.

“Even after successful surgical treatment, endometriosis can come back.  There could be spots too small to be seen, and if you can’t see them, you can’t treat them.”  Said Kracht

However, treatment is not limited to medical intervention. Some individuals have reported dietary, lifestyle and exercise habits have had a positive impact on the severity of their symptoms.

“While there is not a lot of data to show that lifestyle changes can help,” said Kracht, “I know plenty of people who have seen chronic problems improve after making strides to become healthier. Endometriosis is kind of like a bike wheel with many spokes, it will affect multiple areas of your life, so it often requires a multifaceted approach to make it better.

One of the biggest resources available to individuals struggling with endometriosis is connection. Finding others who are going through the same thing is great way to learn more about what works for them.

“Talking with others in your position and getting new ideas can really help,” remarked Kracht. “It’s not necessarily a ‘one size fits all’ approach, so I encourage my patients to not be afraid to lean on others for support.”

Finding care

Lawrence OB-GYN Specialists is available to guide you through your healthcare journey. Whether you are preparing for adulthood, motherhood or menopause, we provide comprehensive gynecological and obstetrical care that is focused on you and your unique needs. From healthy births and families to preventive screenings and advanced gynecological surgery, we are ready to be your partners for lifelong health. We offer online scheduling for annual well woman visits through My Patient Portal, or you can contact the clinic direct to schedule an appointment at 785-505-4950. Visit lmh.org for more information.