Endometriosis

What is Endometriosis?

Endometriosis is a female disease in which endometrial-like tissue is found outside of the uterus. Endometriosis lesions are characterized as estrogen-dependent, benign, inflammatory, stem-cell driven and at times progressive with diffuse fibrosis, deep infiltration, and resistance to apoptosis (cell death) and progesterone. This tissue, which normally lines the uterus, is associated with monthly menstruation and is often characterized by abnormal painful and heavy periods, as well as pelvic pain, severe cramps, and pain with sex (dyspareunia).

Endometriosis is a painful reproductive disorder that affects an estimated 176 million women worldwide [1]. The economic impact of the disease is staggering: Businesses lose billions of dollars each year in lost productivity and work time because of the disease. A leading cause of infertility and chronic pelvic pain, it has also been linked to other health concerns, including certain autoimmune diseases, fibroids, adenomyosis, interstitial cystitis, and even certain cancers. It is also one of the leading reasons for laparoscopic surgery and hysterectomy in the United States.

Where does it occur in the body?

  • Typical: It typically develops on the pelvic structures including the ovaries, fallopian tubes, bladder and bowels (intestines).
  • Common: It is common for the disease to develop on the top of the vagina (anterior cul-de-sac) and in the peritoneal cavity between the rectum and the posterior wall of the uterus (posterior cul-de-sac).
  • Rare: The disease can spread to the diaphragm, lungs, kidney, appendix, and, surprisingly, the gastrocnemius (calf muscles).

What are the stages?

StagesAmerican Society of Reproductive Medicine Severity Classifications
Stage I Minimal
Stage II Mild
Stage III Moderate
Stage IV Severe

What are the Descriptive Classifications?

Because the four stages of the disease do not have any correlation to a patient’s symptoms or the nature of the infiltration itself, we often use a more descriptive system:

Dr.Seckin's Preferred ClassificationDescription
Early peritoneal
  • Infiltration to the lining of the abdomen (peritoneum)
Ovarian endometriomas
  • Large, "chocolate" fluid-filled cysts that form on, and even encapsulate, the ovaries
Cul-de-sac obliteration
  • Infiltration of the tissue lining the back wall of the uterus and rectum (posterior cul-de-sac), an extension of the peritoneum
Deep infiltrating endometriosis (DIE)
  • On bladder: Invasive endo that penetrates to the bladder and bowel wall
Frozen pelvis
  • Rare condition, in which there are deep infiltrative attachments to pelvic ligaments, nerves and muscle tissue that partially or totally cements pelvic organs
retrograde menstruation
A high rate of retrograde menstruation is a popular theory in justifying the cause of the disease [2]. Endometrial cells are carried through the refluxed menstrual debris, which travels through the fallopian tubes

Causes

While there is no known exact cause of it, we accept the theory of "retrograde menstruation," while remaining open to newly developing ideas.

Risk Factors

It is important to note that while the following risk factors increase one’s likelihood for endo, there are many cases in which women are diagnosed without any of the following:

  • Family history, especially mother or sister
  • Average age range 25-40
  • History of menstruation complications (i.e. long menstrual cycles, frequent periods)
  • Not having children
  • High consumption of fats and red meat
  • Heavy alcohol intake

How does it affect pregnancy & fertility?

  • It is said to be responsible for one-third of infertility cases [3]
  • The longer a woman has endo, the more risk she has of infertility
  • Up to 70% of women with mild to moderate endo are still capable of conceiving

How can it lead to infertility?

  • Adhesions among ovaries, uterus and fallopian tubes impede the transfer of the egg to the fallopian tube
  • Ovarian implants prevent a release of the egg
  • The decrease in the number and quality of healthy eggs [4]

What is adenomyosis? How is adenomyosis different from endo?

  • Adenomyosis can be thought of as endo strictly within the uterine muscle, whereas endo is outside the uterus
  • 50% of adenomyosis patients also have endo

What conditions can it be related to?

Part of the reason why endo is such a complex and dangerous condition is that it can lead to several other related conditions, including:

  • Adenomyosis
  • Adhesions
  • Ovarian cysts
  • Bowel Endometriosis
  • Chronic pelvic pain
  • Infertility

What can it be misdiagnosed as?

It can mask itself as a number of conditions causing your doctor to misdiagnose or mistreat your condition as:

  • IBS
  • Appendicitis
  • Hemorrhagic Cysts
  • Need for Hysterectomy
  • A normal period or "just a bad period"
  • "In your head"

→ click for more Endo symptoms and signs

What are the symptoms?

What are the signs and symptoms that should concern me of endometriosis?

