Endometriosis affects more than 11% of American women in the United States between the ages of 15 and 44, according to the Office on Women’s Health. UC Davis Health Clinic Medical Director of Obstetrics and Gynecology Clara Paik answered some frequently asked questions about endometriosis.
What is endometriosis?
Endometriosis occurs when the tissue that makes up the uterine lining, which sheds every month during monthly menstruation, implants and grows outside of a woman’s uterus. We think in many cases, it’s caused by retrograde menstruation, which is when menstrual blood and tissue flows back through the fallopian tubes and into the pelvic cavity. Endometriosis can lead to chronic pelvic pain and infertility.
What are the symptoms of endometriosis?
Women typically will present with very painful menstrual periods. However, it can be difficult to distinguish endometriosis with painful period cramps also known as dysmenorrhea. Other symptoms may include pain with intercourse, pain with bowel movements and heavy periods.
What causes endometriosis?
We still do not know exactly what causes endometriosis or what factors exacerbate the disease. It could be due to a combination of environmental factors, dietary and nutritional factors, and genetics.
What are the treatment options?
If a young woman is presenting with painful periods, we often start with nonsteroidal anti-inflammatory drugs like Ibuprofen. We can also prescribe birth control pills or other contraceptives with the hope of improving painful period cramps or dysmenorrhea.
Women with endometriosis usually do not respond to these initial therapies. Then we must discuss laparoscopy and surgical removal of the endometriosis implants or move on to medications specifically designed for endometriosis.
Women who suffer a great deal from endometriosis and have tried multiple therapies and are done with childbearing may choose to have a hysterectomy and remove their ovaries.
What medications can be prescribed?
The medications we typically prescribe prevent the ovaries from producing estrogen because estrogen is the hormone that stimulates endometrial tissue. These medications are either GnRH agonists such as Lupron Depot, which is an injectable medication or GnRH antagonists such as Elagolix, which is a newer oral medication.
With endometriosis, we must consider long-term therapy. For example, if a woman has Lupron therapy for six months or a year or she has surgery, the likelihood of endometriosis recurrence is high if she resumes monthly menstrual periods after her therapy is completed. In general, after we treat endometriosis with surgery or medical therapy, we try to suppress a woman’s menstrual periods either with continuous hormonal contraception or progestin IUD.
Can you have endometriosis after menopause?
Endometriosis is stimulated by the hormone estrogen so in menopause, endometriosis is rarely a problem because the ovaries have stopped producing estrogen. Women with endometriosis are usually able to clear the endometriosis implants after menopause.
Is infertility linked to endometriosis?
Infertility is not always associated with endometriosis. A woman can have endometriosis and not necessarily have infertility. A woman may not know if she has fertility problems unless she tries to conceive and is unsuccessful in getting pregnant. The definition of infertility is inability to achieve pregnancy within six months to one year depending on the woman’s age.
Is it difficult to get pregnant if you are being treated for endometriosis?
If a woman is on medications for endometriosis, then she will not likely achieve pregnancy because ovulation is suppressed. If a woman wants to get pregnant, she might consider laparoscopy instead of medical therapy.
What do you see for the future of treating endometriosis?
Endometriosis is still poorly understood. Education and awareness of endometriosis is very important in order to diagnose this condition at an earlier age than it typically is currently. There are also newer medications in development for endometriosis. I think that in the future, women will be diagnosed earlier and that there will be many more options for treating this condition.