Learn the Facts About This Serious and Often-Missed Gynecologic Condition
Painful periods and intense pelvic pain might be enough to make many women seek medical attention, for good reason: These are symptoms of endometriosis, a common, chronic gynecologic condition. But more subtle signs of endometriosis such as gastrointestinal issues, fatigue and frequent urination often get overlooked.
Endometriosis affects about 10 percent of women and girls worldwide but is often undiagnosed, leaving many others to endure the condition in silence. You can better gauge your risks—and get relief if you’re affected—by understanding answers to questions like these:
What is endometriosis?
Endometriosis is a long-term hormonal and immune disease that can affect women from puberty to menopause. It occurs when tissue similar to the inner lining of the uterus grows outside the womb, generally on organs in the pelvic cavity such as the ovaries, fallopian tubes and bowel. Cysts, scar tissue and adhesions may form. The condition can be painful and may have a devastating effect on quality of life.
How does lack of awareness boost risks?
Studies show that about 54 percent of people don’t know what endometriosis is. Of those who realize endometriosis is a gynecologic condition, 35 percent can’t name any symptoms.
“Lack of knowledge of the disease combined with stigma causes an average delay of 10 years from onset of symptoms to diagnosis,” says Jessica Opoku-Anane, MD, an obstetrician/gynecologist (OB-GYN) at Robert Wood Johnson University Hospital; a minimally invasive gynecologic surgeon and associate professor and section chief of benign gynecological surgery at Rutgers Health / Robert Wood Johnson Medical School; and a member of RWJBarnabas Health Medical Group. “At the same time, girls with endometriosis have been shown to be at greater risk for 12 cancers, seven autoimmune diseases, allergic diseases and heart disease. Receiving an early diagnosis and treatment for this condition can have a major impact for patients.”
What causes the condition?
The cause isn’t clear, but possible contributing factors include retrograde menstruation, in which menstrual blood flows back into the pelvic cavity instead of leaving the body; movement of endometrial cells to other parts of the body; the transformation of cells due to hormones or other factors; surgical scar complications; and abnormal immune responses.
What are warning signs to watch for?
Symptoms of endometriosis include periods with pelvic, lower back and stomach pain; heavy periods and/or bleeding between periods; painful bowel movements and/ or urination; pelvic pain outside of periods; and painful intercourse. In addition to frequent urination and fatigue, women also may experience diarrhea, constipation, bloating, nausea and nerve problems. Up to 50 percent of women with endometriosis have difficulty conceiving.
Endometriosis can be mistaken for conditions with similar symptoms and is often misdiagnosed as, for example, pelvic inflammatory disease, ovarian cysts, irritable bowel syndrome, appendicitis, ovarian or colon cancer, fibroids, polycystic ovary syndrome or sexually transmitted diseases.
Regular pelvic exams and discussions with an OB-GYN and/or endometriosis expert can help identify and correctly diagnose endometriosis.
Who is at risk?
Women with a low body mass index, those who have never given birth and those with increased estrogen levels carry a greater risk of developing endometriosis. So do those who experience early-onset menstruation or late-onset menopause, short menstrual cycles (less than 27 days) and heavy menstrual flow for longer than seven days. Women who have one or more close relatives with endometriosis are three to seven times more likely to have the condition.
How can endometriosis be treated?
While no known cure exists for endometriosis, hormone medicines and surgical treatments can help. Lesions tend to extend deep into tissue, and many doctors recommend fully removing the growths through various types of surgery. Hospitals throughout the RWJBarnabas Health system offer minimally invasive laparoscopic and robotic surgery using the da Vinci Xi Surgical System (see below). In some cases, hysterectomy may be suggested.
Timely treatment may help halt progression of the disease and reduce associated infertility and pain. “It’s really important to get the diagnosis as early as possible to treat either with hormonal medications or surgery to try and prevent that progression,” says Dr. Opoku-Anane. “Women who have bad periods that truly affect their lives should not wait to see a physician. If your menses are preventing you from doing your normal activities, that’s not normal. You should see your OB-GYN.”
Using Robotic Surgery for Endometriosis
Surgeons throughout RWJBarnabas Health offer minimally invasive laparoscopic and robotic surgery using the da Vinci Xi Surgical System to treat numerous gynecologic conditions, including endometriosis. The computer-assisted system integrates advanced imaging and sophisticated instruments that allow surgeons to access the body without large incisions. Robotic-assisted procedures are less invasive than traditional surgeries, and using the da Vinci system typically results in comparatively less post-op pain; lower risk of infection and scarring; and faster recovery.
During a procedure, the surgeon sits at a console with tools that virtually extend human eyes and hands. A high-definition camera provides a magnified, 3D view of the entire surgical area. Robotic arms give the surgeon a 360-degree range of motion not possible with a human wrist, allowing precise, real-time movements in delicate and hard-to-reach areas. Such advanced control allows doctors to remove endometriosis tissue more effectively while preserving healthy tissue.
To learn more about comprehensive women’s health services available through RWJBarnabas Health, visit our Women’s Health page.
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