What is endometriosis and how is it treated?
A closer look at a disease that affects millions of women
Endometriosis affects millions of women in the United States, and is one of the leading causes of infertility. If it hasn’t affected you, chances are it has affected a family member or friend.
Endometriosis is a disease of the female reproductive system. It happens when the uterine lining grows outside the uterus, causing pain, irregular bleeding and sometimes infertility.
It’s estimated that one in 10 women of childbearing age has endometriosis, according to the American College of Obstetricians and Gynecologists. It is most common in women in their 30s and 40s.
There is no cure yet and no one knows for certain why it happens.
“The good news is that there are plenty of treatment options for endometriosis to ease symptoms and improve quality of life," says Lily Tsai, MD, a robotic surgeon and obstetrician-gynecologist at Scripps Clinic.
Treatment includes medication, surgery or both. When surgery is necessary, it often can be done in a fertility-sparing way without having a hysterectomy, which is the removal of the uterus.
“Minimally invasive surgery, including robotic surgery, can remove the abnormal tissue associated with the condition,” Dr. Tsai says.
What are the symptoms of endometriosis?
Endometriosis most often occurs on or under the ovaries, on the fallopian tubes, behind the uterus, on the tissues that hold the uterus in place or on the bowels or bladder.
Endometriosis tissue may grow and bleed like the uterine lining does during menstrual cycle. This can cause pain and inflammation in the surrounding tissue.
Chronic pelvic pain is the most common symptom, especially just before and during menstruation.
Other symptoms include:
Pain during or after sex
Painful bowel movements or painful urination
Heavy menstrual periods
However, many women with the condition experience no symptoms at all.
How does it affect pregnancy?
Inflammation may damage the sperm or the egg, or interfere with their movements through the fallopian tubes and uterus. Surgery can be done to relieve pain and improve fertility.
Treatment options for endometriosis
Treatment depends on the extent of the disease.
Diagnosis usually involves going over your medical history with your doctor, getting a pelvic exam and when necessary, an imaging test.
Surgery is the most certain way to know if you have the disease. The most accurate method is a minimally invasive procedure known as laparoscopic surgery.
During this procedure, the surgeon makes small incisions and inserts a tiny camera and surgical instruments into the body.
“The camera projects images onto a video screen and, guided by the images on the screen, an experienced surgeon can perform the surgery,” Dr. Tsai says.
Robotic surgery is also a minimally invasive procedure, meaning it is less invasive than open surgery.
It is often done using the da Vinci surgical system. It is basically a laparoscopic procedure with an added layer of technology for better visualization.
“In some cases, this enables the surgeon to see tissue that we might have missed with standard laparoscopic views,” Dr. Tsai says.
In addition, the robotic instruments mimic the human hand and wrist and can be turned and rotated for better dexterity and precision. “This greatly expands our ability to perform surgery,” Dr. Tsai says.
Benefits of minimally invasive surgery
Minimally invasive surgery offers several benefits, including:
Reduced risk of complications
Less blood loss
Much smaller scars
Shorter hospital stays
“Like all surgery, minimally invasive surgery has both benefits and risks. So, it's important to talk to your doctor about all your treatment options,” Dr. Tsai says.
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