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Endometriosis: Symptoms, Causes, and Treatments

What is endometriosis?

Endometriosis is a chronic disease in which endometrial-like tissue is found outside of the uterus. This tissue, which normally lines the uterine cavity, is associated with monthly menstruation and is often characterized by abnormally painful and heavy periods, as well as pelvic pain, severe cramps, and pain with sex (dyspareunia). The lesions are estrogen-dependent, benign, inflammatory, stem-cell driven, and at times progressive.

Endometriosis affects an estimated 176 million women worldwide. A leading cause of infertility and chronic pelvic pain, it has also been linked to other health concerns, including certain autoimmune diseases and cancers, fibroids, adenomyosis, and interstitial cystitis. It is one of the leading reasons for laparoscopic surgery and hysterectomy in the United States. The economic impact of endometriosis is staggering. Businesses lose billions of dollars each year in compromised productivity and absenteeism because of the disease.

Where does occur?

Endometriosis typically develops on the pelvic structures including the ovaries, fallopian tubes, bladder, and bowels (intestines).

It is also common for endometriosis to develop on the top of the vagina (anterior cul-de-sac) and in the peritoneal cavity between the rectum and the posterior wall of the uterus (posterior cul-de-sac).

In rare cases, endometriosis can spread to the diaphragm, lungs, kidney, appendix, and, surprisingly, the gastrocnemius (calf muscles).

Stages of endometriosis

The American Society of Reproductive Medicine classifies endometriosis according to severity.

StagesAmerican Society of Reproductive Medicine Severity Classifications
Stage IMinimal
Stage IIMild
Stage IIIModerate
Stage IVSevere

Classifications

Because the four stages of endometriosis do not necessarily have any correlation to a patient’s symptoms or the nature of the infiltration itself, we often use a more descriptive system:

Dr.Seckin’s Preferred ClassificationDescription
Early peritoneal
  • Infiltration of the lining of the abdomen (peritoneum)
Ovarian endometriomas
  • Large, fluid-filled “chocolate” cysts that form on, and even encapsulate, the ovaries
Cul-de-sac obliteration
  • Infiltration of the tissue lining the back wall of the uterus and rectum (posterior cul-de-sac), an extension of the peritoneum
Deep infiltrating endometriosis (DIE)
  • Invasive endo that penetrates to the bladder and bowel wall
Frozen pelvis
  • In this rare condition, deep infiltrative lesions attach to pelvic ligaments, nerves, and muscle tissue. As a result, pelvic organs can be partially or entirely cemented

Causes of endometriosis

The exact cause of endometriosis is not known. However, several plausible theories exist, including retrograde menstruation, Meyer’s theory, and more. We remain open to newly developing ideas.

Risk factors

While the following risk factors increase a woman’s risk of developing endometriosis, there are many cases in which women are diagnosed without any of the following:

  • family history of the disease, especially in the mother or sister
  • age (between 25 and 40)
  • history of menstrual complications (i.e. long menstrual cycles, frequent periods)
  • not having children
  • high consumption of fats and red meat
  • heavy alcohol intake
retrograde menstruation
A high rate of retrograde menstruation is a popular theory in justifying the cause of the disease [2]. Endometrial cells are carried through the refluxed menstrual debris, which travels through the fallopian tubes

How does endometriosis affect pregnancy and fertility?

Endometriosis is likely responsible for one-third of infertility cases. The longer a woman has endometriosis, the more risk she has of infertility. However, up to 70% of women with mild to moderate endometriosis are still capable of conceiving

Adhesions on or near the ovaries, uterus, and fallopian tubes impede the transfer of the egg to the fallopian tube and may cause infertility. Moreover, ovarian implants may prevent the release of an egg and cause infertility. Finally, endometriosis can lead to a decrease in the number and quality of healthy eggs.

What is adenomyosis and how is it different from endometriosis?

Adenomyosis is endometriosis strictly within the uterine muscle. However, 50% of adenomyosis patients also have endometriosis

Part of the reason why endometriosis is such a complex and dangerous condition is that it can lead to several other related conditions, including:

  • adenomyosis
  • adhesions
  • ovarian cysts
  • chronic pelvic pain
  • infertility

What can it be misdiagnosed as?

