Endometriosis in Cincinnati, OH
If you suspect you may have endometriosis, Crescent Women’s Medical Group, led by board-certified gynecologists (OB-GYN) Drs. Chandra Gravely and Cindy Hansel, will work with you for the best treatment options. Our team of experts provides state-of-the-art gynecologic care for women who reside in the Cincinnati and Blue Ash areas of Ohio.
What is Endometriosis?
Endometriosis is a condition marked by the growth of endometrial tissue, or uterine lining outside the uterus and, in some cases, on other neighboring organs. Endometriosis is typically diagnosed when women complain of lower abdominal pain, pain accompanying menstruation or pain during sexual intercourse, and, in some women, the condition impairs the ability to become pregnant. Still other women with endometriosis may experience little to no symptoms.
It is estimated that endometriosis affects between three and 10 percent of women during the reproductive years. Endometriosis is best diagnosed by a doctor performing a laparoscopy, a surgical procedure that allows a physician to examine the inside of the abdominal cavity via a lens usually inserted through the belly button. In women who exhibit none of the typical symptoms of endometriosis, the disease may be diagnosed while having surgery for another reason. For example, among women who undergo elective sterilization surgery, such as having their tubes tied, one to seven percent will be diagnosed with endometriosis during surgery, as will 12-32 percent of women undergoing surgery for pelvic pain and nine to 50 percent of women undergoing surgery for infertility. Endometriosis is uncommon in pre-pubescent girls, but about 50 percent of teen girls and younger women who exhibit symptoms of chronic pelvic pain and painful menstruation actually have endometriosis.
Causes of Endometriosis
There are several theories on the causes of endometriosis. One is that during menstruation, blood and tissue from the uterus may squeeze out through the fallopian tubes and into the abdominal cavity. This is referred to as retrograde menstruation. Another theory is that certain cells outside the uterus may actually morph into the same type of cells that line the uterus. This is a common explanation for endometriosis found at unusual sites, such as the thumb or knee. Another theory is that the cells from the lining of the uterus may travel through blood vessels or through the lymphatic system to other organs or areas in the body. Endometriosis may also spread during surgery. For example, during a cesarean section, endometriosis cells could become attached to the abdominal incision leading to endometriosis at the site of the scar from the surgery.
Although a majority of women experience some degree of retrograde menstruation, only a small percentage of women will develop endometriosis, possibly due to variations in immune system health. Endometriosis may also be genetically influenced as the disease is much more common in women who have had close relatives who also had endometriosis.
Why Does Endometriosis Cause Pain?
During menstruation, endometriosis causes bleeding not only from the cells and tissue inside the uterus but also from cells and tissue outside the uterus. The presence of this blood in the abdominal cavity may cause inflammation and irritation, causing pain. Additionally, scar tissue may also develop as a result of endometriosis, causing irritation and inflammation in the lower abdomen, which also causes pain.
Why is Endometriosis Associated with Infertility?
Between 20 and 40 percent of women with infertility are diagnosed with endometriosis. Endometriosis causes infertility by distorting the fallopian tubes so that they are unable to perform their normal function after ovulation and by causing inflammation around all the reproductive organs that impair the function of the ovary, egg, fallopian tubes and/or uterus.
Symptoms of Endometriosis
Pain, particularly in the pelvis or lower abdomen, and chronic pain with menstruation, is the most common symptom of endometriosis. Some women also report pain during sexual intercourse. The symptoms are typically “cyclical” with levels of pain intensifying just prior to or during the menstrual period and lessening after menstruation. Some women experience constant pelvic or lower abdominal pain as well. Other symptoms may include subfertility, pain with bowel movements, bloating, constipation, blood in the urine, pain with urination, and in some cases, abnormal vaginal bleeding.
How is Endometriosis Diagnosed?
Endometriosis is best diagnosed by a doctor performing a laparoscopy, a surgical procedure that allows a physician to examine the inside of the abdominal cavity via a lens usually inserted through the belly button, and by taking a tissue sample. Some physicians opt to treat suspected endometriosis with medications in an attempt to alleviate symptoms without surgery. Although this may be possible, improvement in symptoms with medication alone is not sufficient evidence for an accurate diagnosis. When viewed during surgery, endometriosis lesions are said to look like “cigarette burns” inside the abdomen, although there are many variations in the appearance of endometriosis lesions. Endometriosis may also be located on and even inside an ovary, causing an endometrioma, or a cyst of endometriosis. These cysts are often described as “chocolate cysts,” because the inside of the cyst resembles chocolate syrup.
How is Endometriosis Treated?
The most conservative treatment option for endometriosis is by using medications. Non-steroidal anti-inflammatory medications, such as ibuprofen, may alleviate the pain associated with endometriosis. Some doctors may prescribe medications that affect hormone levels, such as oral contraceptive pills or gonadotropin-releasing hormone (GnRH) agonists, the latter of which invoke a “temporary menopause.”
Surgery is used to not only diagnose endometriosis but also to treat the condition. Surgery can effectively remove the endometriosis or burn the lesions outside of the uterus to eliminate them. Surgery can also remove scar tissue so that the ovaries and tubes may return to their normal location and function. Surgery has been shown to alleviate pain associated with endometriosis and may also help women become pregnant. If a woman with endometriosis is not interested in future pregnancy, she and her physician may decide to remove the ovaries and possibly the uterus.
If you seek the most advanced and compassionate gynecologic care available to women in the Cincinnati and Blue Ash areas of Ohio, contact our team of experts at Crescent Women’s Medical Group today. Our team of specialists is on hand to treat a variety of women’s medical problems, including endometriosis and other conditions affecting the reproductive organs.