Endometriosis: What it is and how it can best be treated

This content is sponsored by MedStar Washington Hospital Center

Endometriosis affects an estimated 200 million women worldwide and 1 out of 10 women in the United States, according to the Endometriosis Foundation of America.

Even though there are so many cases, many women go undiagnosed.

Endometriosis occurs when the endometrium — the mucous membrane lining the inside of the uterus – grows instead on surfaces outside the uterus such as the intestines and bladder. There are several symptoms and pain associated with endometriosis, said Dr. Vadim V. Morozov, a minimally invasive gynecologic surgeon with MedStar Washington Hospital Center.

Endometriosis can only be diagnosed with certainty through a laparoscopic procedure, although many women can determine that they have it based on their symptoms and a physical examination, Dr. Morozov said.

“To be 100 percent sure, usually we have to look and see the lesions of endometriosis and even better to biopsy those lesions and send them to pathology to tell us ‘yes it is exactly endometriosis,’” he said.

It is not entirely clear why some women get endometriosis and others do not, Dr. Morozov said. However, genetics can play a role.

The most common symptoms connected with endometriosis include very difficult menstrual periods, pain with intercourse, pain when going to the bathroom and cramping, said Dr. Morozov. He adds that while pain is a common symptom, pain perception is individualized.

“It depends on the patient, her perception of pain, support structure that she has and goals in life,” he said.

Fortunately, treatment is available to reduce the symptoms.

Endometriosis is very unlikely to go away on its own, however some treatments can radically reduce symptoms for many patients. Medication such as non-steroidal anti-inflammatories or birth control can reduce pelvic inflammation and control hormonal fluctuations.

Still, most people don’t handle medications well and opt for a minimally invasive surgery, Dr. Morozov said. This procedure is performed through incisions in the belly that are less than an inch in length. Often the patient can get diagnosed with endometriosis and have the lesion removed at the same time, he added.

“Endometriosis, to a certain extent, is almost like cancer — obviously it doesn’t kill you, but tends to spread through the abdomen and the pelvis in a similar way,” Dr. Morozov said, adding that they both become involved and invade bowels and bladder and other structures and organs in the pelvis.

“If you leave severe endometriosis untreated, you’re at risk of developing complications related to it,” Dr. Morozov said.

It’s important for women who experience endometriosis symptoms to see a doctor as soon as they come up, Dr. Morozov said. That’s so doctors can work to control it before it can spread to other organs. Also, pelvic inflammation caused by endometriosis could be associated with a higher likelihood of endometrioid-type ovarian cancer, according to a recent study.

“Very often by the time we see women, the disease is severe enough that it’s near impossible to make them completely pain free. And I try to have a very honest discussion with my patients in anticipation of whatever treatment options we choose. Saying ‘the goal … is not to make you 100 percent pain free. The goal of everything we do is to bring you to the point where you can function normally every day,’” Dr. Morozov said.

Women who get diagnosed with endometriosis should keep a few things in mind, Dr. Morozov said. He suggests women ask themselves about the long-term prognosis – is this a mild case or does it involve the spread to several organs? Also, patients should ask next if this diagnosis will impact their chances of getting pregnant and see if they need to consult a fertility specialist. Finally, women should question what it means when they’re done with childbearing, and what are the options for definitive surgical management of the condition?

There are several advancements with endometriosis treatment that could pave the way for better outcomes with future patients. One is the development of biological markers for the disease, which would allow doctors to diagnose it by drawing patients’ blood or doing a saliva test. Another involves the development of better laparoscopic tools for surgery.

MedStar Washington Hospital Center is one of the largest and best-equipped groups in the region when it comes to taking care of women with endometriosis, Dr. Morozov said.

“We have multiple fellowship-trained specialists who deal exclusively with endometriosis and pelvic pain,” he said. “Our group at the National Center for Pelvic Surgery has multiple urogynecologists and specially-trained female urologists that deal with the conditions of pelvic pain and other reproductive disorders.”

For more insights from Dr. Morozov, including his podcast on identifying and treating endometriosis, click here.

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