Endometriosis is a disease where the lining of the uterus — called endometrium — grows in the wrong place. This uterine lining is necessary for a woman’s pregnancy to develop after an egg is fertilized and attaches to the uterine wall. If a pregnancy isn’t conceived, the endometrial lining is shed during the menstrual period. For reasons that are still not fully understood, some of this endometrial lining may escape the uterus and grow on other organs, including the bowel and ovaries, causing inflammation and chronic pain.
"Endometriosis is a fairly common problem in women of reproductive age," Balli says. "Unfortunately, many women don't know they're suffering from this disease — they just know they're experiencing pain and discomfort."
The primary indicator of endometriosis is pelvic pain, Balli says. Nearly 75% of women who are experiencing regular pelvic pain are diagnosed with the disease. Balli describes this pain as more than just cramping and pelvic discomfort that accompanies a period.
"A woman who has endometriosis will generally be experiencing pelvic pain between periods, excessive pain during periods, pain with bowel movements and even pain with sex,” Balli says.
Endometriosis can also cause difficulties for women trying to become pregnant.
Balli encourages women experiencing ongoing pelvic pain to be evaluated for endometriosis by a gynecologist. “Most gynecologists should bring up the possibility of endometriosis if their patient complains of pelvic pain, but if they don’t, the patient should bring it up on their own,” Balli explains.
Patients are often incorrectly told they have the disease without being formally diagnosed, Balli says. “Sometimes, we think our patients probably have endometriosis from their history, but the only way to make a true diagnosis is through a surgical biopsy,” he says. "It's very important to see an endometriosis expert, like our gynecologic surgeons here at Loma Linda University Health, who can diagnose and treat the issue correctly at the time of surgery."
This surgical biopsy is nearly always performed during a laparoscopy — a surgery that involves a thin tube with a camera and light inserted through a tiny surgical incision. With the camera, the physician will be looking for patches of endometriosis outside of the uterus.
While there is no known cure for endometriosis, there are treatment options to help reduce the disease's symptoms. Balli groups the treatments into two sections: medication treatments and surgical treatments.
Medication treatments focus on decreasing a woman's estrogen, which causes endometriosis to grow and increasing progesterone, which shrinks it. These treatments include pills, injections and intrauterine devices that can often be used long-term to decrease pain, Balli says. However, he says medication treatments don’t improve a woman’s fertility, as they are all typically used for birth control.
Medications can often be used hand-in-hand with surgery to achieve the best outcomes. “The initial surgical treatment should typically be a laparoscopic excision of endometriosis," Balli says. This allows the physician to remove and destroy the endometriosis patches without damaging the reproductive organs. Women seeking to become pregnant may have their odds of pregnancy improved after surgery through the removal of scarring around the fallopian tubes.
Women who are finished with childbearing may also consider a hysterectomy. Removal of the uterus, and sometimes the ovaries, is considered the best way to halt the disease and its debilitating symptoms. However, it is not a suitable option for women who still want to have children.
Balli stresses the importance of seeking treatment at an institution that specializes in endometriosis care.
“Loma Linda University Health has surgeons with expertise in removing endometriosis if found during a laparoscopy,” Balli says. “This ensures that the endometriosis can be removed safely and effectively, the first time.”
He reminds women to listen to their bodies. “It’s not normal to have pain all the time,” Balli says. “If something feels wrong, seek the help of your gynecologist.”
If you’re experiencing pelvic pain or other endometriosis symptoms, make an appointment to speak with one of Loma Linda University Health’s specialists.