Endometriosis is a fairly common disorder that affects over 10% of American women during their childbearing years. It causes painful periods, and most patients I diagnose with it are between 30 and 40 years old.
I have more patients than I could ever count who come to me after seeing a dozen or more doctors, all of whom failed to diagnose them properly. It is one of the tragedies of modern women’s health that so many must suffer needlessly for years from painful periods.
Here is something extremely important to remember: painful periods are not normal!
Because endometriosis is so difficult for most doctors to diagnose, most women who come to me for a diagnosis and care have been suffering for an average of eleven years before being properly diagnosed!
What are common endometriosis symptoms?
For most women, common symptoms of endometriosis include severe PMS symptoms,such as:
If you’re experiencing pelvic pain and heavy bleeding, schedule a consultation with me for an examination. Many conditions can present with similar endo symptoms (ovarian cysts, to name just one). We will carefully review your medical history during your appointment and conduct a thorough physical and pelvic examination.
The only way to diagnose endometriosis with absolute certainty is to examine your pelvic organs and endometriosis tissue via a surgical laparoscope. During this minor laparoscopy procedure, I insert a thin, flexible, lighted instrument through a tiny incision in your abdomen.
The laparoscope allows me to closely examine your pelvic organs and see any endometrial implants up close from various angles. I can also take a biopsy of any suspicious-looking tissue to send it out for further testing.
Why is endometriosis so hard to diagnose?
It’s infuriating that the average woman living with endometriosis in the United States suffers from symptoms for 11 years before she is correctly diagnosed. I believe that the medical profession has failed to support women adequately.
Diagnosing endometriosis is complicated because many symptoms can be due to other gynecological conditions. The truth is that endometriosis is pretty wily because the symptoms that patients experience don’t always correlate to the locations of the endometrial implants (endometrial tissue growing outside the uterus). GI symptoms appear just as often as gynecological symptoms in women with endometriosis.
Over 80% of women I diagnose with endometriosis describe their primary symptom as abdominal bloating. Alternatively, they may experience symptoms such as periodic bloating and altered bowel habits, including diarrhea, constipation, painful bowel movements, nausea, and vomiting. Many women experiencing these symptoms will go to a GI specialist, who, unfortunately, can lead to an erroneous presumptive diagnosis of IBS (irritable bowel syndrome) after lengthy and invasive diagnostic testing fails to turn up anything.
Another confounding overlap between endometriosis and GI conditions is that many women who suffer from endometriosis also suffer from SIBO (small intestine bacterial overgrowth). When gut bacterial growth becomes imbalanced, it can cause diarrhea, gas, bloating, and abdominal cramping — symptoms also associated with endometriosis.
Because up to 75% of women with IBS also have SIBO, many GI doctors will quickly diagnose a woman as having IBS, overlooking the possibility that she might have endometriosis. Luckily, a rapid breath test can be done at your primary doctor’s office to rule out SIBO: known as the lactulose hydrogen breath test.
If you test negative for SIBO, seek a women’s health specialist to determine if you may have endometriosis. If you are diagnosed with SIBO, the treatment is a two-week course of antibiotics. If GI symptoms don’t improve after completing antibiotic therapy, you should seek a qualified endometriosis specialist to determine whether you might have endometriosis.
What’s the exact cause of endometriosis?
The endometrium is the mucus membrane that makes up the uterus lining. During the menstrual cycle, it responds to hormones by thickening blood vessels in preparation for pregnancy.
Every time the egg fails to be fertilized by a sperm, the body clears away the new endometrial tissue inside the uterus, and this elimination is your period.
However, sometimes, the body does not clear away all the endometrial cells, and they accumulate month after month. This accumulated tissue eventually gets pushed outside the uterus and then grows on the fallopian tubes, ovaries, cervix, the external surface of the uterus, intestines, urinary organs, and even the rectum.
The sites of abnormal endometrial tissue growth are known as implants. These endometrial implants respond to hormones like the uterine lining by thickening, breaking down, and shedding. But since this occurs outside the uterus, the tissue becomes inflamed, irritated, and scarred. This scar tissue is called adhesions. Adhesions can cause organs to stick together, which usually causes terrible menstrual cramps and severe pain before and during your period.
Retrograde menstruation may also contribute to endometriosis. Menstrual blood containing endometrial cells flows back through the fallopian tubes and into the pelvic cavity instead of out of the body. These displaced endometrial cells stick to the pelvic organs’ pelvic walls and surfaces, growing and continuing to thicken and bleed throughout each menstrual cycle.
When endometriosis affects the ovaries, cysts known as endometriomas may form.
All of these factors likely interact, making endometriosis a multifactorial disease that requires personalized care. Dr. Aliabadi tailors her diagnostic and treatment strategies based on the complex nature of each patient’s condition.
