Endometriosis Treatment in New Jersey

According to the World Health Organization, endometriosis, an often-painful gynecologic condition, affects roughly 10 percent (190 million) of women and girls of reproductive age globally. This disease can affect females from the onset of their first menstrual period until menopause. The causes of endometriosis are mostly unknown, and there are no known cures, however, it can be managed through modern medical and surgical treatments.

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What Is Endometriosis?

Endometriosis is a condition that occurs when tissue similar to the inside of the uterus or “womb” lining begins to grow outside of it. These tissue deposits are called implants, and they can attach to the outside of the uterus, the ovaries (the glands where the eggs form) and fallopian tubes (the structures that carry the ovaries to the uterus). In later stages, endometriosis implants can also spread to other parts of the body such as the connective tissues, bladder, intestines and other areas.

Endometriosis causes inflammation or swelling in the body, which often causes physical pain and can create challenges for women attempting to get pregnant. Managing the symptoms of endometriosis, including possible infertility, can be emotionally challenging for many women.

Why Choose RJWBarnabas Health for Endometriosis Treatment?

The gynecologic specialists at RWJBarnabas Health understand how difficult the physical and emotional pain of endometriosis can be. In partnership with Rutgers Robert Wood Johnson Medical School, Rutgers New Jersey Medical School and Rutgers Health, we offer comprehensive services such as preventive care, diagnostic services and minimally invasive surgeries. We provide compassionate women’s health care services tailored to each woman’s reproductive needs. Our partnership with Rutgers University makes us New Jersey’s largest academic health care system dedicated to providing high-quality patient care, leading-edge research, and world-class health and medical education.

Causes of Endometriosis

Endometriosis is a complex disease that can affect anyone who menstruates, from adolescence to menopause. Although the causes of endometriosis aren’t entirely understood, there are a few theories, which include:

• Menstrual blood flowing backward. Retrograde menstruation occurs when a woman's menstrual blood flows back into the fallopian tubes and pelvic cavity. This blood can contain cells like the ones that line the womb, which can attach and grow outside the uterus.
• Cellular changes. Cellular metaplasia is when one type of cell changes form into another. In cases of endometriosis, cells similar to the ones in the endometrium change form and implant themselves outside the uterus.
• Stem cells. One theory suggests that stem cells in the uterus may be able to migrate outside of the uterus and implant themselves where they do not belong.
• Hormonal connections. While a specific connection has not been found, endometriosis is known to depend on estrogen, a hormone that aids in female body trait growth.

Risk Factors for Endometriosis

A few hereditary and lifestyle factors are known to raise or lower your risk of developing endometriosis.

Factors that increase risk of developing endometriosis include:

• Genetics. If you have a mother, sister, or daughter with endometriosis, you are more likely to develop it.
• Early onset periods. If you started your menstrual period before age 11, you are more likely to develop endometriosis.
• Short monthly cycles. If your monthly cycles are less than 27 days, you have an increased risk for endometriosis.
• Heavy monthly periods. Women with heavy monthly periods lasting more than seven days have an increased risk of developing endometriosis.

Factors known to lower your risk of developing endometriosis include:

• Late-onset periods. Women whose periods started late in adolescence have a lower risk of developing endometriosis.
• Pregnancy. Women who have had at least one pregnancy have a decreased risk.
• Breastfeeding. Women who breastfeed their babies have a decreased risk.

