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

Submit a question for a CHOC Doc

Related posts:

Ask a CHOC Doc: Can I Use a Kitchen Spoon to Measure Medicine?

Question: Is it okay to use a kitchen spoon to give my child their medicine?  -Anonymous


No! Household spoons are not accurate for measuring the correct dose. Always ask the pharmacist for a syringe or dosing cup. Have the pharmacist show you which line to draw up the volume to make sure your child receives the exact dose prescribed.

 If you’re ever unsure about something regarding your child’s medication, ask your pharmacist! You can call a 24-hour pharmacy any time you need more information about a side effect, how to give your child their medication, or to ask if it should be taken with food.

-Whitney Pittman, clinical pharmacy resident at CHOC Children’s

Whitney Pittman, clinical pharmacy resident at CHOC Children’s
Submit a question for a CHOC Doc

Related posts:

Ask a CHOC Doc: Are Heart Palpitations Dangerous?

Question: Sometimes I experience heart palpitations. I want more information on what exactly causes them and if I can do anything to reduce their frequency. At what point should I mention this to my doctor?  –Anonymous


A heart palpitation is the feeling of your heart beating too fast, skipping a beat, or fluttering in your throat, chest or neck.

Palpitations, also known as irregular heartbeats, are most likely caused by non-heart-related triggers. Strenuous exercises as well as strong emotions of anxiety or stress, most common among the younger generation, are frequent causes. Consuming caffeine, nicotine, alcohol, certain herbal supplements, cold and cough medication, or asthma medication, which all contain stimulants, as well as illegal drugs such as cocaine are common triggers. Some people report having palpitations after certain heavy meals that contain large doses of carbohydrates, sugars or fat. Sometimes, eating foods with excessive amounts of sodium can bring them on as well. However, some palpitations are caused by actual medical conditions including cardiac arrhythmias, thyroid disease, anemia, low blood pressure, fevers, and dehydration. If palpitations ever occur with chest pain, exercise, or fainting, this could represent a cardiac arrhythmia, and you should notify a physician.

Changing your diet is another key factor in reducing heart irregularities. Cutting back on caffeine intake such as tea, coffee, sodas, and energy drinks can be quite effective.  As a replacement, drink more water. Dehydration can lead to decreased blood pressure which triggers the body’s compensatory response of adrenaline which makes your heart race. Staying hydrated throughout the day can keep your heart rate normal.

If your heart is racing unexpectedly, there are also several things you can try at home to reduce your heart rate. Vagal maneuvers are ways to send anti-adrenaline signals to your heart and blood vessels. These maneuvers include “bearing down,” blowing through a straw, forceful coughing, and placing ice or cold water on your forehead or neck, among others. Sometimes even headstands accomplish the vagal maneuver! These actions stimulate the vagus nerve, which is the nerve that connects your brain to your heart and helps control the rate at which your heart beats. If these maneuvers make your palpitations stop abruptly, that is a good thing, but it also means that you are likely to have a primary cardiac arrhythmia, like supraventricular tachycardia which requires further evaluation and treatment. If palpitations continue despite vagal manuevers, contact your physician or seek medical care.

Palpitations are most likely harmless; however, it is important to know when it is time to see your doctor. When palpitations are accompanied by severe shortness of breath, fainting, chest pain or discomfort, or dizziness seek immediate medical attention. When your heart is beating too fast, it causes your blood pressure to drop which could potentially lead to fainting. Fainting due to low blood pressure can be a possible sign of a heart problem such as a cardiac arrhythmia, congenital heart disease or a heart valve defect. Palpitations accompanied by these other symptoms are also known to have been related to cardiac arrest, strokes, coronary artery disease, heart muscle problems and heart failure.

Here are some helpful questions to keep in mind before seeing your doctor:

  • Is the onset abrupt or gradual?
  • Check your pulse once your heart starts palpitating. Is your heart beating fast or slow? Is it beating at regular intervals or irregularly?
  • During palpitations do you feel dizzy, short of breath, or experience chest pains?
  • How often do your palpitations occur and for how long?
  • What are you doing when they start? Exercise? Calm and relaxed?

Is there anything else unusual about when your palpitations start? Are you sick with fevers, vomiting or diarrhea? Have you consumed less water that day? Are there other stressful and/or unusual events occurring in your life?

Dr. Anthony McCanta

-Dr. Anthony McCanta, a pediatric cardiac electrophysiology specialist at CHOC Children’s

Submit a question for a CHOC Doc

Related posts:

  • Surprise Heart Defect Diagnoses at Birth: Noah’s Story
    When Noah was born last May, his parents Lauren and John were expecting a healthy baby boy. They were shocked to learn that prenatal ultrasounds had missed several heart defects. ...
  • CHOC Children’s Volunteer Forms Friendship with Patient
    Through her weekly shifts and as host of the FRC’s weekly Story Time, which is broadcast to all patient rooms within CHOC’s Orange campus, Fran has formed a special bond ...
  • Meet Dr. Nita Doshi
    CHOC Children’s wants its patients and families to get to know its specialists— today, meet Dr. Nita Doshi, a pediatric cardiologist with expertise in fetal cardiology.

Ask a CHOC Doc: Where Should I Store My Child’s Medications?

Question: Where should I store my child’s medications?  –Anonymous


Contrary to its name, a medicine cabinet in the bathroom is not the best place to store medications. This is because the steam from showers can change the properties of the medication and it may lose some of its effectiveness. Storing medications in a cabinet near the stove is not ideal for the same reason. All medications should be stored in a cool, dry place away from light. Medications should be stored up and away out of reach of children. If possible, they should be stored in a locked cabinet.

Some medications require refrigeration. The bottle should say “refrigerate” on it. Liquid Augmentin® is a medication that must be kept in the refrigerator. Some medications, like liquid amoxicillin, don’t need to be refrigerated, but taste better if you refrigerate them. Others, like liquid azithromycin for bacterial infections, should not be refrigerated because it can get too thick and your child likely won’t want to take it.

-Whitney Pittman, clinical pharmacy resident at CHOC Children’s

Whitney Pittman, clinical pharmacy resident at CHOC Children’s

Submit a question for a CHOC Doc

Related posts:

Ask a CHOC Doc: How Important Is It To Finish An Entire Course of Antibiotics?

Question: Is it really that important for my child to finish their entire prescription of antibiotics?  -Anonymous


Yes! Even if your child is feeling better, they should still finish the full course of their prescription as directed by their doctor. Even if, for example, they feel better on day five and their prescription is for 10 days of antibiotics, they need to finish the entire course as prescribed because the bacterial infection might still be present. To really beat the bacterial infection, it is important for your child to finish their entire course. Stopping short could cause your child to get sick again. If your child is experiencing a side effect, contact your pharmacist or pediatrician for more information on how to manage the side effect, such as taking the medication with food to help ease an upset stomach. If your child is having a side effect that they can’t tolerate or an allergic reaction, contact your child’s doctor immediately.

If the pharmacy gave you a full bottle of a liquid antibiotic, you might still have medication left in the bottle. If this is the case, you should always properly dispose of old medicine. It is not a good idea to keep the medication in the refrigerator or cabinet for the next time your child gets sick. Medications expire and they might not work properly or may cause your child to have an unexpected side effect. There is also the possibility that someone might accidentally take the medication.

-Whitney Pittman, clinical pharmacy resident at CHOC Children’s

Whitney Pittman, clinical pharmacy resident at CHOC Children’s

Submit a question for a CHOC Doc

Related posts: