Understanding and treating endometriosis

RAPID CITY, S.D. — In gynecology there is a condition that often eludes patients and doctors alike, a condition that can take years to diagnose – endometriosis. This condition is believed to affect one in ten women, making it an unfortunately common problem. Each case of endometriosis is unique, and symptoms range on a wide spectrum, but once a diagnosis is made there are many treatment options available.

An unfortunate reality of endometriosis is the difficulty in diagnosing the condition. Heather Moline, MD, specializes in Obstetrics and Gynecology (Ob/Gyn) at Rapid City Medical Center, and shares the difficulty of diagnosing the condition. “Endometriosis can be a very challenging chronic condition for patients where many of them seek care from multiple different medical providers in search of a diagnosis. It can be very frustrating for patients and for physicians as it is often a diagnosis of exclusion.”

A diagnosis often comes after a list of other possibilities is whittled down. A major difficulty in diagnosing endometriosis is the wide range of symptoms that patients may experience, and an almost limitless area of where the condition can form.

Simply put, endometriosis forms when endometrial tissue, which is the tissue that lines the uterus, implants itself in a place where it doesn’t belong. These endometrial cells can be found on the ovary, bladder, fallopian tube, or almost anywhere else in the pelvic or abdominal cavity. These endometrial cells will still react to the hormonal changes in a woman’s cycle, meaning they will grow, thicken, and eventually break down and bleed. Since the tissue is going through these changes outside of the uterus, women with endometriosis can often experience cyclical abdominal or pelvic pain that is not typical normal period.

“It can be frustrating because for many patients with endometriosis, the first few periods they have may be normal,” Dr. Moline says, “But over time, their periods get worse and worse, and they have more and more pain. With each subsequent year their periods often become heavier or more painful, and their menstrual cycle becomes more life-limiting every year if they are untreated.”

Most patients will seek medical attention when they are in their twenties, years after they experience worsening periods. With the many unknowns surrounding endometriosis, there are unfortunately no preventative measures women can take to reduce their risk. The best course of action is to know and understand the symptoms and speak with a doctor right away if you experience them.

In some cases endometriosis is diagnosed when a woman is seeking help for an issue completely unrelated to abnormal abdominal pain. Some patients who are having trouble with fertility will discover that they have endometriosis when they begin examining possible causes of infertility.

Another problem some endometriosis patients experience is discomfort during sex. Like many of the other symptoms, this discomfort can be linked to a woman’s menstrual cycle, but it can be a subtle change that can be easy to ignore or explain away.

No matter how a diagnosis comes about, the good news is that there are multiple treatment options available for women with endometriosis.

Dr. Moline says that the best treatment for most endometriosis cases is hormonal therapy. “If we can control the menstrual cycle, then we may be able to have better control of the endometriosis symptoms,” she says.

Many women will decide to use a birth control method with either estrogen and progesterone or progesterone alone, such as a birth control pill or an IUD. The goal is to reduce the effect of the natural surge of hormones that cause ovulation, because these hormones will stimulate endometriosis lesions to grow and/or bleed, causing a patient’s painful symptoms.

A newer treatment option that recently became available is the prescription medication Orilissa, which is the only medication that is FDA approved specifically to treat endometriosis. Hormonal treatment options like Orilissa or birth control work to not just stop the endometriosis lesions from expanding and causing pain, but can actually work to reduce their size and severity of the endometriosis within the abdomen.

For some who do not see results from hormonal treatment, surgically removing the endometrial lesions is the next option, particularly if they have formed a growth called an endometrioma. When these growths occur they often have to be removed before a patient’s pain is alleviated.

In the most severe cases of endometriosis, removal of the ovaries or a complete hysterectomy may be required. Dr. Moline says that while it is sometimes necessary, these procedures are not as common as they once were in the medical field for treating endometriosis. Today gynecologists will rule out every other option before resorting to a hysterectomy.

A wider understanding of endometriosis is one of Dr. Moline’s goals, as it is oftentimes a very misunderstood condition.

“There are many patients who lose days at work and quality of life because of endometriosis,” she says, “and it can be very frustrating and it can be very challenging for people to manage their life when their endometriosis is particularly severe. It’s also very misunderstood. Some people who think that if a woman is having a heavy or painful period, they should just take some ibuprofen. But for patients with endometriosis, pain management should not be the only intervention. Hormonal therapy should be a consideration and patients should talk to their doctor about options that are right for them.”

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