Gyn LA is a full-service women’s healthcare practice providing a range of gynecological treatments and surgeries. The team of highly-qualified and experienced doctors is committed to providing a broad spectrum of healthcare services to women as they progress through different stages of womanhood. Serving to empower women in and around the Los Angeles area, all our medical professionals are skilled and have years of experience to address various health needs of women. The doctors and staff have successfully handled cases of endometriosis while taking care of a woman’s unique medical needs and desires in a friendly and respectful environment.
Endometriosis: An Overview
Endometriosis is a common health problem in women. Sometimes referred to as "endo," endometriosis has acquired its name from the term endometrium—a tissue that normally lines the interior of a womb or uterus. Endometriosis occurs when tissue similar to endometrium grows in a location outside the uterus or any other part of the body. The abnormally implanted tissue that grows outside of the uterus cavity is called an endometrial implant. Although these endometrial implants cause problems, they are mostly benign (non-cancerous).
Endometriosis most commonly occurs in the abdomen or pelvic area and can grow to affect the reproductive organs in a woman. The endometrial implants are mostly found on the fallopian tubes, ovaries, the outer layer of the uterus, the bowel, and the peritoneum. The other less common sites involve the cervix, vagina, rectum, or bladder. In occasional cases, they may be found in other organs of the body, such as liver, lung, brain, and old scars.
In a condition of endometriosis, although the endometrial implant grows outside of the uterus, it continues to act like the endometrium, which sheds during menstruation every month. As the endometrial implant grows and bleeds, the blood finds no way to exit the body during the menstrual period, and it gets trapped. When this menstrual blood touches the surrounding organs, it causes painful scarring and inflammation. This condition can also result in developing scar tissue and adhesions, which further contributes to the pain.
This chronic disorder is a common gynecological condition that is estimated to affect 3 to 10 percent of women during reproductive years.
Symptoms of Endometriosis
Over 5.5 million women in America exhibit symptoms of endometriosis. Symptoms about endometriosis are generally present during the reproductive age. It is more likely to occur as you get into your 30s and 40s. The symptoms can be unclear and may match to symptoms of other medical conditions too. A lot of women experiencing symptoms of endometriosis may take two to five years before being diagnosed with the condition.
Pelvic pain is the primary sign of endometriosis and often associated with menstrual pain that is a whole lot worse than usual pain during menstrual periods. However, the severity of pain isn’t always a reliable indicator of the condition’s stage or extent.
Other common symptoms of endometriosis include:
- Heavy and painful menstrual bleeding (gets worse with time)
- Severe menstrual cramps
- Heavy spotting or bleeding between periods
- Chronic pain in the pelvis or lower back
- Pain during or after sexual intercourse (dyspareunia)
- Pain during bowel movements or urination
- Trouble to get pregnant, infertility
- Other symptoms include bloating, nausea, fatigue, constipation, diarrhea, especially during the periods.
Some other medical conditions, such as ovarian cysts, irritable bowel syndrome (IBS), and pelvic inflammatory disease (PID) can show closely related symptoms of endometriosis. In some cases, women with endometriosis may not show any signs and symptoms at all.
Stages of Endometriosis
Based on the American Society for Reproductive Medicine (ASRM), endometrial implant’s location, depth, and extent, endometriosis is classified in a system of staging. According to There are four stages of endometriosis, which include:
Minimal Endometriosis (Stage 1): Characterized by a few small implants or small wounds or lesions that may be present on your pelvic lining.
Mild Endometriosis (Stage 2): Characterized by light wounds or lesions and shallow implants that are deeper in the tissue than in stage 1. They may grow on an ovary and the pelvic lining.
Moderate Endometriosis (Stage 3): Characterized by several deep implants and may also have small cysts on the ovaries. Flimsy lesions may also be present.
Severe Endometriosis (Stage 4): Characterized by many deep implants on your pelvic lining, thick adhesions on your bowels and fallopian tubes, and large cysts on one or both ovaries.
Endometriosis is often classified based on the affected area in the pelvic region. Following are the four types of endometriosis:
- Superficial peritoneal endometriosis
- Deeply infiltrating endometriosis (DIE)
- Abdominal wall endometriosis
Causes of Endometriosis
The exact cause of endometriosis is unclear and has not been identified by the experts, but experts have certain theories about how and why this condition occurs.
If you have a family history of endometriosis, like your mother or sister had this condition, there is a higher probability that you will get it too. If you start menstruation at a relatively young age or if your menstruation period lasts longer than seven days, you are at a higher risk of getting endometriosis.
Another theory suggests that endometrial cells present in the menstrual blood flow back into the pelvic cavity in place of getting out of the body. These cells then stick to organs, keep growing and bleeding over a period. This is called retrograde menstruation.
Sometimes, the misplaced endometrial cells may also shift to the female pelvic cavity in other ways, such as during cesarean delivery. These cells may also fail to move out of the body due to an immune system disorder.
Some women may be more prone to developing endometriosis than others. Following factors may increase the risk:
- Reproductive age of 30 to 40 years
- Family history of endometriosis
- A condition of never having given birth
- Personal medical history
- Menstrual cycles of less than 27 days
- Consumption of alcohol and caffeine products
- Lack of exercise
A diagnosis of endometriosis is possible through the following:
Medical History and Physical Exam. During a physical pelvic examination, the doctor will try to manually feel your pelvic region to reveal abnormalities like scars or cysts in the uterus, ovaries, or cervix. The smaller areas of endometriosis are mostly harder to feel unless a cyst has formed.
