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If you suffer from heavy, painful periods, you may have endometriosis. Make an appointment with the trusted gynecologists and endometriosis excision specialists at Maiden Lane Medical in Midtown Manhattan.

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What is endometriosis?

Around 10% of women of reproductive age live with endometriosis — a disease that occurs when the cells that line the uterus grow outside of the uterus. In addition to causing painful symptoms, endometriosis also increases your risk of infertility.

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What are the signs of endometriosis?

Most commonly, endometriosis causes painful periods, painful intercourse, and infertility. You may also experience a frozen pelvis. However, other common signs of endometriosis include:

 

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

 

These problems have many potential causes and don’t mean that you have endometriosis. These symptoms are comorbidities — issues that exist with another condition. You should talk to your doctor about these symptoms for an accurate diagnosis and treatment.

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

These factors lead to identifying characteristics, 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?

Endometriosis can cause pain via multiple mechanisms. The endometriosis surgeons at Maiden Lane Medical truly understand both endometriosis and pain. They offer you a multi-pronged approach, including medical and surgical treatments that both relieve your pain and address issue causing it.

Medical treatments for endometriosis

Medical therapies that actually treat endometriosis really only exist in one class of drugs – the aromatase inhibitors. In medical trials, aromatase inhibitors decrease the anatomic volume of endometriosis. This is important because it is often that distortion of anatomy that leads to pain. 

Other medical therapies such as birth control pills, hormone releasing agonists, and progesterone suppress endometriosis pain by: 

  • Reducing inflammation
  • Decreasing local estrogen responsiveness
  • Acting on the estrogen receptors in the spinal cord (which partially explains why some of these therapies alleviate pain not associated with endometriosis).

So, in the long run, these treatments, which may produce significant side effects, suppress your pain symptoms without actually treating and eliminating the root cause – endometriosis.

Surgical treatments for endometriosis

The optimal surgical management for pain associated with endometriosis is radical resection of endometriosis. During this procedure, your endometriosis excision specialist removes the maximum amount of visible endometriosis regardless of its location. They extract endometrial tissue from the root and cut deeply underneath the disease until only healthy tissue is left behind.

The gynecologists and endometriosis excision experts at Maiden Lane Medical don’t usually offer endometrial ablation services. They find that ablation doesn’t remove all of the disease and increases your risk of additional damage by burning your pelvic tissue.

Our endometriosis surgeons also understand that endometriosis is a chronic disease and specializes in a multidisciplinary approach to chronic pelvic pain to avoid reoperation and optimize pain control by working with a pain management physician, physical therapists, urologists, and a nutritionist all within our practice.

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. Radical resection of endometriosis has been performed numerous times on many young women.

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.

 

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