What is endometriosis?
Stages, Symptoms, Causes, Diagnosis and Treatment

OVERVIEW

What is Endometriosis?

Endometriosis is a female disease in which endometrial-like tissue is found outside of the uterus in other parts of the body. 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 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 4 commonly used classifications 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 one of the most highly believed theories 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 regular period in youth
  • "In your head"

SYMPTOMS

→ 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)

 

DIAGNOSIS

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:

  • US/Sonogram
  • MRI

What imaging tests help definitively diagnose 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. 

TREATMENT

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 are a mean 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 endometrioma 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

OUR APPROACH

How does our care differ from others?

Dr.Seckin, endometriosis surgery, endometriosis care and surgeryEven 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.

PATIENT STORY

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 646-960-3040 or have your case reviewed by clicking here.

References

  1. EndoFound https://www.endofound.org/endometriosis.
  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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Welcome to Seckin Endometriosis Center (SEC), an award-winning practice where you’ll find Dr. Tamer Seckin, an endometriosis excision specialist surgeon…

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Stages of Endometriosis
Stages of Endometriosis

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Patient Reviews

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  • Sheena Wright

    I underwent surgery with Dr. Seckin in 2017 and have felt like a new woman ever since. If you have, or suspect you have endometriosis, Dr. Seckin and his compassionate team of surgeons and staff are a must-see.

  • Angela Aro

    I have struggled with endometriosis and adenomyosis since first starting my period at 13. I was diagnosed at 21 and what followed was a series of unsuccessful surgeries and treatments. My case was very aggressive and involved my urinary tract system and my intestines. After exhausting all of my local doctors I was lucky enough to find Dr. Seckin. We…

  • Emi O

    Seckin and Dr. Goldstein changed my life!

  • Kristin Sands

    Like so many women who have tirelessly sought a correct diagnosis and proper, thorough medical treatment for endometriosis, I found myself 26 years into this unwanted journey without clear answers or help from four previous gynecological doctors and two emergency laparoscopic surgeries. I desperately wanted to avoid the ER again; a CT scan for appendicitis also revealed a likely endometrioma…

  • Wilfredo Reyes

    Dr. Seckin literally gave my wife her life back. I am eternally grateful to him for his generous, determined spirit to see that Melanie finally live free from the prison bonds of Endometriosis.

  • Carla

    I am so grateful to Dr Seckin and Dr. Goldstein. My experience was nothing short of amazing. I was misdiagnosed with the location of my fibroids and have had a history of endometriosis. Dr. Seckin was the one who accurately diagnosed me. Dr Seckin and Dr. Goldstein really care about their patients and it shows. They listened to my concerns,…

  • Melissa Boudreau

    When I think of Dr. Seckin these are the words that come to mind. Gratitude, grateful, life-changing, a heart of gold. I feel compelled to give you a bit of background so you can understand the significance of this surgery for me. I am passionate about Endometriosis because it has affected me most of my life and I have a…

  • Jaclyn Harte

    Dr. Seckin and Dr. Goldstein radically changed my quality of life. They treat their patients with dignity & respect that I've personally never seen in the literally 25+ doctors I've seen for endometriosis. This summer, I had a surgery with Dr. Seckin & Goldstein. It was my first with them, but my 5th endo surgery. I couldn't believe the difference,…

  • Megan Rafael Moreno

    I was in pain for 2 years. I was getting no answers, and because dr Goldstein and dr seckins were willing to see and treat me I'm finally feeling almost back to normal. They were very down to earth and helpful in my time of need. Dr Goldstein was easy to talk to and caring, she took care of me…

  • Nancy Costa

    Dr. Seckin is one of the best endometriosis surgeon. Every time I go to the office, he really listens to me and is always concerned about my issues. Dr Seckin's office staff are a delight and they always work with me. I feel I can leave everything to them and they will take care of it. Thank you to the…

  • Rebecca Black

    Fast forward 5 years to find out incidentally I had a failing kidney. My left kidney was only functioning at 18%. During this time, I was preparing all my documents to send to Dr. Seckin to review. However, with this new information I put everything on hold and went to a urologist. After a few months, no one could figure…

  • Monique Roberts

    I'll never stop praising Dr. Seckin and his team. He literally gave me back my life.

  • Erin Brehm

    I had a wonderful experience working with Dr. Seckin and his team before, during and after my surgery. I came to Dr. Seckin having already had laparoscopic surgery for endometriosis 5 years prior, with a different surgeon. My symptoms and pain had returned, making my life truly challenging and my menstrual cycle unbearable. Dr. Seckin was quick to validate my…

  • Anita Schillhorn

    I came to Dr. Seckin after years of dealing with endometriosis and doctors who didn't fully understand the disease. He quickly ascertained what needed to be done, laid out the options along with his recommendation and gave me the time to make the right decision for me. My surgery went without a hitch and I'm healing very well. He and…