A color-enhanced, scanning electron micrograph of endometriosis. A layer of endometrial epithelium (pink) can be seen growing on an ovarian cyst (brown). Ciliated and secretory cells are visible as well as considerable fibrin debris. Image credit: Yorgos Nikas, Wellcome Images.
Three Questions for Our Expert: Endometriosis
Endometriosis is a gynecological disorder in which cells from the uterus lining grow in other areas of the body and it is the number one reason for hysterectomies in women ages 18-35. Approximately 8 million women in the U.S. are affected by endometriosis so we’ve asked Sanjay Agarwal, MD, director of Fertility Services at UC San Diego Health System, three questions about this condition.
Question: Many women confuse endometriosis with having heavy periods. Is there a difference? How is endometriosis treated?
Answer: Yes, definitely. Endometriosis typically produces pelvic pain around the time of periods. It can also produce pain with intercourse and at other times. Heavy periods are more likely due to other gynecological conditions, such as fibroids.
Endometriosis related pain is usually initially treated with simple birth control pills. If after 3 months of taking these pills continuously – that is without the placebos—the pain is not sufficiently better, other medical and surgical options are usually required. Medical options include a variety of drugs including Depo-Provera, Danazol and Lupron. Each of these is FDA approved for the treatment of endometriosis. Although none has been shown to be more effective than the others, they do vary in side effects, which should be discussed with your doctor. Endometriosis can also be treated surgically by laser laparoscopy. The definitive surgical treatment is a hysterectomy with removal of the ovaries.
Q: A symptom of endometriosis is usually pain in the pelvic region but it isn’t necessarily confined to this area of the body. How can endometriosis affect other areas of the body?
A: This is absolutely correct. Pain from endometriosis is usually, but not always, in the pelvic region. Although endometriosis is not a cancer, it can spread to other areas of the body. In fact, I have a couple of patients with endometriosis in their lungs. They cough up blood whenever they have periods. The endometriosis probably gets to the lungs (or other areas away from the pelvis) via the blood or lymphatic systems.
Q: Does a diagnosis of endometriosis automatically equal a diagnosis of infertility? Should women with endometriosis attempt pregnancy?
A: Although some women with endometriosis have difficulty conceiving, many have no trouble whatsoever. Women with endometriosis wanting to conceive should go ahead and try. If the woman is under 35 years of age, it is reasonable to try for up to a year before seeking medical help. For women over 35 trying for up to 6 months prior to obtaining medical help is appropriate.
Agarwal is currently leading The Violet Petal Study at UC San Diego. This clinical trial is testing the effectiveness of an oral drug, Elagolix, for endometriosis. For more info, visit: https://www.violetpetalstudy.com/HomePage.aspx
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