The Cause

The lining of a woman’s uterus, the endometrium, is made up of special cells that are perfect for the functions of menstruation and pregnancy. When these special cells and their supportive structures (endometrial tissue) grow outside of the uterus endometriosis develops. When these cells and their supportive structures grow within the body of the uterus the condition is called adenomyosis.

Endometrial tissue reacts to hormonal changes. That’s why women bleed during menstruation and can support a growing fetus during pregnancy. The endometrial tissue that grows outside of the uterus or within the muscular structures of the uterus reacts to hormones as well, causing internal bleeding during menstruation and scarring once menstruation stops. Depending on where these growths form, they can cause pain, infertility, bowel problems, even adhesions that bind organs together. Furthermore, under rare conditions, endometriosis can grow into any surgical scars, the diaphragm, the lung – in one extreme case, we diagnosed endometriosis of an eye.

Endometriosis affects many women, behaves quite aggressively at times, causes an infinite number of problems – both emotional and physical – grows anywhere it wants to in a human body, and yet it is not cancer. It’s no surprise that this condition was called a “mystery of the century,” although this mystery involves way more than one century of extensive scientific work.

The Symptoms

  • Chronic pelvic pain that gets worse during menstruation
  • Pain during intercourse
  • Increased menstrual pain
  • Infertility
  • Painful urination and/or bowel movements
  • Nausea
  • It can lead to silent (asymptomatic) kidney damage as a result of ureteral obstruction
  • Fatigue, chronic stress, and emotional disturbances
  • Frequent yeast infections

If you have any of these symptoms, your physician may suspect endometriosis. While endometriosis can be suspected based on the symptoms alone, if a cyst or deep endometriotic nodules are detected, a transvaginal ultrasound or MRI may need to be perfumed to evaluate the extent of the condition and the state of the surrounding organs and structures. The only definitive way to diagnose the condition, however, is through laparoscopy, a minimally invasive surgical procedure that allows your gynecologist to look inside your body with a thin camera inserted through a 1-1.5 cm incision in your abdomen. Through this outpatient procedure, the size, location, and extent of endometrial growth can be determined and treatment can take place.

The Treatment
Endometriosis may be treated with medication, surgery, or both, depending on the extent of the problem, the amount of pain it causes, and whether or not the patient is able, and desires, to have children.

At times we feel that treatment of endometriosis involves treatment of a couple. When good communication is established to address the problem, a cooperative treatment plan can begin. In this way, the entire family feels attended and cared for and the healing can begin in earnest.

Depending on the age, extent and location of endometriosis, and in consideration of the reproductive needs of a woman, we select medical or surgical approaches. Various hormonal regimens may be prescribed to suppress the mechanism that leads to pain, to suppress the growth of endometriotic lesions and reduce the formation of new ones, and as a result, to prevent the formation of new adhesions. Neither treatment will eradicate current growths or adhesions, however.

Another option is minimally invasive laparoscopic/endoscopic surgery that focuses on removal of endometriotic growths and adhesions. This option applies to women who consider pregnancy in the near future and cannot have intercourse due to pelvic pain. It also applies to women who experience pain that does not respond to hormonal medications or non-medical approaches. We remove these lesions, or perform separation or removal of the adhesions, using a contact nd:Yag laser scalpel that allows for a precise dissection with minimal blood loss. Additionally, Laparoscopy allows for a inspection of the tissue under magnification, enhancing our ability to detect all lesions and to select a specific surgical strategy.

We reserve hysterectomy for women who have completed their reproductive function and in whose case we highly suspect adenomyosis. We very rarely recommend removal of ovaries or tubes based on lack of pain reduction. If pain does not respond to excision or Lupron, there might be additional cause of pain not diagnosed previously.

If you think you have endometriosis
If you suffer from any of the symptoms of endometriosis, please make an appointment with Dr. Stepanian.

At Academia of Women’s Health and Endoscopic Surgery, we have extensive experience with the diagnosis and treatment of endometriosis. We focus on your goals with a holistic, minimally invasive approach. We treat the whole person, considering mental, emotional, and social factors as well as the symptoms of your problem.

  • Do you want to stop pain in a specific area?
  • Do you want to eliminate the pain you feel during sexual intimacy?
  • Do you want to have children?

By prioritizing and focusing on your goals, we make sure that your treatment is precisely what you need to live a healthy, fulfilling life.