Tame the Pain of Endometriosis
By Minda Green, MD, OB/GYN, Virtua OB/GYN — Cherry Hill
For some women, their period is simply a monthly inconvenience. But for those living with the pain of endometriosis, it’s a time they could definitely do without.
Endometriosis affects up to 10% of women of childbearing age, is a major cause of infertility and pelvic pain, and can be a challenge to manage.
Your treatment largely depends on your symptoms, age, and whether you plan to get pregnant in the near future.
Misplaced Uterine Tissue
Endometriosis occurs when tissue that lines the uterus, called the endometrium, grows and implants itself outside of the uterus in the abdomen and pelvis. The exact cause isn’t certain, but one possible explanation is retrograde menstruation, when blood containing endometrial cells flows back through the fallopian tubes and into the pelvic cavity.
The cells implant themselves on the pelvic walls and organs, such as the lining of the abdomen and pelvis (called the peritoneum), the outer surface of the uterus, the ovaries, intestines, rectum, and bladder, forming bands of fibrous tissue called adhesions.
The tissue reacts hormonally during the menstrual cycle, bleeding inside the pelvis, leading to inflammation, scarring, and pain.
Common symptoms include:
- Pain before and during your period
- Pain during or after sex
- Pain with bowel movements or urination, especially during your period
- Changes to your menstrual cycle
- Digestive problems like diarrhea or constipation
The amount of pain you have may not reflect the extent of your condition. You can have mild endometriosis and severe pain, or a more advanced case without any symptoms at all.
Beat the Discomfort
Diagnosing endometriosis typically begins with your response to medical therapy, such as nonsteroidal anti-inflammatory drugs and hormonal contraceptives to prevent ovulation and reduce menstrual flow.
Another option is a gonadotropin-releasing hormone (GnRH) antagonist, an injection that blocks the ovaries from producing estrogen and progesterone. The injection places the body in a sort of “medical menopause,” but should not be used for long periods because of the risk of bone loss.
The Virtua team was involved in a clinical trial several years ago for a newer pill, a GnRH antagonist that reduces estrogen production and can be used for longer periods of time in people who were not successful with other medical therapies.
If your symptoms persist or worsen despite medical therapy, minimally invasive laparoscopic and robotic-assisted surgery can remove the adhesions. This will relieve your symptoms and improve your fertility.
However, there also is a high chance of recurrence. Treatment may depend on your age. If you are in your 20s, you may require additional medical management and possibly surgery again down the road. If you are in your 40s, there is a shorter time to menopause, and additional surgery may not be needed.
If you have completed childbearing and have difficult-to-control (refractory) symptoms, hysterectomy can be considered as a last resort option as well.
Endometriosis may be mistaken for other conditions that cause pelvic pain. If you experience symptoms like pain during your menstrual cycle or during sex, contact your health care provider for an evaluation.
Get Relief from Pelvic Pain
Updated April 26, 2022