Endometriosis is the abnormal growth of tissue normally present only in the lining of the uterus, outside of its normal location. It can be present in between the walls of the uterus, on any of the pelvic organs such as the rectum, ovaries, bladder, or on bowel or the abdominal or pelvic wall. Symptoms can occur as a result, typically because this normal endometrial tissue fluctuates in size and character with hormonal variations normal in the female patient.
Other possible causes of endometriosis are issues linked to the immune system, metaplasia, and endometrial cells that form before birth. Scientists believe the condition may affect more than 11% of American women between the ages of 15 and 44.
Endometriosis is common, and commonly diagnosed, in women in their 30s and 40s. The condition may make it harder to get pregnant, and treating the condition can improve your chances of getting pregnant.
Symptoms of Endometriosis
- Painful periods (dysmenorrhea): Pelvic pain and cramping may begin before and extend several days into a menstrual period. You may also have lower back and abdominal pain. • Pain with intercourse. Pain during or after sex is common with endometriosis.
- Pain with bowel movements or urination: You’re most likely to experience these symptoms during a menstrual period.
- Excessive bleeding: You may experience occasional heavy menstrual periods or bleeding between periods (intermenstrual bleeding).
- Infertility: Sometimes, endometriosis is first diagnosed in those seeking treatment for infertility.
- Other signs and symptoms: You may experience fatigue, diarrhea, constipation, bloating or nausea, especially during menstrual periods
The severity of your pain isn’t necessarily a reliable indicator of the extent of the condition. You could have mild endometriosis with severe pain, or you could have advanced endometriosis with little or no pain, depending on the location of the abnormal tissue.
Endometriosis is sometimes mistaken for other conditions that can cause pelvic pain, such as pelvic inflammatory disease (PID) or ovarian cysts. It may be confused with irritable bowel syndrome (IBS), a condition that causes bouts of diarrhea, constipation and abdominal cramping. IBS can accompany endometriosis, which can complicate the diagnosis.
We treat a variety of pelvic conditions at NYC Surgical Associates, and are therefore well experienced with excluding other causes of pelvic pain that may present with the same sort of symptoms endometriosis does.
Complications of Endometriosis
One of the main complications of endometriosis is impaired fertility. Approximately one-third to one-half of women with endometriosis have difficulty getting pregnant.
For pregnancy to occur, an egg must be released from an ovary, travel through the neighboring fallopian tube, become fertilized by a sperm cell and attach itself to the uterine wall to begin development. Endometriosis may obstruct the tube and keep the egg and sperm from uniting. But the condition also seems to affect fertility in less-direct ways, such as by damaging the sperm or egg.
Even so, many with mild to moderate endometriosis can still conceive and carry a pregnancy to term. Doctors sometimes advise those with endometriosis not to delay having children because the condition may worsen with time
Higher Risk of Gynecologic Cancers
Ovarian cancer does occur at higher than expected rates in those with endometriosis. But the overall lifetime risk of ovarian cancer is low to begin with. Some studies suggest that endometriosis increases that risk, but it’s still quite low, and should not cause a major concern immediately to the patient diagnosed with this problem. Although rare, another type of cancer – endometriosis-associated adenocarcinoma – can develop later in life in those who have had endometriosis.
Other Conditions With the Same Symptoms
The most common condition that presents with almost identical symptoms is pelvic congestion syndrome, although cysts, fibroids, pelvic floor issues, and interstitial cystitis can also be common issues that would present in a similar fashion.
NYC Surgical Associates will help you get to the bottom of your issue, with a detailed review of your medical history, a comprehensive physical exam, and imaging if needed. Common tests for endometriosis are:
- Pelvic exam
- Magnetic resonance imaging (MRI)
Endometriosis Treatment Options
The primary treatment options for endometriosis consist of two main categories: medical management and surgical management. However, with most diseases, including this one, there is an emerging treatment arm which is less invasive than traditional surgery, called “interventional” treatment.
While interventional treatment is less invasive than traditional surgical options, it can be very effective for appropriately selected patients, and is geared towards patients looking to either avoid traditional surgery, or in patients where traditional surgery has failed.
Endometriosis Surgery: Our Approach
If we have ruled out all other causes of pelvic pain, and are fairly sure that endometriosis is indeed the likely culprit, we start with interventional procedures first, as surgery tends to be rather involved, and higher risk in many patients. Typically, interventional treatments carry with them lower risk because of the lower level of invasiveness. At NYCSA, our preferred management is to start with laparoscopic transabdominal sclerotherapy.
To prevent damage to the ovaries and other organs, as well as other complications a more conservative approach to the management of endometriosis and endometriomas specifically is ideal in many cases.
Sclerotherapy provides such a conservative solution. Endometriomas typically are filled with a bloody fluid and can be aspirated utilizing a needle passed through the abdominal wall under direct visualization with a small camera typically inserted into the bellybutton.
This is a relatively simple, minimally invasive technique. The patient is anesthetized while the procedure is done, typically in less than 1 hour. The problem with aspiration alone is that endometriomas tend to reform if the cyst wall is not removed. For this reason, after aspiration, while the needle is still in place, a sclerosing agent (agent that damages the cyst lining to prevent recurrence) is used to flush the cyst, most commonly ethanol. This agent disrupts the lining of the cyst to minimize recurrence. The ethanol is withdrawn after injection, and the patent is left with an empty cyst, which typically is absorbed by the body in a few weeks.
The patient recovers in the office after the procedure for a short duration prior to leaving, and typically downtime and post-operative pain are minimal.
It is important to keep in mind that surgery is not necessary if you are diagnosed with endometriosis. The condition is not life-threatening, and the decision should not be a rushed one, nor one made without all appropriate information.
Risks of Interventional Management
In general, quite low. There are risks associated with any sort of medical procedures, such as infection, bleeding, and damage to adjacent structures, but we can tell you with confidence, in our hands these risks are very low, but must be discussed.
Typically, the risks are much lower than traditional surgical procedures, and having an interventional procedure does not disqualify you from undergoing surgery if the procedure is not completely successful, which is an important point to note.
Not all patients will be a candidate for interventional treatment and typically the information that enables us to make that decision may be provided by MRI, or diagnostic laparoscopy (looking into the abdomen with a small endoscope).
Risks of Non-Treatment
In general, not catastrophic. Some patients present to us with very advanced disease and the question on whether to operate or not is very simple as a result. Most often, however, the condition progresses slowly over the course of several years, and not dramatically. This is rarely a life threatening disease, and causes mostly morbidity and distress. That being the case, rushing into this decision probably isn’t the right move. The perceived benefit for any surgery, is usually very closely correlated to how much distress the condition caused the patient. What this means is, a patient with a worse problem would be more satisfied than the patient with a lesser problem by the surgery, even with a similar outcome. Pick surgery when the condition is causing you a significant amount of distress, and you feel confident in your choice and have considered other options
Endometriosis Treatment in New York & New Jersey
NYC Surgical Associates is committed to helping patients receive the best care possible. That journey always begins with a medical consultation.
To schedule your consultation with NYC Surgical Associates, please contact us or call 888.286.6600. Prior to booking our team will collect your insurance information to determine if our providers accept your specific insurance plan.
If we do not accept your medical insurance, we will inform you of any out of pocket costs associated with a endometriosis consultation and help you weigh your options. Either way, a doctor must see you before we can tell you what treatment for your condition will entail, from both a medical and cost standpoint.