Do you experience unbearably painful periods? Do you have severe pain in your abdomen or lower back every time your menstrual cycle starts? Are your menstrual cycles characterized by excessive bleeding, painful urination, painful sexual intercourse, or painful bowel movements?

You might want to consider getting checked to see if you are suffering from a condition called endometriosis.

With these symptoms, you should see a gynecologist or female pelvic medicine and reconstructive surgery (FPMRS) physician as soon as possible. At Advanced Urology Institute, we have FPMRS physicians at our Fort Myers center who can provide a proper diagnosis.

What is endometriosis?

EndometriosisEndometriosis is a disorder in which a tissue, similar to the tissue that lines the inside of your uterus, grows in an area outside of it. Although found outside the uterus, the endometrial-like tissue behaves like a typical endometrium. That is, it thickens, breaks down, and bleeds with every menstrual cycle.

Unlike the by-products of normal endometrial tissue, they have no way of leaving your body. That means they are trapped somewhere in your body and eventually result in complications.

They cause severe irritation, pain, and excessive bleeding, particularly during menstrual periods. They may also cause scar tissue and adhesions, making pelvic tissue and organs stick to each other. Ultimately, this condition may interfere with your sex life and even cause infertility.

How can it affect you?

Endometriosis commonly occurs in the ovaries, fallopian tubes, and the tissue lining the pelvis. But it can also affect the vagina, vulva, intestines, bladder, cervix, rectum, and abdominal surgery scars.

It may also develop in the outer areas of your uterus—in the uterosacral ligaments (ligaments that support the uterus), the space between the uterus and rectum (posterior cul-de-sac), or between the uterus and bladder (anterior cul-de-sac).

What causes endometriosis?

The cause of endometriosis remains unclear. However, it is believed to result from the direct implantation of endometrial tissue during menstruation or a transformation of other body cells into endometrial cells.

For instance, some endometrial cells flow back up through the fallopian tube into your abdomen, where they attach and grow. Portions of your endometrial tissue may also travel through the blood or lymphatic channels and implant in other areas of the body.

In some cases, body cells change into endometrial cells in any location of the body, and the resulting tissue then thickens, breaks down, and bleeds during subsequent menstrual cycles.

Endometriosis may also occur after a cesarean section, should endometrial cells transplant to the abdominal wall.

So the specific causes of endometriosis include:

  1. Retrograde menstruation
  2. Transformation of peritoneal cells
  3. Immune system disorder
  4. Endometrial cell transport
  5. Surgical scar implantation
  6. Embryonic cell transformation

What are the symptoms of endometriosis?

  1. Pain during sexual intercourse
  2. Painful periods (dysmenorrheal)
  3. Excessive bleeding
  4. Infertility
  5. Pain in the abdomen or the lower back, especially intense menstrual cramps
  6. Painful urination during menstrual periods
  7. Painful bowel movements during menstrual periods
  8. Heavy or abnormal menstrual flow
  9. Gastrointestinal problems, like constipation, diarrhea or nausea
  10. Blood in urine or stool
  11. Fatigue, constipation, bloating, diarrhea, or nausea, during menstrual periods

It is important to understand that the severity of menstrual-related pain is not a reliable indicator of the extent of endometriosis. You may have mild endometriosis that presents with severe pain. Or you may also have a severe condition with little or no pain.

How is endometriosis diagnosed?

Your urogynecologist will review your medical history and conduct a physical examination, including a pelvic exam, to have a better understanding of your condition.

With endometriosis, the body presents various symptoms, more commonly infertility or pain. The examination focuses on these symptoms and aims to understand their extent, particularly the nature of the pain.

At Advanced Urology Institute, a pelvic ultrasound is the first test, followed by the use of a trans-vaginal probe to detect the condition. Endometriosis typically presents itself as a cyst (fluid-filled sac) behind or in front of the uterus or between the vagina and rectum.

In most of the cases we see at AUI, the ultrasound exam is enough to detect endometriosis. However, in some cases, more sophisticated magnetic resonance imaging (MRI) may be necessary.

Your female pelvic medicine and reconstructive surgery (FPMRS) physician may also perform a laparoscopy. This procedure is done to extract a piece of suspicious tissue to confirm the condition by examining the tissue under a microscope. It is referred to as tissue biopsy and is a very reliable means of determining endometriosis.

What are the treatment options?

If it is confirmed that you have endometriosis, a multidisciplinary team will convene to carefully plan your treatment. The specific treatment depends on your overall health, medical history, the extent of disease, desire for pregnancy, and tolerance for specific medications, procedures or therapies.

If you have mild symptoms, your urogynecologist may recommend watchful waiting, where no further treatment, other than pain medication, is given. The pain medication is usually non-steroidal anti-inflammatory drugs, such as ibuprofen.

In some cases, your urogynecologist may recommend hormone therapy. You will be given oral contraceptives, with synthetic progestin alone or estrogen combined with progestin. You can also receive a gonadotropin-releasing hormone agonist, which stops the production of ovarian hormones.

When conservative options are inappropriate or ineffective, your female pelvic medicine and reconstructive surgery (FPMRS) physician may recommend surgery. Your lead urogynecologist will ensure you fully understand the planned surgery, including the benefits, risks, and alternative treatments.

Why Advanced Urology Institute?

At Advanced Urology Institute, we provide personalized care for women with all stages of endometriosis and related disorders. Our urogynecologists work with patients to develop comprehensive treatment plans suitable to their needs.

When you trust us to care for you, we will conduct an initial consultation to review your medical history and then perform a pelvic exam to confirm the condition. Once we diagnose your condition, we will devise a personalized treatment plan that we share with you before we can begin treatment. If surgery is recommended, your urogynecologist will perform a minimally-invasive vaginal, laparoscopic or robotic procedure through incisions as small as 5-8 millimeters, ensuring less blood loss, minimal scarring, and faster recovery.

Our approach to care is compassionate and multidisciplinary. It allows you to understand your diagnosis and treatment options and guarantees the best possible outcomes.

Speak with our skilled and experienced female pelvic medicine and reconstructive surgery (FPMRS) physicians at our Fort Myers center and put an end to unbearable pain during your menstrual cycles. For more information about endometriosis and other gynecologic disorders, visit the Advanced Urology Institute website.