  • Painful menstrual cramps (dysmenorrhea or "killer cramps")
  • Heavy menstrual bleeding (menorrhagia)
  • Chronic pelvic pain
  • Pain upon intercourse (dyspareunia)
  • Abdomen pain and bowel dysfunction that includes painful bowel movements, diarrhea, bloating, gassiness or cramps
  • Bladder dysfunction, such as painful urination
  • Weakness, numbness or pain in nerves (neuropathy)
  • Fatigue
  • Infertility
  • Genetics
  • Personality changes (depression, stress, apathy)

 

What is the first step needed in order to diagnose?

Before any imaging is done, you should speak with a GYN physician who is familiar with diagnosing endo and can provide a full comprehensive pelvic exam. Between the physical exam and informing them of your symptoms and past medical history, a physician will have a better understanding if imaging tests are needed.

What are the imaging tests used to identify?

In order to properly diagnose a patient with endo, one or multiple of the following imaging tests must be conducted in order to ensure that a patient is in need of surgery:

  • Ultrasound/Sonogram
  • MRI

What imaging tests help definitively diagnose endometriosis during surgery?

While in an operating room, a well-trained and experienced GYN surgeon will be able to visualize any anatomical abnormalities or endometriosis lesions through the following tests:

  • Hysteroscopy
  • Laparoscopy

How is it detected?

While a physical exam and other imaging tests can give insight into whether or not a patient may have endo, the only way to definitively diagnose endometriosis is through laparoscopic excision surgery. This must be accompanied by a biopsy sample that is sent to pathology in order to confirm a diagnosis of the disease. 

What are the treatments?

There is currently no cure for endo but there are surgical and non-surgical treatment options for pain and infertility related to the disease.

What are non-surgical ways that can relieve symptoms?

It is important to note that the following methods are not treatments of the disease itself, but rather  a means to control a patient’s pain and symptoms. They provide a relief, not a cure.

  • Endometriosis Inflammation, Endometriosis Antioxidant DietPainkillers
  • Acupuncture
  • Birth Control
  • Diet
  • Medicated IUD

What surgical procedures can be performed during surgery?

There are a variety of surgical treatments that a patient can undergo to treat endo depending on the severity, stage, and abundance of the endometrioma lesions.

TechniqueDescription
Laparoscopic Deep Excision Surgery The "gold standard" for removing all endometriosis in the body, ranging from in the ovaries to the intestine
Myomectomy Removal of fibroids, necessary only when fibroids develop
Hysterectomy Removal of the uterus, which is only needed in cases of diffuse endometrioma tissue in the uterus such as with adenomyosis

How does our care differ from others?

Even to the common OB/GYN, endo is not an easy condition to diagnose. However, our care provides a number of advantages [5]:

  • Over 20 years of experience identifying, diagnosing and treating endo
  • Over 20 years of experience in laparoscopic deep excision surgery
  • Strong preference for laparoscopic deep excision surgery
  • Strong preference for excision surgery over robotics or laser ablation
  • Only performing hysterectomies or oophorectomy as last resorts, which is often rare
  • Patented technology, including the Aqua Blue Contrast technique (ABC)
  • High-quality surgical imaging

 

As a patient, your health and wellbeing come first. Having had decades of experience, we know that this is the most important aspect in treating the disease. Every patient is different and therefore every patient must be heard.

constant pain and suffering from endometriosis

Menoka M. was experiencing severe pelvic pain for the past seven years and was not diagnosed with endo for nearly five years. After seeing many doctors and having several surgeries, Menoka found us and was soon scheduled for laparoscopic deep excision surgery. Read about Menoka's journey here, as well as how she is doing now.

You can read more stories of patients with endo, of varying stages, in our testimonial section.

Our office is located on 872 Fifth Avenue New York, NY 10065.
You may call us at (646) 960-3080 or have your case reviewed by clicking here.

  1. What is endometriosis? Endometriosis Foundation of America
  2. Sampson, J.A., Metastatic or Embolic Endo, due to the Menstrual Dissemination of Endometrial Tissue into the Venous Circulation. Am J Pathol, 1927. 3(2): p. 93-110 43.
  3. D'Hooghe, T.M., et al., Endo and subfertility: is the relationship resolved? Semin Reprod Med, 2003. 21(2): p. 243-54.
  4. Goud, P.T., et al., Dynamics of nitric oxide, altered follicular microenvironment, and oocyte quality in women with endo. Fertil Steril, 2014. 102(1): p. 151-159 e5.
  5. Seckin, T., The Doctor Will See You Now: Recognizing and Treating Endometriosis. 2016.

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