Can endometriosis cause infertility?
Yes! Unfortunately, endometriosis can also cause fertility problems. In rare cases, infertility may be the only symptom of endometriosis (called “silent endometriosis”). About 40% of women who have difficulty getting pregnant suffer from endometriosis.
Because endometriosis results in inflammation of the ovaries and fallopian tubes, the fallopian tubes may stick together (known as adhesions), blocking the egg’s path to the uterus. Severe endometriosis can even affect the egg reserve, leading to poor egg quality and, potentially, infertility.
Yes! There are two approaches to endometriosis treatment:
Address the symptoms and suppress the spread of the disease.
Remove the diseased tissue within the pelvis and reproductive organs via surgery.
I always have a frank discussion about the best course of treatment for you, considering your age, the type and severity of your symptoms, the stage of your disease, and your plans to bear children in the future.
What are the treatments for endometriosis?
There are several treatments for endometriosis, including:
Medications for endometriosis pain
Endometriosis-associated pain and cramping during menstrual periods can be managed with nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. You can purchase these over the counter or, if necessary, receive prescription-strength pain medications.
Hormonal therapies
Because endometriosis is hormonally driven, I can successfully suppress the disease in most patients with birth control pills (oral contraceptives with estrogen and progesterone, GnRH (gonadotropin-releasing hormone) agonists, and progestin medications with minimal side effects.
While these treatments won’t cure endometriosis or remove existing diseased tissue, they can reduce the appearance of new endometrial implants, prevent adhesions from forming, and provide relief from symptoms.
I have successfully treated most of my endometriosis patients with careful monitoring and a hormonal suppression treatment plan that considers their age, disease severity, egg health and count, and future fertility desire.
Surgery
Women trying to get pregnant might elect to have their endometrial implants surgically removed. I perform this minimally invasive surgery with just two or three tiny incisions, using a slender, lighted instrument to view and remove endometrial implants and break up scar tissue, thus improving fertility.
Surgery does not cure endometriosis, but it removes abnormal endometrial tissue within the pelvis. While it will provide short-term pain relief, it is important to know that unless you undergo hormonal suppression therapy after surgery, new endometrial plaques will form, and symptoms will return.
Surgery plus suppressive hormone therapy for pain and infertility
For women who plan on having children, combining surgery with hormone therapy yields the best results for combating pain and fertility problems by preventing new implants from forming. After this treatment protocol, some women are even able to get pregnant spontaneously without the aid of in vitro fertilization.
Too many gynecologists perform surgery to remove endometrial implants and fail to start their patients on hormonal suppression therapy. The net result is that, in a few years, these women will have new endometrial implants that need to be removed again.
You must have appropriate post-op monitoring and be placed on hormonal suppression therapy if you do not want surgery after surgery to remove recurring endometriosis.
The last resort treatment for severe endometriosis is a hysterectomy
A hysterectomy is the surgical removal of the uterus and ovaries. Removing the ovaries significantly reduces the chance of pain coming back after surgery. A hysterectomy is typically only used as a last resort because, after the procedure, you will no longer have a period or be able to become pregnant.
Because removing the reproductive organs is a serious step, the decision for surgery should never happen until we have reviewed all of your treatment options. It is critically important that you thoroughly understand the pros and cons of every available option.
Dr. Thais Aliabadi, an expert in the treatment of endometriosis
Endometriosis affects hundreds of thousands of women each year. If you believe you are experiencing symptoms of, or suffering from, endometriosis or have questions about endometriosis, I encourage you to see your healthcare provider, preferably an endometriosis expert. Painful periods (dysmenorrhea) are not normal, and your quality of life shouldn’t suffer because of endometriosis.
Dr. Aliabadi’s peers frequently recognize her as the best OBGYN in her region, citing her innovative techniques, commitment to patient education, and outstanding outcomes in managing complex endometriosis cases. Her technical expertise and collaborative approach with multidisciplinary teams ensure that patients receive care that is both advanced and compassionate.
Dr. Thais Aliabadi is a member of the American College of Obstetricians and Gynecologists. Her practice is conveniently located for patients throughout Southern California and the Los Angeles area. We are near Beverly Hills, West Hollywood, Santa Monica, West Los Angeles, Culver City, Hollywood, Venice, Marina del Rey, Malibu, Manhattan Beach, and Downtown Los Angeles.
Endometriosis FAQs
What should a patient expect during an appointment with Dr. Aliabadi?
Patients receive a comprehensive evaluation, including a detailed medical history and physical examination. Dr. Aliabadi provides a collaborative, educational approach so that each patient understands their condition and treatment options.
Can endometriosis cause cancer?
