Endometriosis is a health issue that can affect women through their childbearing years. It’s when the tissue that typically lines the uterus grows in other parts of the body, most commonly in the lower abdomen, affecting the ovaries, fallopian tubes and tissue lining the pelvis.
“With endometriosis, the endometrial tissue outside the uterus acts the same way as it does inside the uterus, responding to the hormones the ovaries make each month, thickening and breaking down,” said Jennifer Gell, M.D., an obstetrician/gynecologist and reproductive endocrinologist at Geisinger. “But because the tissue is outside the uterus on surfaces where it does not belong, inflammation occurs.”
This can cause irritation and scarring of the surrounding tissue. It can also cause added pain during menstruation, during or after intercourse, during urination or bowel movements, as well as excessive bleeding and, in some cases, infertility.
There are a number of treatments for endometriosis, ranging from taking over-the-counter pain medication like ibuprofen or acetaminophen to reduce inflammation and pain; to contraceptives like birth control pills, the patch or the ring; to other types of hormone therapy.
However, many of these treatment options also prevent women from trying to conceive and, importantly, don’t treat infertility related to endometriosis.
“About one-third to one-half of women with endometriosis have trouble conceiving naturally without some medical intervention,” said Dr. Gell. For these women, a surgical procedure may be necessary if other treatment isn’t effective.
One procedure used to treat endometriosis is laparoscopic surgery to remove scar tissue, endometrial tissue and cysts that build up as a result of endometriosis. During the procedure, a surgeon will insert a laparoscope into a small incision in the abdomen to see endometrial tissue and remove it.
“Laparoscopic surgery that keeps the ovaries and uterus intact may help a woman who’s trying to get pregnant, and it can reduce pain for other patients,” said Dr. Gell. “However, endometrial tissue and pain can reappear following surgery.”
In some cases, more traditional abdominal surgery using a larger incision may be done to remove widespread endometriosis.
In rare cases, a hysterectomy and oophorectomy may be necessary to fully treat advanced endometriosis. A hysterectomy is a surgical procedure to remove the uterus and cervix; an oophorectomy is a surgery to remove the ovaries. Removing the ovaries will cause estrogen levels to drop, which will most likely reduce pain symptoms.
However, this may also spur menopause symptoms.
“This type of surgery is really a last resort for women whose pain is unmanageable and who have tried other treatments with no success,” said Dr. Gell. “When trying to treat endometriosis, it’s vital to work with a doctor you trust to find the best treatment option for you.”