Paul Tyan, MD is an OB-GYN and minimally invasive gynecological surgery expert. He is board-certified in obstetrics and gynecology.

Endometriosis is a common and underdiagnosed cause of chronic pelvic pain and infertility among women. Our best estimate is that around 10 percent of reproductive-age women have endometriosis. 

The innermost layer of the uterus, called the endometrium, is extremely susceptible to hormonal fluctuations. Every menstrual cycle, the endometrium is stimulated by hormones and grows as it gets ready for a potential pregnancy. If a pregnancy does not occur, the layer sloughs off, and a menstrual cycle ensues. Endometriosis occurs when this hormonally active layer seeds on other organs. As those cells are stimulated, they proliferate and cause inflammation, which can result in significant pain, depending on which organ they affect. The most commonly affected organs are the ones close to the uterus, such as the ovaries and fallopian tubes, the large bowel, the bladder, and the lining of the pelvis. However, endometriosis can be found in almost any organ in the human body. There are several theories about what causes endometriosis, but none has been conclusively proven.

The diagnosis of endometriosis can be very broad, as patients can experience a wide array of symptoms. Most commonly, the organs that are affected by endometriosis become persistent pain generators for patients. Given the wide range of organs that can be affected, the list of symptoms caused by endometriosis is long. These symptoms are also shared with multiple other disease processes, making the diagnosis of endometriosis even more difficult. Furthermore, not every patient who has endometriosis has pain symptoms, and the degree of involvement does not correlate with the severity of the symptoms. This diagnostic dilemma has resulted in a significant and frustrating delay from the onset of symptoms to diagnosis. On average, it takes patients seven to ten years to get a conclusive diagnosis. 

The only way to conclusively diagnose endometriosis is by surgical observation and removing the disease. Usually, when a patient comes to the clinic with symptoms that suggest endometriosis, a physician can offer medical or surgical treatment options. Choosing surgery or medications as a first-line treatment is complex and requires shared decision-making between the patient and her physician. There are benefits to both surgical and medical treatment of endometriosis. Surgery can provide a conclusive diagnosis, and endometriosis can be excised at the same time. Medications allow patients to see improvement in symptoms without having to undergo surgery. If a patient chooses the medical treatment path, her diagnosis would be presumptive and not conclusive. 

Obstetricians and gynecologists are well versed in the medical management of endometriosis. However, surgical management of endometriosis requires advanced surgical skills. Patients should seek out surgeons trained in minimally invasive surgery who perform a high volume of procedures. To learn more, join Dr. Tyan and his partner, Nadim Hawa, MD, for a live Zoom session about endometriosis on March 23 from 5 – 6 p.m. Dr. Tyan and Dr. Hawa will discuss the signs, symptoms and treatment options for endometriosis as well as answer your questions. Please register here.

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