Endometriosis Symptoms

While some women experience no symptoms of endometriosis many experience discomfort or pain. Since the symptoms vary widely from woman to woman, it can be challenging to diagnose, however, the most common endometriosis symptoms include:

• Pelvic pain that comes and goes. This can include a feeling of heaviness, pressure or even a stabbing sensation in the lower abdomen or belly area. It may be more noticeable at certain times, such as during a menstrual period, urinating, having a bowel movement, or during or after sex.
• Chronic pelvic pain. Some women report constant pelvic pain, which may extend to their lower back or down one or both legs.
• Heavy bleeding. A woman may experience endometriosis symptoms like heavy bleeding and cramping, known as dysmenorrhea, during their period or in between periods.
• Bloating or nausea. A general feeling of being bloated or sick to your stomach could be a symptom.
• Fatigue. Tiredness, weakness and fatigue are other endometriosis symptoms.
• Infertility. Infertility or trouble getting pregnant may result from scar tissue buildup that may block your eggs from traveling down your fallopian tubes during ovulation.
• Depression or anxiety. As with many other complex health conditions, the symptoms of endometriosis can have significant social and financial effects, causing women with this disease to feel down, depressed or anxious.

How Is Endometriosis Diagnosed?

If you are experiencing endometriosis symptoms, you should schedule a gynecologic exam with your OB/GYN immediately. Diagnosing endometriosis can sometimes be difficult, as it can mimic other conditions like an infection or cancer. However, early detection and treatment increase your chances for a successful outcome.

During the appointment, your gynecologist may ask questions about your menstrual cycle and the symptoms you are experiencing. They may also perform a pelvic exam to check for signs of cysts or growths. In addition, they will likely prescribe imaging of your pelvic area. Scanning options include:

• Ultrasound. This technology uses high-frequency sound waves to create images of the inside of your body. Although ultrasound alone cannot establish an endometriosis diagnosis, it can produce detailed images that show cysts, which are growths associated with the disease.
• Magnetic resonance imaging (MRI). An MRI is another exam used to create detailed images of the inside of the body. Using magnetic fields and radio waves, an MRI can give your doctor clear images of your female reproductive organs, showing any growths that could be signs of endometriosis.

Stages of Endometriosis

There are four main stages of endometriosis, with Stage I being the most minor and Stage IV being the most severe. Staging is based on the location, number and size of the implants and the amount of scar tissue there is. The more advanced stage of endometriosis, the more difficult it may be for a woman to get pregnant.

• Stage I (minimal). This stage is known as peritoneal endometriosis. It is very slight, with only a few small implants found and they are limited to the membrane that lines the abdomen. The implants are often too small to show up on imaging.
• Stage II (mild). This stage of endometriosis is relatively minor, with more and deeper implants found. Endometriomas or “chocolate cysts” can be found in the ovaries.
• Stage III (moderate). Deep infiltrating endometriosis (DIE I) reflects many deep implants, small cysts on one or more ovaries and adhesions or bands of scar tissue. It has spread to other body parts such as the uterus wall or rectum. This degree of tissue growth can be enough to significantly change the shape of the pelvic organs.
• Stage IV (severe). This deep infiltrating endometriosis (DIE II) stage impacts organs both inside and outside the pelvic region. It includes many deep implants, large cysts on one or both ovaries and dense masses in other places in the body like the bowels, lungs, heart and other organs.

Nonsurgical Endometriosis Treatments

While there is no cure for endometriosis, there are medications and surgical options that can manage tissue overgrowth and its symptoms. Your path of treatment for endometriosis depends on how severe your symptoms are and if you plan on having children in the future. Common treatment options include:

• Over-the-counter medication. When used as directed, nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen sodium may help soothe painful menstrual cramps and other pains from endometriosis.
• Prescription pain medication. For severe pain not helped by NSAIDs, your doctor may prescribe prescription pain medication, including opioids, which should only be used as directed.
• Hormonal therapy. Hormone therapy can help ease the pain of endometriosis. During your menstrual cycle, your hormones rise and fall, which causes the endometrial implants to thicken and bleed. Hormonal medication like the birth control pill, patches, vaginal rings and other therapies are thought to slow this excess tissue growth and prevent new implants from forming.

Surgical Endometriosis Treatments

To help manage symptoms of endometriosis or to improve your chances of becoming pregnant in the future, your gynecologist may recommend surgery. Common surgery options include laparoscopy and laparotomy.

