Endometriosis is a gynecological condition found in women of reproductive age where the lining cells of the uterus grow outside of the uterus under hormonal stimulation (endometrial implants).
While implants are most commonly on the ovaries, they can also be found on/in the:
Rarely, endometrial implants have been found to travel outside the pelvis to old surgery scars, the lungs, brain, and liver.
Endometriosis, which is a common cause of infertility, affects as many as 5% to 18% of women in the United States and is a leading cause of pelvic pain.
Not every woman with endometriosis has pelvic pain. The intensity of the pain is no reflection on the extent or size of the endometrial implants.
The cause of endometriosis is unknown. However, a widely accepted theory is that of retrograde menstruation: the uterine cells flow upward with blood during the monthly period and out the fallopian tubes into the pelvis.
Doctors Who Treat Endometriosis
As endometriosis is diagnosed, treated and managed, you may encounter the following team of doctors and specialists listed below in this Endometriosis Patient Education.
- Gynecologist – concentrates on the health of the female genital system and associated conditions. They often work in the capacity of primary care doctor for women. The gynecologist is the one to perform surgery for diagnosis and treatment of endometriosis
- Nurse Practitioner – focuses on prevention, wellness, and education of patients about health and health choices. The nurse practitioner reviews the menstrual chart and symptoms with the patient and, if endometriosis is suspected, will refer the patient for further evaluation to the gynecologist
- Family Physician (General Practitioner) – deals with prevention, discovery, and treatment of illnesses in all age categories. The doctor may prescribe hormonal therapy or advise nonsteroidal anti-inflammatory drugs (NSAID) initially to further strengthen the diagnosis of endometriosis, while providing some relief of symptoms.
- Infertility Physician – also known as a reproductive endocrinologist, maintains health and treats reproductive disorders for women
How to Prepare for Your Endometriosis Doctor Visit
Having made an appointment with a healthcare provider, there are certain actions that you need to take in order to maximize the benefit of your endometriosis doctor visit. Read more in this Endometriosis Patient Education.
Compile a list of:
- Family history
- Significant past medical history
- Past contraceptive history and any side effects experienced
- Allergies
- Any lab results in possession from the last year
- Record of pain and when it occurred
- Menstrual record
Also, be sure to wear comfortable clothing that can easily be changed.
If a sonogram is planned, you may be advised to have a full bladder which means drinking 4-5 glasses of water and not urinating prior to the test.
Questions to Ask Your Doctor about Endometriosis
From your initial diagnosis throughout your treatment and care, you will have questions about your condition. Highlighted below in this Endometriosis Patient Education is a list of questions to discuss with the doctor so you can make informed decisions about your condition and care.
Questions About My Diagnosis
- Can this diagnosis be confused with other conditions?
- Is endometriosis associated with other medical conditions?
- Can this resolve on its own?
- Can this cause infertility?
- Is this condition permanent?
- Is this condition associated with cancer of my pelvic organs?
- What tests would confirm this diagnosis?
Questions About My Treatment
- Is there medication that can cure my condition?
- Are there drugs for pain that will enable me to function?
- Should I look into starting infertility treatments right away?
- Are there natural herbs or supplements that treat this?
- Would birth control pills affect endometriosis?
- If I have surgery, would the problem reoccur?
- What can I do to alleviate the symptoms?
Questions About My Lifestyle and Family
- Does this run in families?
- Can I work and drive during treatments for my symptoms?
- Is there an exercise program that can help my symptoms?
- Are there positions during sex that would be more comfortable for me?
- Is there a support group that I can go to?
- Is there a local group that my family can get information from?
Common Tests or Labs to Diagnose Endometriosis
The initial test for endometriosis consists of a simple physical examination and frank discussion with your physician.
At the time of the rectovaginal examination (where the examiner has one finger in the vagina and one in the rectum), the physician can palpate nodules or hard lumps (endometrial implants) along the ligaments that suspend the organs to the pelvic side walls and behind the uterus. The examination itself may induce pain or pelvic/abdominal discomfort.
Occasionally bluish-purple spots or deposits (endometrial implants) are visualized on the exterior of the cervix upon visual examination with the speculum inside the vagina.
Further testing will confirm the suspected diagnosis. Read more in this Endometriosis Patient Education guide.
| Test |
Why Test |
What Happens |
Normal Result |
| Pelvic Ultrasound (sonogram) |
Enables visualization of growths or tumors of the uterus, ovaries, and Fallopian tubes |
After lying down on the table, the technician places clear water-based gel on your tummy and pelvic area. A hand-held probe is then moved back and forth over the area, transmitting sound waves. The echoes of these waves create an image on a computer monitor.
Sometimes a transvaginal ultrasound is performed. Here, you lie on the exam table with knees bent and feet in stirrups. A covered probe is lubricated and placed in the vagina. The probe emits sound waves and the echoes create an image on a computer monitor.
|
No tumors or cysts of uterus, tubes, or ovaries |
| Laparoscopy |
Visualizes any abnormalities in the pelvis including strictures, masses, adhesions, implants, cysts, and fibroids |
After lying down on the operating table, anesthesia is administered (usually general/gas).
An incision is made just under the umbilicus (belly button) and a blunt ended needle is inserted to inflate the abdomen with gas under monitoring.
A lighted tube is then inserted through this incision with an attachment to a monitor screen for visualization.
Another lower incision is made through which instruments are placed to manipulate organs and tissue. If implants are seen, biopsies can be taken with these instruments.
The tube and instrument are then withdrawn along with the air and the incisions are sutured closed with small tape bandages applied.
|
No abnormal masses, cysts, strictures, adhesions, or implants are visualized.
|
Common Medications and Treatments to Treat Endometriosis
| Drug/Treatment |
How it works |
| Hormonal contraception (birth control pills, transdermal patches, vaginal ring) |
Manages the hormones that stimulate the endometrial implants to grow, helping them to shrink down and decrease or eliminate the pain of mild to moderate endometriosis |
| Medroxyprogesterone injection |
Decreases or stops menstruation, thereby shrinking implants and reducing symptoms (Side effect: can cause weight gain and depression) |
| Gonadotropin-releasing hormone (Gn-RH) agonists and antagonists |
Medications block production of hormones that stimulate the ovaries, inhibiting menses and decreasing estrogen levels which shrink the endometrial implants; Remission may last years after treatment (Side effects: menopausal symptoms may occur such as hot flashes, mood swings, vaginal dryness, decreased sex drive) |
| Laparoscopy |
Finds and removes implants, adhesions, and cysts, or destroys implants with lasers |
| Hysterectomy |
Uterus, cervix, and ovaries are removed in severe cases when pregnancy is no longer desired or a possible option |
| NSAIDS (nonsteroidal pain medication |
Gives symptomatic relief and decreases swelling (does not treat the implants, but improves daily functioning) |
| Warm baths/heating pad |
Decreases discomfort by relaxing pelvic muscles; Decreases cramps |
