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Endometriosis

OVERVIEW of Endometriosis

What is Endometriosis?

Endometriosis is a female disease in which the tissues responsible for menstruation are found elsewhere in the body outside the uterus. It is associated with monthly menstrual cycles and is characterized by pelvic pain, heavy periods, prolonged bleeding, severe cramps, and pain with sex (dyspareunia).

Endometriosis is a painful reproductive disorder that affects 176 million women worldwide. The economic impact of endometriosis 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 endometriosis occur in the body?

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

What are the "Stages of Endometriosis?"

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

What are the "Descriptive Classifications of Endometriosis?"

Because the 4 commonly used classifications of endometriosis do not have any correlation to a patient’s symptoms or the nature of the infiltration itself, we often use a more descriptive system:

Seckin Endometriosis Center's Preferred ClassificationDescription
Early peritoneal endometriosis
  • 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 (cul-de-sac), an extension of the peritoneum
Deep infiltrating endometriosis (DIE)
  • Invasive endometriosis 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 menstruationWhat causes endometriosis?

While there is no known exact cause of endometriosis, we believe that the best established theory of causation is "retrograde menstruation."

What risk factors make me more likely to develop endometriosis?

It is important to note that while the following risk factors increase one’s likelihood for endometriosis, 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. short menstrual cycles, frequent periods)
  • Not having children
  • High consumption of fats and red meat
  • Heavy alcohol intake

How does endometriosis relate to infertility?

  • Endometriosis is said to be responsible for onw-third of infertility cases
  • The longer a woman has endometriosis, the more risk she has of infertility
  • Up to 70% of women with mild to moderate endometriosis are still capable of conceiving

How does endometriosis specifically lead to infertility?

  • Adhesions among ovaries, uterus and fallopian tubes impede the transfer of the egg to the fallopian tube
  • Fallopian tube implants block the egg’s passage
  • Ovarian implants prevent release of the egg

How does endometriosis differ from adenomyosis?

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

What other related conditions can endometriosis cause?

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

What can endometriosis be misdiagnosed as?

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

  • IBS
  • Appendicitis
  • Ovarian cysts
  • Need for Hysterectomy
  • Regular period in youth
  • "In your head"

SYMPTOMS of Endometriosis

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

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

 

DIAGNOSIS of Endometriosis

What is the first step needed in order to diagnose my endometriosis?

Before any imaging is done, you should speak with a GYN physician who is familiar with diagnosing endometriosis 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 imaging tests are used pre-surgery to identify endometriosis?

In order to properly diagnose a patient with endometriosis, 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

How is Endometriosis formally diagnosed during surgery?

While in an operating room, a well-trained and experienced GYN surgeon will be able to visualize and see any endometrioma scar tissue through the following tests:

  • Hysteroscopy
  • Laparoscopy

TREATMENT of Endometriosis

What are non-surgical ways that can relieve endometriosis symptoms?

It is important to note that the following methods are not treatments of the disease itself, but rather are 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
  • Progestin
  • Medicated IUD

What surgical procedures are performed to treat endometriosis?

There are a variety of surgical treatments that a patient can undergo to treat endometriosis 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 to Endometriosis

How does our care differ from others?

Dr.Seckin, endometriosis surgery, endometriosis care and surgeryEven to the common OB/GYN, endometriosis is not an easy condition to diagnose. However, our care provides a number of advantages:

  • Over 20 years of experience identifying, diagnosing and treating endometriosis
  • 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 ovariectomies 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 endometriosis. Every patient is different and therefore every patient must be heard.

Our office is located on 5th Ave and 68th NY, NY.
You may call us at 212-988-1444 or have your case reviewed by clicking here.

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PATIENT STORY

Menoka M. was experiencing severe pelvic pain for the past seven years and was not diagnosed with endometriosis 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.

 

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