Ultrasound and MRI. Your doctor may perform a pelvic ultrasound test to check for cysts on one or both ovaries from endometriosis. Another common imaging test if the Magnetic resonance imaging (MRI) that involves seeing the inside of your body through a picture.
Laparoscopy. For a diagnosis of endometriosis, your doctor must perform a laparoscopy procedure (keyhole surgery) that involves a thin, lighted scope inserted into a tiny hole in your abdomen (or pelvic area) to visualize the endometriosis tissue on the ovaries through a camera. Sometimes your doctor may diagnose endometriosis just by looking at the endometrial growths, while in other cases, he or she may possibly take a small sample of suspected endometriosis tissue for biopsy to confirm the condition. Sometimes, during random biopsies done for laparoscopy can display microscopic endometriosis, although no growths are visualized.
If the doctor fails to find any symptoms of an ovarian cyst in an ultrasound test, he or she may prescribe certain medications like Gonadotropin-releasing hormone (GnRH) agonists or hormonal birth control.
One of the main complications with endometriosis is that it might affect your fertility. In women with endometriosis, the egg released from an ovary, which travels through the fallopian tube is obstructed from uniting with the sperm cell to begin future development. However, it does not mean that endometriosis also affects a woman's fertility in other ways, for example, by damaging the egg or sperm.
A higher rate of ovarian cancer is seen in women who have endometriosis; however, the chances are still relatively less.
In rare cases, endometriosis-associated adenocarcinoma, a type of cancer can develop later in life in women who have had endometriosis.
Since there is no proper understanding of the cause, there are no ways to totally prevent endometriosis. However, you can lower the chances of developing endometriosis by managing your symptoms.
One way to reduce your chances of getting endometriosis is by lowering your estrogen hormone levels in your body. Your doctor may prescribe birth control methods, such as patches, pills, or vaginal rings with low doses of estrogen. The severe pain experienced during endometriosis can be controlled with hormone therapy, but it will work only if you continue to take the hormones.
Exercising regularly is a great way to lower your chances of developing endometriosis. It will help you reduce the percentage of body fat, which decreases the amount of estrogen circulating in the body. Having a quality sleep at night will boost your immune system as well as finding ways for stress management and relaxation through yoga, mindfulness therapy,
Women should also avoid consumption of a large amount of alcohol or drinks like sodas and green tea, which may raise estrogen levels in their body. Several research studies have been done on this, and they have mixed results.
There is no standard cure for endometriosis; still, there are treatments available to control the symptoms and manage potential complications. Your doctor generally starts the treatment with conservative therapies, such as medications.
Pain-relief Medications. During the reproductive years, the symptoms for endometriosis are merely managed. Your doctor may prescribe you pain medications, such as non-steroidal anti-inflammatory drugs (NSAIDs). NSAIDs, like naproxen or ibuprofen, will help you relieve pain and menstrual cramping associated with endometriosis. These medication drugs only treat the symptoms, not the underlying condition. Birth control pills may also prevent the monthly buildup of endometrial tissue on the ovaries or other locations in the body. This helps to reduce the symptoms of endometriosis while making the menstrual periods lighter.
Hormonal Therapies. Hormonal therapy may be used as a treatment for minimal to severe endometriosis to reduce pain if medications don’t help. However, it is not a permanent fix for the problem.
Managing with hormone therapies will include:
- Combined oral contraceptive pill (COCP)
- Progestin therapy
- GnRH agonists and antagonists
- Aromatase inhibitors
Surgery. If other treatments don’t contribute to improving your condition, your doctor may recommend surgery to remove the endometrial implants without disturbing your ovaries and uterus. This can be done by traditional abdominal surgery or more commonly through laparoscopy surgery. During a laparoscopy treatment, the doctor may remove endometrial growths or adhesions, providing immediate pain relief. However, it has been seen that about 45 percent of women experience a recurrence of symptoms after a year. Hormonal therapy immediately followed by surgery may help.
In cases of extensive endometriosis, surgical removal of the uterus (and sometimes also the fallopian tubes and ovaries) can be done for women who don’t want to get pregnant. This procedure is called a hysterectomy. Sometimes it is paired with oophorectomy, i.e., surgical removal of ovaries. This leads women to menopause. It may help with improving pain for some women but may cause other health concerns for others.
An appointment with a gynecologist may help you with where to start and how to proceed with your endometriosis treatment. During an appointment, in order to better understand your condition and treatment, you may want to jot down your questions you may want to ask, prepare answers for those your gynecologist may have for you, and keep track of the type and time of your symptoms. Every bit of provided information about the symptoms would help the doctor to decide the best treatment for you.
Find a Los Angeles Gynecology Practice Specializing in Endometriosis
Pain and cramping during your period can be seriously discomforting. However, if you or a loved one have symptoms of endometriosis, the pain you feel can be intense and can even start interrupting your daily life. Early diagnosis and understanding of your diagnosis by a multidisciplinary medical team may result in better management of your symptoms. Located in Los Angeles, Gyn LA is a full-service medical practice with a specialized team of expert doctors that can help you in early diagnosis and treatment of endometriosis through medication or surgery. Call us at 310-375-8446 to speak to one of our skilled doctors and schedule an appointment to discuss any of your gynecological needs.