Endometriosis can mask itself as a number of conditions. It is often misdiagnosed and mistaken for the following conditions:

Symptoms of endometriosis

What are the signs and symptoms that should concern me of endometriosis?

Endometriosis can cause the following symptoms.

  • painful menstrual cramps (dysmenorrhea or “killer cramps”)
  • heavy menstrual bleeding (menorrhagia)
  • chronic pelvic pain
  • pain with intercourse (dyspareunia)
  • abdominal pain and bowel dysfunction including painful bowel movements, diarrhea, bloating, gas, or cramps
  • bladder dysfunction, such as painful urination
  • weakness, numbness, or pain in the nerves (neuropathy)
  • fatigue
  • infertility
  • personality changes (depression, stress, apathy)

Diagnosis of endometriosis

What is the first step towards diagnosing?

Before pursuing imaging, you should speak with a GYN physician who is familiar with diagnosing endometriosis and can provide a comprehensive pelvic exam. A physical exam and a discussion about your symptoms and medical history will help a physician determine if imaging tests are necessary.

What imaging tests are available?

In order to properly diagnose a patient with endometriosis and determine whether surgery is necessary, one or both of the following imaging tests must be conducted:

  • ultrasound/sonogram
  • MRI

What procedures and tests help definitively diagnose endometriosis?

In an operating room, a well-trained and experienced GYN surgeon will be able to visualize any anatomical abnormalities or endometriosis lesions through the following procedures:

While a physical exam and other imaging tests can give insight into whether or not a patient may have endometriosis, the only way to definitively diagnose endometriosis is through laparoscopic excision surgery. This must be accompanied by a biopsy sample that is sent to a pathology lab in order to confirm a diagnosis of the disease.

Treatment of endometriosis

There is currently no cure for endometriosis. However, there are surgical and non-surgical treatment options for pain and infertility caused by the disease.

Non-surgical methods to relieve symptoms

It is important to note that the following methods are not treatments for the disease, but rather may help control a patient’s pain and symptoms.

The Relationship Between Endometriosis, Inflammation and Diet

Surgical procedures

There are a variety of surgical treatments that a patient can undergo to treat endometriosis depending on the severity, stage, and quantity of the lesions.

TechniqueDescription
Laparoscopic Deep Excision SurgeryThe “gold standard” for removing all endometriosis in the body, ranging from lesions on the ovaries to the intestine
MyomectomyRemoval of fibroids, necessary only when fibroids develop
HysterectomyRemoval of the uterus, which is only needed in cases of diffuse endometrioma tissue in the uterus such as with adenomyosis

Our approach

Endometriosis is not an easy condition to diagnose. Our practice provides a number of advantages.

  • over 20 years of experience identifying, diagnosing, and treating endometriosis
  • over 20 years of experience in laparoscopic deep excision surgery
  • strong preference for laparoscopic deep excision surgery
  • strong preference for excision surgery over robotics or laser ablation
  • only performing hysterectomies or oophorectomy as last resorts
  • patented technologies, including the Aqua Blue Contrast technique (ABC)
  • high-quality surgical imaging

Your health and wellbeing come first for us. With decades of experience, we know that this is the most important aspect of treating the disease. Every patient is different and therefore every patient’s unique story and symptoms must be heard.

Patient story

Living with constant pain and suffering from endometriosis

Menoka M. was experiencing severe pelvic pain for the past seven years and did not receive a diagnosis for nearly five years. After seeing many doctors and having several surgeries, Menoka found us and was soon scheduled for laparoscopic deep excision surgery. Read about Menoka’s journey here, as well as how she is doing now.

You can read more stories of patients with endometriosis in our testimonial section.

Ready for a Consultation?

Our endometriosis specialists are dedicated to providing patients with expert care. Whether you have been diagnosed or are looking to find a doctor, they are ready to help.

Our office is located on 872 Fifth Avenue New York, NY 10065.
You may call us at (212) 988-1444 or have your case reviewed by clicking here.

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Disclaimer: The information offered on the website is intended to educate users on health care and medical issues related to endometriosis. Any information presented should not be considered or used as a substitute for, medical advice, diagnosis, or treatment. You should always talk to your health care provider for specific questions regarding personal health or medical conditions.

© 2021 Seckin Endometriosis Center