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Endometriosis – Overview

January 30, 2021


“Endometriosis is a particularly challenging condition for women and gynecologists. So endometriosis usually results from the endometrial lining, which is the part of the uterus that bleeds, having little implants outside of the uterus and in other areas of the pelvis. So it can occur on the outside of the uterus, on the fallopian tubes, on the bladder, the rectum, or anywhere inside the pelvis. And if this lining or endometrium is outside of where it should be, it can still cycle and it can still cause inflammation and bleeding in all of the other areas where it is seated. And so endometriosis is often a cause of pelvic pain. Now, what we know is that people can have endometriosis detected on surgery and never have any symptoms or people can have endometriosis that is very, very severe. And when surgery is done to look inside, we really don’t see much at all.

And so the extent or severity of the symptoms of endometriosis often don’t coincide with what we actually see. And that means that surgery is not necessarily the best way to go with endometriosis. In fact, it’s not required to have surgery in order to have a diagnosis or a treatment. So endometriosis is a cycling of those endometriosis implants around the time of a menstrual cycle. So the symptoms of endometriosis would be cyclic pelvic pain, and that pain usually starts just before a period would be expected and it can usually stop after the period starts. So sometime during the cycle, the pelvic pain of endometriosis usually goes away. And then there’s a period of calm through the month when there is no cycling of the endometriosis. And because it’s a cycling symptomatology, the treatment is to suppress the ovaries or to suppress that cycling.

And so treatment would include anything that creates ovarian suppression or suppresses menstrual cycles, things like a birth control pill, things like a depo provera injection, or even an intrauterine contraceptive device that carries a little bit of progesterone that helps to basically stop the ovaries from doing that monthly cycle and therefore stop the implants from creating that monthly cyclic pelvic pain from the endometriosis. Some of the complications of endometriosis can be that the implants, when they’re outside the uterus, they can actually lead to scarring. And so some people with endometriosis have scarring of the fallopian tubes. They may have a change in the environment in the pelvis, and both of those things can actually make pregnancy more difficult in some people who have endometriosis. So endometriosis is thought to be one of the potential causes of infertility in some women.”

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