The pain caused by endometriosis can be severe and worsen over time, yet many patients struggle to get a proper diagnosis. That means some women suffer from their endometriosis symptoms for years without treatment.
Endometriosis occurs when the lining of the uterus implants inside the abdomen. The lining is normally sloughed off with each menstrual period. However, in some patients, it flows backwards up the fallopian tubes and into the abdomen, implanting and growing there. Complications can include infertility, inflammation and increased depression and anxiety.
Endometriosis effects about 5-10% of women. Hugh Taylor, MD, Chief of Obstetrics and Gynecology at Yale New Haven Hospital and Chair, Department of Obstetrics Gynecology and Reproductive Sciences at Yale School of Medicine, said that number could be higher because patients tend to have their symptoms ignored.
“We all accept menstrual cramps as normal,” Dr. Taylor said. “So almost uniformly when someone first complains about painful menstrual cramps, it’s dismissed. Their friends, their family, their doctors say, ‘Oh, just take a Motrin, toughen up.’ We need to be better at recognizing endometriosis.”
Symptoms of endometriosis
In addition to painful periods and cramps, common symptoms associated with endometriosis include:
- Pain with urination
- Pain with bowel movements
- Pain with intercourse
- Fatigue
- Anxiety
- Depression
- Metabolic changes
Any pain that is cyclical occurring during that time of the month could be a red flag.
“I can’t tell you the number of times I see patients who have what I consider clear cut endometriosis, but they’ve seen a gastroenterologist for some diarrhea or cramping of the colon, and they get a colonoscopy and there’s nothing there,” Dr. Taylor said. When symptoms occur only with menses, one should consider endometriosis first.
Diagnosis for endometriosis
Endometriosis is not visible on ultrasounds or MRIs, so the most common tool for diagnosis is laparoscopic surgery. Dr. Taylor says he believes that approach is antiquated, resulting in a terrible delay in care. With a growing awareness of endometriosis, he is hopeful more clinicians will be able to recognize symptoms sooner to start treatments before resorting to surgery.
Treating endometriosis
Since endometriosis is a hormonally driven disease, the most common first line treatment is birth control pills. Other medications can be helpful for patients who do not respond well to hormonal birth control.
GnRH antagonists are oral medications that reduce estrogen levels, which is what drives the endometriosis. These medications are available in low doses and do not have the same harsh side effects associated with older injectable medications. Androgens, associated with male hormones, can be helpful in some patients but side effects can include acne and facial hair.
Surgery is also an option for some patients including those who do not respond well to medication or those who are trying to become pregnant. Those who do not wish to expand their family may opt for a hysterectomy, although that is usually the last option to be considered.
The good news is with treatment, patients can experience relief.
“The key is to be aware,” Dr. Taylor said. “If your symptoms are getting worse, see a physician who understands that and is willing to consider the diagnosis of endometriosis.”
