Reporting Pain is First Step Toward Minimizing Suffering and Improving Fertility
Painful periods. Discomfort during sex. Abdominal pain. Diarrhea. Constipation.
Each of these are symptoms of endometriosis, a common medical condition in which tissue that normally grows inside the uterus grows outside of the uterus as well.
Endometriosis affects approximately 1 in 10 women of childbearing age and is a leading cause of female infertility — yet many women suffer for years before receiving an accurate diagnosis. The North American Endometriosis Association reports that a decade or more may pass between the onset of symptoms and proper diagnosis.
That’s because both women and healthcare providers often minimize the symptoms of endometriosis. “Women may think, ‘I thought periods should hurt’ or ‘pain is part of periods,’ ” says Dr. Victor Dabelea, an OB-GYN with Consultants in Obstetrics and Gynecology at Presbyterian/St. Luke’s Medical Center. “And many times, healthcare providers may not ask the right questions to diagnose a woman with endometriosis.”
Prompt diagnosis and treatment, however, can minimize suffering and improve fertility.
Straight Talk About Symptoms
Too many women accept pain as a normal part of menstruation and sexual activity. You can help your healthcare provider protect your health by speaking frankly about the sensations you experience on a regular basis. The American College of Obstetricians and Gynecologists, as well as Dabelea, urge women to report these symptoms:
- Pelvic pain
- Painful intercourse
- Low back pain, especially pain with no other physical explanation
- Abdominal pain, bloating or changes in bowel habits, especially if these changes seem related to your period
- Painful urination
Of course, these symptoms can occur for other reasons as well. Your healthcare provider should conduct a physical exam and may order some medical tests to determine the cause of your symptoms.
Dabelea says that it’s a good idea for women to directly ask, “Is there a chance that these symptoms might be endometriosis?”
If your healthcare provider brushes off your symptoms or if your symptoms persist despite a diagnosis and treatment, seek a second opinion. “If a woman doesn’t get a satisfactory answer from her physician, she should go and see another one. That is perfectly fine,” Dabelea says.
Such self-advocacy can decrease the delay between symptom appearance and proper diagnosis and treatment.
Diagnosing & Treating Endometriosis
Unfortunately, there are no blood tests or medical imaging tests that can accurately detect endometriosis.
“The best diagnostic tool is laparoscopy,” Dabelea says. Laparoscopy is a minimally invasive surgery allowing a surgeon to insert a thin, lighted tube into the abdomen through a small incision. Visualizing the interior of the abdomen, physicians can confirm (or rule out) the presence of endometriosis. It also helps them determine the extent of the disease and plan treatment.
Dabelea uses robotic-assisted surgery if he suspects endometriosis. “The biggest advantage of robotic surgery versus conventional laparoscopy is better visualization,” he says. Better visualization leads to improved diagnosis and treatment because physicians can pinpoint the sites affected by endometriosis.
Surgically removing the endometrial tissue can improve symptoms. “The more endometriosis we remove, the better the outcome for the patient,” Dabelea says. “Particularly in women who want to preserve fertility, we want to excise as much endometriosis as possible.”
The more experience the surgical team has, the more successful the surgery is likely to be. “In terms of treatment, it is important to find a center with a proven robotics track record in treating endometriosis, as well as one that provides a great overall experience,” Dabelea says.
Endometriosis may recur over time, so continued monitoring is essential. Women and their providers should work together to find a treatment regimen that meets women’s needs and respects their reproductive choices.
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