An estimated one out of every 10 women suffer from endometriosis in the United States. UC Davis Health clinic medical director of Obstetrics and Gynecology Clara Paik answered some frequently asked questions about endometriosis.
What is endometriosis?
Paik: Endometriosis is when the tissue that makes up the uterine lining, which sheds every month during menstruation, implants and grows outside a women’s uterus. In many cases, endometriosis is believed to be caused by retrograde menstruation, which is when menstrual blood and tissue flows back through the fallopian tubes and into the pelvic cavity instead of exiting the body.
How do I know if I have endometriosis?
Paik: First, I should say that many women with endometriosis have some of the following symptoms, but not all. Oftentimes, women will experience painful menstrual periods -- some who say they've always had this pain during menstruation. These are women we think of as possibly having endometriosis. However, it’s difficult to distinguish endometriosis with garden variety period cramps or dysmenorrhea.
What are the treatment options for endometriosis?
Paik: Treatment options often start with nonsteroidal, anti-inflammatory drugs, like Ibuprofen or Motrin. Physicians sometimes prescribe birth control pills or other contraceptive-type methods with the thought being that if you get rid of a woman’s period, you can possibly get rid of her pain. However, women with endometriosis may not respond to these initial therapies. From there, we move to higher-level medications or even surgery.
What medications can be prescribed?
Paik: The medications we typically think about for treating endometriosis are those that cause the ovaries to stop producing hormones because, just like endometrial lining tissue, endometriosis is stimulated by a hormone called estrogen. The idea is that if we give an injectable medication called Lupron, we can prevent ovaries from producing estrogen. This will then allow the body to take care of the implants. What I tell my patients is that their bodies are going to sweep up the endometriosis and clear it away. That’s the idea of Lupron therapy. With surgery, you can excise or burn those lesions as well.
Once endometriosis is cleared away, can it return?
Paik: With endometriosis, it’s really a long-term thing. If a woman has Lupron therapy for six months or a year or she has surgery, the likelihood of the endometriosis returning is high if she is back to her monthly menstrual periods. In general, after endometriosis is treated with surgery or medical therapy, we try to suppress women from having menstrual periods -- either with continuous birth control pills or progestin IUDs, like the Mirena or Liletta IUDs. Even with that, the pain will sometimes come back.
Can women have endometriosis after menopause?
Paik: Endometriosis is stimulated by the hormone estrogen. In menopause, endometriosis is rarely a problem because the ovaries have stopped stimulating or producing estrogen. Women with endometriosis will be able to clear their endometriosis implants after menopause. Alternatively, women who suffer a great deal from endometriosis and are done with child bearing may choose to have a hysterectomy and remove their ovaries. This causes women to stop producing the hormones that are stimulating endometriosis.
Is infertility linked to endometriosis?
Paik: Infertility is not always a side effect of endometriosis. Women can have endometriosis and not have infertility. You won’t know if you have fertility problems unless you try to get pregnant and are unsuccessful over a 12-month period -- that’s the definition of infertility. If a woman is older in her advanced maternal age, we don’t want to waste too much time; so sometimes we lessen that to six months in trying to diagnose infertility. However, not everyone with endometriosis will have fertility problems. In fact, most women with endometriosis are going to be able to get pregnant.
Is it difficult to get pregnant if you’re being treated for endometriosis?
Paik: With endometriosis, it is kind of like a fork in the road. You do have to choose between treating endometriosis, or the pain, with oral contraceptives or Lupon therapy or getting pregnant. The good thing about either pathway is that the pain could get better because you are not menstruating when you are pregnant.