This post is written and sponsored by HCA Midwest Health.
Some think it’s too personal, embarrassing or just plain rude to talk about “that time of the month,” but it’s a fact of life and a natural function of the female body. So, let’s talk about menstruation.
As an urogynecologist, my job is talk about pelvic pain and help women identify and treat their pain. Urogynecology is a specialized field of gynecology and obstetrics that deals with female pelvic medicine and reconstructive surgery. Urogynecologists are doctors who diagnose and treat pelvic pain and pelvic floor conditions, such as weak bladder or pelvic organ prolapse.
I see many patients who are suffering from a debilitating condition called endometriosis. We all know periods can be painful. Couple that with endometriosis, which usually overlaps with your cycle, and it’s pure agony. Not to mention, the timeframe from the onset of your symptoms to an endometriosis diagnosis averages 10 years!
I want patients to know that their “bad” periods may be something more serious. Here are some common questions about endometriosis that can help you research treatment options.
What are the warning signs of endometriosis?
The most common symptom for women with endometriosis is painful periods. Other warning signs include:
- Having pain during bowel movements, particularly during menstruation
- Pain during urination and pain during deep penetrating intercourse
- Trying to conceive for more than a year without success
How can women distinguish between normal cramps and endometriosis?
Cramping that can be treated with a localized heating pad and over-the-counter medication is typical. However, it’s not normal when a woman is unable to go to work or school at the onset of her menstrual period because the pain is so severe and does not respond to over-the-counter medications.
Endometriosis involves more than just the uterus. Where can endometrial tissue implant in the body?
Unfortunately, the whole abdominal cavity is at risk when a woman has endometriosis. Not only do women bleed vaginally, but there’s also blood that goes backward through the fallopian tube and sometimes implants on the outside of the uterus. More commonly, this tissue can implant on the ovaries themselves and on the tissue behind the uterus.
What causes backward blood flow?
We think most women have backward blood flow, but not all women have endometriosis. So, there’s something on a genetic or cellular level that’s different. There are a few theories behind how it occurs, including:
- Endometrial tissue can actually spread through the lymphatic system.
- It travels through the blood vessels, which would help explain some unique cases where women actually have endometriosis tissue in their lungs or, oddly enough, in their brains.
- The tissue was always there – even during fetal development.
How is the condition diagnosed?
The gold standard is performing a laparoscopy and seeing a lesion, but less invasive investigations can be performed first. We could start very simply by taking a history. The next step would be an internal pelvic examination to feel the pelvic structures. Then, if there is a concern about pain related to endometriosis, most OB/GYNs will recommend an ultrasound evaluation of the pelvis. All of these can be done before we consider surgery.
Can endometriosis prevent women from getting pregnant?
Not all women with endometriosis are infertile. What we worry about with endometriosis is distortion of the pelvic anatomy that makes it hard for the fallopian tube to successfully pick up an egg from the ovary. Endometriosis can also implant in the ovaries and form a cyst. Unfortunately, this can lower a woman’s egg count and cause infertility.
The good news is that most women with endometriosis don’t have these conditions, so the condition doesn’t have a negative impact on their fertility. Seeking care early on is important, so the disease doesn’t progress to a stage that would involve the pelvic structures, increasing the likelihood of infertility.
Is surgery the mainstay of treatment for endometriosis?
There are some great minimally invasive surgical solutions, but surgery is by no means the only option. In fact, depending on a patient’s unique circumstances, we often discourage surgery because it may not lead to a resolution of the symptoms.
What medications are used to manage the condition?
There are various medical management strategies that can reduce the number of menstrual cycles across a woman’s lifetime, improve her pain symptoms and prevent progression of her disease. These may involve continuous birth control pills or injectable contraceptives, or daily oral agents that are taken to reduce estrogen levels. Many of these can be very effective.
Are there any lifestyle changes that could help ease endometriosis symptoms?
From a non-medication, nonsurgical standpoint, my view is that engaging in exercise and having supportive social networks can be very helpful.
So, there are treatments but no cure for endometriosis?
I always tell patients that, just like diabetes, this will always be something that they will have to contend with, which can be a little disheartening because no one wants to have a chronic condition.
Will symptoms disappear after menopause?
Any woman who’s menstruating is at risk for endometriosis, but menopause doesn’t mean you’re going to be free of the condition either. Many patients who’ve been long-term sufferers of endometriosis are thrilled to go through menopause because they assume they finally won’t have to manage the condition anymore. Unfortunately, women can still have symptoms from their endometriosis even during menopause.
What advice do you offer women struggling with endometriosis or who suspect they have it?
Many women suffer for years and have normalized their severe symptoms. It’s important to have an open dialogue with your healthcare provider about what you’re experiencing and how it’s affecting your daily life and productivity. If you’re already under the care of a gynecologist who you feel is not responsive to your concerns or questions, don’t be afraid to seek a second opinion. A second physician might be able to provide a different perspective or treatment strategy that better meets your needs.
Dr. Erika Hunter
is an urogynecologist who is board-certified in female pelvic medicine and reconstructive surgery with HCA Midwest Health and practices in Overland Park, KS. She specializes in urogynecology and advance laparoscopic surgery, including the most complex surgical cases of endometriosis involving the bowel, bladder and ureters, mesh excision, recurrent prolapse and frozen pelvis.
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