Maiden Lane Medical

ENDOMETRIOSIS SPECIALISTS

Q: HOW IS ENDOMETRIOSIS PAIN TREATED?

Since endometriosis can sometimes be difficult to diagnose, the initial consultation will help your gynecologist know how to proceed most effectively. Although an ultrasound won’t give your gynecologist a sure diagnosis, it’s very useful to identify cysts that can be associated with endometriosis. Various over-the-counter medications might be used to help ease painful symptoms while further testing is being carried out. Hormone therapy, although not a cure, has been known to reduce or even eliminate the pain associated with endometriosis. Depending on the extent of the endometriosis, various surgeries are available, from laparoscopic surgery for “conservative surgery,” to hysterectomy and oophorectomy when needed

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What is endometriosis?

A disease that occurs when the cells that line the uterus (endometrium) grow outside of the uterus. In addition to causing painful symptoms, endometriosis also increases your risk of infertility. Around 10% of women of reproductive age live with endometriosis. Up to 85% of women with chronic pelvic pain have endometriosis.

Endometrium

Endometrium forms to line your uterus with every menstrual cycle. It grows on organs and tissue outside of your uterus if you have endometriosis.

Irregular Periods

Endometriosis can make your periods irregular. You may not have a regular 28 day cycle and your period may be heavy and painful.

Bowel Problems

Endometriosis can develop on or near your bowel causing inflammation, pain, and abnormal bowel movements.

Pelvic Pain

Endometriosis and subsequent scarring causes pelvic pain and can lead to pain during sex.

Fertility Problems

Endometriosis can cause a decreased ability to become pregnant.

Woman sitting on bed with laptop researching endometriosis

What are the symptoms of endometriosis?

The most common symptoms of endometriosis are painful periods, painful intercourse, and infertility. However, there are many conditions associated with endometriosis. These include:

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These problems have many potential causes and having one of them does not mean that you have endometriosis. These conditions are comorbidities — issues that exist with another condition. You should talk to your doctor about these symptoms for an accurate diagnosis and treatment.

Migraine headaches
Chronic fatigue syndrome
Irritable bowel syndrome
Fibromyalgia
Pelvic floor muscle spasm
Interstitial cystitis
Depression
Central pain syndrome

What are the symptoms of endometriosis?

The most common symptoms of endometriosis are painful periods, painful intercourse, and infertility. However, there are many conditions associated with endometriosis.

Migraine headaches
Chronic fatigue syndrome
Irritable bowel syndrome
Fibromyalgia
Pelvic floor muscle spasm
Interstitial cystitis
Depression
Central pain syndrome

What causes endometriosis?

While the exact cause of endometriosis is still under debate, doctors and medical researchers have identified several contributing factors, including:

Immunologic dysfunction
Alterations in inflammatory processes
Various genetic factors

African American woman clutching stomach in pain from endometriosis

Illustration showing endometriosis within the female anatomy

These factors lead to the identifying characteristics of endometriosis including:

SCARRING
INFLAMMATION
INVASION ACROSS TISSUE PLANES

Many of the theories about endometriosis have been proven false. For example, almost all women have endometrial cells enter the pelvis during menstruation – this is called retrograde menstruation. Because it happens so frequently and relatively few women have endometriosis, there must be factors at work other than retrograde menstruation.

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Why does endometriosis cause pain?

Endometriosis causes a significant amount of inflammation that can result in scarring and nerve damage. The scarring and nerve damage stimulates your spinal cord and ultimately sends continuous pain signals to your brain. When pain signals are long-term and severe, phenomena such as spinal wind-up and neuroplasticity occur, leading to difficult-to-treat chronic pain.

Interestingly, a woman can have mild or severe endometriosis and not have any pelvic pain. So, there must be other factors at work in regulating how much pain a woman experiences from endometriosis.

In general, multiple factors make up your pain threshold — the amount of pain it takes before you actually feel pain. These factors are: genetic, experiential, psychological.

How is endometriosis pain treated?

Initial consultation

Since endometriosis can sometimes be difficult to diagnose and manage, the initial consultation will help our endometriosis experts know how to proceed most effectively using a multidisciplinary and comprehensive treatment approach.

Ultrasound

Although an ultrasound won’t give your gynecologist a sure diagnosis, it’s very useful to identify cysts that can be associated with endometriosis.

Medication

Various over-the-counter medications might be used to help ease painful symptoms while further testing is being carried out. Hormone therapy, although not a cure, has been known to reduce or even eliminate the pain associated with endometriosis. However, when hormonal therapy is stopped the pain returns 100% of the time.

Surgery

Unless you have completed your reproductive plans, our surgeries focus on sparing fertility and removing, from the root, 100% of the endometriosis and scar tissue. We use robotic and laparoscopic techniques.

Here at Maiden Lane Medical, we focus on resolving the issue causing your pain. While you can take pain medication or oral contraceptives to ease your pain and other symptoms, we use minimally invasive laparoscopic procedures to remove the endometrial tissue.

Can I have a radical resection and keep my reproductive organs?

Absolutely! The goal is to work within your reproductive needs. This procedure is a safe and effective method for minimizing or eliminating endometriosis-related pain while maintaining fertility. We have performed thousands of radical endometriosis resection surgeries even in women with the most severe frozen pelvis while retaining and improving reproductive potential.

To both treat the pain and maximize future health outcomes, it is best to optimize the production of natural hormones. Your endometriosis excision expert leaves your ovaries intact to maintain hormone production without decreasing the effectiveness of the procedure. Remember, the purpose of a radical resection is maximally removing endometriosis, not the healthy tissue affected by endometriosis.

Does leaving my ovaries inside lead to more endometriosis?

Multiple studies have shown that there is no difference in pain outcomes when leaving the ovaries in versus removing them. Thus, we leave them in because there are so many benefits to having your own natural estrogen production. The doctors at Maiden Lane Medical understand the basic science of endometriosis and the underlying biochemistry. We know that endometriosis cells produce their own estrogen and are not dependent on your ovaries to grow.