Women with endometriosis have about four times the risk of developing ovarian cancer compared to those without the condition, with the risk being even higher, up to nearly tenfold, for those with severe forms like deep infiltrating endometriosis or ovarian endometriomas. However, while the relative risk is increased, the overall chance of developing ovarian cancer remains low for most women with endometriosis.
Can lifestyle changes impact the severity of endometriosis symptoms?
Yes, adopting a balanced diet, engaging in regular exercise, and managing stress can help reduce inflammation and pain, complementing medical treatment and improving overall symptom management.
Can endometriosis cause weight gain?
Endometriosis does not directly cause weight gain, but it can lead to bloating and water retention that may mimic weight gain, and treatments such as hormone therapy, as well as reduced physical activity due to pain, can contribute to actual weight gain in some people.
Is endometriosis an autoimmune disease?
Endometriosis is not classified as an autoimmune disease, but it involves immune system dysfunction and chronic inflammation that share similarities with autoimmune conditions.
Can endometriosis cause back pain?
Yes, endometriosis can cause back pain, especially in the lower back, due to inflammation and the presence of endometrial-like tissue near pelvic nerves, ligaments, or the spine.
Does endometriosis go away with menopause?
Endometriosis often improves after menopause due to lower estrogen levels, but it doesn’t always go away completely, especially if hormone replacement therapy is used or if endometriosis lesions are deeply embedded. Some women may continue to experience symptoms even after menopause.
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Endometriosis flare-ups can be triggered by hormonal fluctuations, stress, inflammation, dietary factors, and genetics. Hormonal changes during the menstrual cycle can exacerbate symptoms. Stress can impact immune function and worsen inflammation. Certain foods like gluten and dairy may also contribute to flare-ups.
Does diet influence endometriosis progression?
Yes, diet can influence endometriosis progression. Certain foods like high levels of trans fats, red meat, and caffeine can exacerbate symptoms. Anti-inflammatory diets rich in fruits, vegetables, whole grains, and omega-3 fatty acids may help alleviate symptoms and slow progression.
Are biopsies essential for diagnosis?
Biopsies are essential for diagnosing endometriosis definitively. During laparoscopy, tissue samples are taken to confirm the presence of endometrial cells outside the uterus. This procedure helps differentiate endometriosis from other conditions with similar symptoms. A biopsy is a crucial step in accurate diagnosis and treatment planning.
Do genetics influence endometriosis risk?
Genetics do play a role in influencing the risk of endometriosis. Research suggests a strong genetic component, with family history increasing the likelihood of developing the condition. While not deterministic, genetic factors can contribute to an individual's predisposition to endometriosis.
Can teenagers develop endometriosis symptoms?
Yes, teenagers can develop endometriosis symptoms. However, diagnosing endometriosis in teens can be challenging due to variations in symptoms and the overlap with other conditions. It's crucial for teens with severe menstrual pain or pelvic discomfort to seek medical evaluation by a knowledgeable healthcare provider.
Does stress exacerbate symptom severity?
Yes, stress can exacerbate symptom severity in endometriosis, leading to increased pain, cramping, and fatigue. Managing stress through relaxation techniques, therapy, and lifestyle changes can help reduce symptom flare-ups and improve quality of life for those with endometriosis.
Is endometriosis linked to cancer?
Endometriosis itself is not directly linked to cancer; however, it may slightly increase the risk of certain types of ovarian cancer. Regular monitoring and evaluation by a healthcare provider are crucial for early detection and appropriate management if any concerns arise.
Are pelvic pain patterns diagnostic?
Pelvic pain patterns can be diagnostic of endometriosis, but they may overlap with other conditions. It's crucial to consult with a healthcare provider for an accurate diagnosis. Tracking symptoms and seeking appropriate medical care are essential for effective treatment.
Can pregnancy alleviate symptom intensity?
Pregnancy might temporarily alleviate endometriosis symptoms due to hormonal changes, but it's not a guaranteed solution. Symptoms may return post-pregnancy as the condition is hormonally driven and doesn't have a definitive cure except through targeted treatments like medication or surgery.
Is chronic fatigue a symptom?
Yes, chronic fatigue is a common symptom of endometriosis. It can be caused by the inflammation and hormonal changes associated with the condition, leading to persistent tiredness and exhaustion in affected individuals.
Do symptoms worsen with age?
Symptoms of endometriosis can worsen over time, especially if left untreated. As a progressive condition, endometriosis can lead to increased pain, more severe menstrual symptoms, and potential complications such as infertility. It's crucial to seek early treatment to manage symptoms and prevent further deterioration.
Can lifestyle changes reduce symptoms?
Yes, lifestyle changes such as maintaining a healthy diet, regular exercise, managing stress, and getting enough sleep can help reduce symptoms of endometriosis. These changes can potentially improve overall well-being and reduce the impact of the condition on daily life.
Are symptom-free periods common?
