Pelvic Pain — Learning about Endometriosis

 


El Camino Women’s Medical Group offers the latest Minimally Invasive Solutions for gynecologic problems.   Drs. Amy TengErika Balassiano, and Pooja Gupta, all members of AAGL (American Association of Gynecologic Laparoscopy) are highly trained and experienced in the field of Minimally Invasive Gynecgologic Surgery.   Dr. Erika Balassiano is also a graduate of the Minimally Invasive Gynecologic Surgery Fellowship at Stanford University, under the supervision of world-renowned Dr. Camran Nezhat.

 

Servicing Mountain View, Los Altos, Los Altos Hills, Atherton, Palo Alto, Redwood City, Burlingame, Saratoga, Cupertino, Sunnyvale, Los Gatos, Campbell, San Jose, Santa Clara, Silicon Valley, Milpitas, South Bay, East Bay, North Bay.


 

Pelvic Pain — Learning about Endometriosis

by Kristina Dragovic, MD

 

              Is it about that time of the month and you feel pelvic pain again? Have you been trying to get pregnant, but have not had any success? For 1 in 10 of women in the US this pelvic pain and or infertility could be a diagnostic clue towards Endometriosis. When the lining of the uterus, the endometrium, is found in any other location- this is called Endometriosis. This is the same endometrial tissue that grows throughout the month in response to hormonal changes, and without a fertilized embryo, then dies off as our monthly cycles. However, when it is in our uterus there is an area for exit. When the endometrial tissue is found elsewhere, there is no exit, yet the tissue is still subject to the same hormonal changes; thus the implants bleed just the same and can cause inflammation and scarring (known as adhesions) to the local tissue. These adhesions can distort normal anatomy (blocking the tubes and preventing fertilization) in addition to causing significant discomfort.

There are many hypothesis regarding the cause of this improper plantation of endometrium, most notably the Sampson Hypothesis- which states that this tissue is simply a result of back flow out from the uterus, into the fallopian tubes and out into the ovaries, colon and nearby structures like the bladder. There have also been cases of endometrial tissue implanting as far up as the lungs. In addition to pelvic pain, common symptoms include painful periods (dysmenorrhea) and painful sex (dyspareunia). The pelvic pain and dysmenorrhea typically presents in women in their reproductive years (late 20’s into the early 40’s) and presents a day or two prior to menses, lasts during menses and subsides days after the menstruation process has finished. As the endometrial tissue can be of varying size and location the symptoms associated also vary; ie chronic symptoms of diarrhea or bowel cramping during menses vs urinary frequency and painful urination are possible clues that may indicate endometrial tissue on the bowel or bladder, respectively. Should the implanted tissue be located on the fallopian tubes, some women may also present with infertility as the tubes may have become obstructed due to inflammation and adhesions.

              The workup for someone experiencing chronic pelvic pain requires that a thorough physical examination to be performed. Your gynecologist will check for appropriate size, mobility and any tenderness with palpation to your pelvic organs. In addition, an ultrasound may be helpful to locate large lesions- but the gold standard for diagnosis is a biopsy of the tissue, usually obtained via a laparoscopic approach that allows your physician to look inside your pelvic cavity for the lesions themselves and remove them at the same time.  In terms of treatment, more conservative options are indicated first. If the endometriosis is suspected and pain is the primary issue, pain medications like Advil or NSAIDs and hormonal treatments including birth control pills, can slow down the tissues growth, but will not remove the improperly implanted endometrium. If the pain persists, and laparoscopic removal of the tissue is performed, most women find relief. However, in some cases the pain will return even if NSAIDs and hormonal therapy is continued. In these severe cases, hysterectomy (removal of the uterus, and in cases of Endometriosis, the ovaries as well (known as an oophorectomy) is the most definitive form of treatment. If infertility is the primary issue- surgical resection of the tissue via laparoscopy is the best line of treatment. Overall, there is a wide array of symptoms and presentation of endometriosis, as are the treatment options. But if you are experience pelvic pain every month or have been unable to conceive in addition to they dysmenorrhea, be sure to discuss your options with your gynecologist.

 

https://www.uptodate.com/contents/evaluation-of-chronic-pelvic-pain-in-women?source=see_link

 

https://www.uptodate.com/contents/endometriosis-pathogenesis-clinical-features-and-diagnosis?source=search_result&search=endometriosis&selectedTitle=3~150#H3234103847

 

http://www.acog.org/About-ACOG/News-Room/News-Releases/2010/Pain-Management-of-Endometriosis

 

 


El Camino Women’s Medical Group offers the latest Minimally Invasive Solutions for gynecologic problems.   Drs. Amy TengErika Balassiano, and Pooja Gupta, all members of AAGL (American Association of Gynecologic Laparoscopy) are highly trained and experienced in the field of Minimally Invasive Gynecgologic Surgery.   Dr. Erika Balassiano is also a graduate of the Minimally Invasive Gynecologic Surgery Fellowship at Stanford University, under the supervision of world-renowned Dr. Camran Nezhat.

 

Servicing Mountain View, Los Altos, Los Altos Hills, Atherton, Palo Alto, Redwood City, Burlingame, Saratoga, Cupertino, Sunnyvale, Los Gatos, Campbell, San Jose, Santa Clara, Silicon Valley, Milpitas, South Bay, East Bay, North Bay.