Out Of Place

Diagnosing and treating endometriosis

You may have a friend—or you may be the one among your friends—whose pelvic pain can be uniquely severe. Perhaps you feel embarrassed when your period is so painful that you have to miss school or work. That’s just your luck, right?

No. Every woman experiences their menstrual cycle differently, but painful periods that disrupt daily life aren’t normal. It could be a sign of endometriosis, a common condition that affects about 10 percent of reproductive-aged women.

What is Endometriosis?

“Endometriosis is a benign gynecologic disease that involves deposits of the uterine endometrium outside of the uterus,” explains Katherine Bebeau, MD, of St. Joseph’s/Candler Physician Network – OB/GYN. “These deposits can lie on pelvic organs such as the fallopian tubes or ovaries, or even be on organs such as the bowel, bladder, abdominal wall and, rarely, in the lungs.”

Just as the lining of the uterus will thicken, break down and bleed during menstruation, so will the endometrial-like tissue outside the uterus. But tissue outside the uterus cannot exit the body, which leads to pain, inflammation and scarring.

“A painful period is the most common symptom,” Dr. Bebeau explains. “Other symptoms include painful intercourse, pelvic pain, or issues with bowel or bladder habits. Some women can be completely asymptomatic, but they may find out they have endometriosis if they have surgery for a non-related reason, or if they have infertility issues.”

The exact cause of endometriosis remains unknown, and there are currently no steps to prevent it. It can affect any woman of reproductive age, but there are some factors that increase your risk. These include:

• One or more relatives with endometriosis, such as a mother, aunt or sister
• Short menstrual cycles — for instance, less than 27 days
• Heavy menstrual periods that last longer than seven days
• Giving birth for the first time after age 30

The initial work-up for endometriosis includes a pelvic exam and ultrasound to look for endometrial deposits on the ovaries found in the form of cysts, or significant scar tissue between the ovaries.

“The only way to actually diagnose endometriosis is with surgery, commonly called a diagnostic laparoscopy,” Dr. Bebeau says. “This involves making a small incision in the abdomen and placing a camera into the belly to look for endometrial deposits. The lesions are then removed and sent to the pathology for confirmatory diagnosis.”

How Is It Treated?

While there is no cure for endometriosis, there are a variety of treatments to help manage the condition. The treatment plan is determined by factors such as the severity of symptoms and the patient’s goals, including whether or not they plan to get pregnant.

“The first line treatment is non-steroidal anti-inflammatory medication during a women’s cycle,” Dr. Bebeau says. “If this is not sufficient, then hormonal medicines can help prevent the endometriosis-related pain.”

If pain medication and hormone therapy do not improve symptoms significantly, and the patient’s life is continually disrupted each month by debilitating pain, then surgery may be necessary. Dr. Bebeau is specially trained in GYN robotic surgery using the da Vinci Xi surgical system. She uses this advanced surgical tool to treat many female reproductive conditions, including endometriosis.

The tissue patches that attach to other parts of the body are called endometriosis implants. Robotic surgery can remove these patches while also preserving the uterus and the ovaries.

“One of the major advantages of robotic surgery is the ability to rotate and bend surgical instruments as a hand would in an open procedure,” Dr. Bebeau says. “This allows for more careful manipulation of the sometimes-fragile tissue in pelvic anatomy.”

Robotic surgery has been shown to benefit patients with a quicker recovery and less bleeding.

“Studies have shown that the precise removal of endometriosis implants enabled to us by robotic surgery has led to much more improvement in symptoms and fertility,” Dr. Bebeau says.

A New Understanding

It’s time to throw away the misconception that some women just have painful periods that they must suffer through or try to ignore. Understanding that endometriosis is a common condition that can be managed with a proper diagnosis and treatment plan is the first step to achieving a much better quality of life. In fact, Dr. Bebeau hopes that patients will take a similar approach with any gynecological issues they may be facing.

“I enjoy having that conversation with patients, where they are fully informed and we can determine the best course of action together,” she says. “It empowers women to be in control of their health.”