Symptom-free periods are not common with endometriosis. Most women experience severe PMS-like symptoms such as chronic pelvic pain, heavy bleeding, painful intercourse, bloating, and more. Seeking early treatment can preserve fertility and prevent complications.
Is infertility a definite outcome?
Infertility is a possible outcome of endometriosis, not a definitive one. Early treatment can help preserve fertility, but it depends on individual factors like disease severity and age. Consulting with a healthcare provider can provide personalized guidance.
Does surgery guarantee symptom relief?
Surgery for endometriosis provides short-term pain relief, but it does not guarantee symptom relief long-term. Without hormonal suppression therapy after surgery, new endometrial plaques will form, and symptoms will likely recur.
Are bowel symptoms indicative signs?
Symptoms like painful bowel movements, diarrhea, constipation, or bloating can be indicative signs of endometriosis. However, they are commonly misdiagnosed as IBS. It's essential to consult an endometriosis expert for accurate diagnosis and treatment.
Can symptoms mimic bladder conditions?
Symptoms of endometriosis, such as urinary frequency and painful urination, can mimic bladder conditions. Misdiagnosis as a bladder issue is common, leading to delayed treatment and worsening symptoms. Early evaluation by an endometriosis specialist is crucial to differentiate and address the root cause accurately.
Is menopause a diagnostic challenge?
Menopause can be a diagnostic challenge due to overlapping symptoms with other conditions like thyroid disorders or depression. Hormonal testing and a thorough evaluation by a healthcare provider are essential to accurately diagnose menopause.
Do non-surgical treatments offer relief?
Non-surgical treatments like hormonal therapy, NSAIDs, and lifestyle changes can provide relief from endometriosis symptoms. These options can help manage pain, reduce inflammation, and improve quality of life without the need for surgery in some cases.
Are hormonal therapies always effective?
Hormonal therapies for endometriosis can effectively suppress the disease, reducing symptoms and preventing new implants. These treatments, like birth control pills and GnRH agonists, provide relief for most patients with minimal side effects. However, they do not permanently cure endometriosis, requiring ongoing management to prevent recurrence.
Can exercise impact symptom management?
Regular exercise can positively impact symptom management of endometriosis by reducing inflammation, improving blood flow, and releasing endorphins that can help with pain and overall well-being. However, it is essential to consult with a healthcare provider before starting any exercise regimen to ensure it suits individual needs and limitations.
Do symptoms disrupt sleep quality?
Symptoms of endometriosis, such as pelvic pain and discomfort, may indeed disrupt sleep quality. Pain and discomfort can make it challenging to fall asleep or stay asleep through the night, potentially leading to sleep disturbances and impacting overall quality of rest.
Can psychological therapy ease symptoms?
Yes, psychological therapy can help ease symptoms of endometriosis by providing coping mechanisms for chronic pain and emotional distress. Therapy can improve overall quality of life and mental well-being for individuals dealing with this condition.
Are fibroids misdiagnosed as endometriosis?
Fibroids are commonly misdiagnosed as endometriosis due to overlapping symptoms. Both conditions can cause pelvic pain and irregular bleeding. Accurate diagnosis requires thorough evaluation and differentiating between the two conditions to ensure appropriate treatment.
Are minimally invasive surgeries available?
Minimally invasive surgeries are available for endometriosis, utilizing small incisions and a lighted instrument to view and remove endometrial implants and scar tissue, improving fertility and reducing pain. Consult with a healthcare provider for personalized treatment options.
Does acupuncture provide symptom relief?
Acupuncture may provide symptom relief for endometriosis. While research on its effectiveness is mixed, some women report reduced pain and improved quality of life with acupuncture treatments. It is essential to consult with a qualified acupuncturist for personalized advice on managing endometriosis symptoms.
Is endometriosis hereditary in families?
Endometriosis can run in families, suggesting a genetic component. If a close family member has endometriosis, the risk increases. However, it is not strictly hereditary and can develop without a family history. Genetic factors play a role, but environmental factors can also contribute to its development.
Can early symptom recognition help?
Early symptom recognition can help in diagnosing endometriosis promptly, preserving fertility, and preventing complications. Recognizing common symptoms like pelvic pain, heavy bleeding, and painful intercourse can lead to timely treatment and improved quality of life.
Are new diagnostic tests emerging?
Yes, new diagnostic tests are emerging, such as rapid breath tests for SIBO, ultrasounds for endometriomas, and laparoscopy for visual confirmation of endometrial tissue growth. These advancements help in early diagnosis and personalized treatment plans for endometriosis patients.
Does menarche age affect risk?
Yes, menarche age can affect endometriosis risk. An earlier age at menarche is associated with an increased risk of endometriosis due to longer exposure to estrogen, which can lead to the development of the condition.
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