Ask a CHOC Doc: Do I Have Endometriosis?

Question: My periods are heavier and more painful than my friends’ periods. I’ve seen a lot in the news recently about endometriosis. Is that what I have?  -Anonymous


Any time you have questions about your body, ask a trusted adult or your doctor. What you’re describing may be endometriosis, but it could be something else. It could also just mean that you have heavier periods and more cramping than your friends do (everyone’s body is different) and you don’t have a diagnosable medical condition.

If you decide you need to see your doctor, here’s more information about endometriosis, so you can be prepared for your appointment.

 What is endometriosis?

Endometriosis is a condition where the tissue that makes up the inner lining of the uterus is present outside of the uterus, or n other organs in other parts of your body. It most often occurs in the ovaries and pelvis.

What are the symptoms of endometriosis?

The symptoms from endometriosis can vary significantly from woman to woman. Some people who have endometriosis actually have no symptoms, and others suffer from debilitating and chronic pain in the lower abdomen and pelvis. It can also cause pain with periods or during sexual intercourse and may even lead to infertility.

Since this condition occurs when tissue from the inner lining of the uterus is present outside that area, symptoms can vary depending on where the tissue is. For example, with bladder endometriosis, someone can have urinary symptoms such as frequency, urgency and pain. With bowel endometriosis, you can have diarrhea, constipation and bowel cramping. If the endometriosis is in the abdominal wall, there could be a painful abdominal wall mass.

Women who suffer from endometriosis are usually diagnosed between ages 25 to 35. However, teens may suffer from endometriosis as well. It’s rarely diagnosed in premenstrual and postmenopausal women.

During a menstrual cycle, the bleeding occurs not only from inside the uterus, which is typical, but also from areas with uterine tissue outside the uterus. The blood irritates these areas in the abdomen, and the irritation causes inflammation, pain and scar tissue.

 How do I know if I have endometriosis? 

In order to definitively diagnose endometriosis, a doctor will perform a laparoscopy, where they’ll make a small incision in the abdominal wall and insert a small camera in order to view the organs in the abdomen. They will remove a small sample of tissue and review it under a microscope to confirm that it is uterine tissue that’s been growing outside the uterus.

During the procedure, endometriosis can be assigned a stage of severity, based on the location and how much uterine tissue is growing outside of the uterus.

This procedure can make a diagnosis and also treat the pain from endometriosis by removing the uterine tissues found outside the uterus as well as removing scar tissue that may be affecting the pelvic organs. Surgery can help lessen the impact on fertility.

If your doctor suspects you might be suffering from endometriosis, they may choose to first explore non-surgical examinations before considering a laparoscopy. Your doctor may order an ultrasound to evaluate your anatomy and look for ovarian endometrioma (large, fluid-filled cysts), in addition to reviewing your medical history and conducting a physical examination. An assumed diagnosis might be made without surgery, but response or lack of response to treatments cannot confirm or exclude the diagnosis.

What is the treatment for endometriosis?

The most commonly prescribed medication is a non-steroidal anti-inflammatory drug (NSAID) such as ibuprofen. It is important to take the right dose as prescribed by your medical provider for adequate treatment of inflammation and pain relief. The use of cyclic hormonal therapy can be used for pain management. This includes using oral hormonal pills, commonly called “birth control,” or injection Depo-Provera to suppress menstruation and changes in uterine tissue, thereby decreasing pain. Another treatment option is the use of gonadotropin releasing hormone (GnRH) agonists, which can help stop the bleeding by decreasing estrogen production. Some side effects of GnRH agonists include menopause-like symptoms like hot flashes, mood changes, vaginal dryness and bone thinning, among others.

Medication should be trialed for at least three months. If there is no improvement to medical therapy within this trial period, your doctor may refer you to a gynecologist, and a laparoscopy surgery should be considered.

If there is any concern regarding a chronic pelvic pain, painful periods or other symptoms that are affecting your life, make a doctor’s appointment to get it evaluated!

By Dr. Janice Koh, pediatric resident at CHOC Children’s and Dr. Terez Yonan, adolescent medicine specialist at CHOC Children’s

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