H3: Laparoscopy

If your doctor sees signs of endometriosis through an ultrasound or MRI, they may refer you to a surgeon for a laparoscopy. While under sedation, your surgeon makes a tiny incision or cut into your abdomen. A thin tool attached to a camera is inserted through the hole to look for signs of endometrial tissue growing outside the uterus. The surgeon can often blast the lesions with lasers or remove them with tiny robotic surgery tools. Removing this extra tissue can help reduce your endometriosis-related pain and may also help with fertility. The doctor may also take a tissue sample for further testing to rule out cancer.

This minimally invasive procedure is relatively safe, but as with any surgery, there are risks of complications which may include:

• Internal bleeding
• Damage to blood vessels or other organs
• Hernia, or a bulge caused by poor healing

Many women can go home shortly after surgery, but if a case is more complicated, you may need to stay overnight in the hospital.

After surgery, limit physical activity for a few days. If you develop severe pain or swelling, call your doctor or go to your local emergency room.

Laparotomy

If your surgeon cannot remove the endometrial implants through a laparoscopy, they may perform an open abdominal surgery called a laparotomy. This procedure is more invasive than laparoscopy and requires a longer recovery time, but it may be necessary if the endometriosis is advanced.

During this procedure, the patient receives anesthesia so they go to sleep. The surgeon will open up the membrane that lines the abdomen to examine the pelvic organs and surgically remove the endometrial tissue from the body.

Depending on the type and extent of endometriosis damage, the surgeon may have to remove the ovaries and fallopian tubes or perform a hysterectomy, which is the total removal of the uterus. When finished, the surgeon will sew up the abdominal wall and skin. Depending on how advanced the endometriosis is, it is possible that follow-up surgery may be necessary.

As this is a major surgery, patients may remain at the hospital for a couple of days while they are assisted with wound care, fed through an IV, and helped with movement and light exercises.

As with any major surgery, possible complications can occur, such as:

• Excess bleeding or hemorrhage
• Infection
• Damage to internal organs
• Abdominal pain or bowel blockage
• Scar tissue formation

Once home, patients must follow their doctors’ instructions, which would include eating a modified diet, avoiding strenuous activity and getting help with daily activities.

Endometriosis Recurrence

Endometriosis is a chronic condition, which means that you will need to continue to monitor it for the rest of your life. Since endometrial implants have a chance of growing back, you may need to continue the therapies prescribed by your doctor, or even have to repeat surgeries. The chances of endometriosis returning can range between 6 and 67 percent, depending on the stage of the disease and a variety of other factors.

Endometriosis and Infertility

There are known connections between endometriosis and problems with conceiving a child. According to the National Library of Medicine, about 25 to 50 percent of infertile women have endometriosis, and about 30 to 50 percent of women with endometriosis are infertile. Naturally, the more advanced the stage of endometriosis, the greater the likelihood of infertility.

Women with endometriosis who do become pregnant are more likely to have a higher-risk pregnancy which may include:

• Preterm delivery, or going into labor early
• Preeclampsia, a condition involving high blood pressure and fluid retention
• Vaginal bleeding, called placenta previa

Fortunately, many women with endometriosis can still become pregnant and deliver a healthy baby. To help with your fertility, your doctor may perform the following procedures:

• Surgery. Removing endometriosis implants is often the first step in achieving fertility.
• Superovulation with intrauterine insemination (IUI). This procedure stimulates two to three eggs, bringing them to maturity and ovulation.
• Assisted reproductive technology (ART). To increase a couple’s chances of conceiving, eggs are surgically removed and combined with sperm in the laboratory and then returned to the woman’s body or implanted into a donor.

Once pregnant, it is important to take care of yourself and have regular checkups with your OB/GYN to stay on top of your health.

Make an Appointment Today

Are you experiencing endometriosis symptoms? RWJBarnabas Health can help. Talk to someone on our OB/GYN team to discuss your health concerns. To connect with an OB/GYN near you, visit request an appointment or call 888-724-7123.

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