Endometriosis: Non-Surgical & Post-Surgical Treatment

What is endometriosis?

Endometriosis is a medical condition where tissue similar to the uterine lining is present outside the uterus in the abdomen, pelvis, or other areas in the body. The uterine lining is called endometrium (“metri” means uterus, and “endo” refers to inside lining). Endometriosis (“endometri” refers to endometrium, “osis” means medical condition).

Endometriosis may start superficial in the lining of the body cavity in the peritoneum (the thin lining of the abdominal cavity). It will then invade deeper into the tissues. 

Endometriosis will grow in response to Estrogen and can cause pain with menstrual cycles, pain with sexual intercourse, chronic unrelenting pelvic-back-hip-leg pain, and may contribute to infertility. Not everyone has every symptom. The intestinal tract may be involved in  10-15% of cases, and the urinary tract may be involved in 1-2% of cases.

Endometriosis Diagnosis

Endometriosis is a surgical diagnosis. This means it cannot be definitively diagnosed by taking your history, physical examination, blood or urine tests, x-rays, ultrasounds, MRI, or CT scan. These studies may suggest endometriosis as a diagnosis, but the physician can only confirm the diagnosis by looking surgically. This is usually accomplished with laparoscopy.

With laparoscopic excision, the physician may be able to make a tissue diagnosis. Some lesions may look like they are definitely endometriosis, but the diagnosis may not be confirmed on pathology. Other lesions are very subtle and not very suggestive of endometriosis, but pathology confirms the tissue as being endometriosis. There are more than one way to treat endometriosis laparoscopically, but Dr. Lucas prefers the precision of excision of the endometriosis for effective pelvic pain relief and management of sexual pain.

If you’ve been told you have endometriosis, please let us know. The surest way to diagnose endometriosis is through surgery, which we can perform as an outpatient procedure. This may afford us the ability to treat the lesions at the same time, offering a comprehensive approach to managing your endometriosis and associated symptoms. To inquire about diagnosing your condition or managing your endometriosis, please contact us through our Secure Patient Contact Form.

Endometriosis Treatment: Non-Surgical, Pre-Surgical and Post-Surgical

Sometimes, patients are unable or unready to undergo surgical intervention for endometriosis.  Other times, surgery is just one of several aspects of treatment.  These patients have already undergone excision surgery for endometriosis yet, some degree of discomfort persists due to either microscopic remnants or other damage (i.e scarring, neuroinflammation, muscle spasm).  In these circumstances, patients need non-surgical therapeutic options that take into account their individual pain picture.
At NECPH, we listen to and treat our patients before AND after they receive expert surgical care.   We are here with you the whole way, which is why we offer in-person or virtual visits, longitudinal monitoring and EMR messaging access for patients with chronic pelvic pain/dysfunction from endometriosis.  Our patients stay connected to notify us of flare-ups so we can treat pain/dysfunction before it gets out of control. 
We are charged with treating pelvic pain, no matter how or when or in whom it occurs.  This is why we develop care plans for pelvic pain that are specific to your experience, resources and preferences.  While we offer surgical expertise when appropriate, we are proud to offer a wide spectrum of therapies to address the multi-system effects of endometriosis.  These options include manual therapy, non-narcotic pain medications, hormonal therapy, infrared laser therapy, injection therapy, and more. 
We also offer our patients resources on coping with chronic pain and the impact of a disease that is often misunderstood, if not ignored.  We are happy to coordinate care with traditional and alternative providers to help endometriosis patients achieve and maintain their fullest life.  These techniques include preventative measures to keep endometriosis pain from flaring in the first place. 
To inquire about managing your endometriosis before OR after having endometriosis surgery, please contact us through our Secure Patient Contact Form.


Frequently Asked Questions About Endometriosis

What are some symptoms of endometriosis?

Endometriosis will respond to the hormone estrogen and can cause pain with menstrual cycles, pain with sexual intercourse, infertility, and unrelenting chronic pelvic, back, hip-and leg pain. Not everyone has every symptom, and some individuals have had pregnancies. Endometriosis is a factor in up to 40% of cases of unexplained infertility.


How common is endometriosis?

Endometriosis affects 10-15% of the female population.

How is endometriosis diagnosed?

 Endometriosis is a surgical diagnosis. This means it cannot be definitively diagnosed by taking your history, physical examination, blood or urine tests, x-rays, ultrasounds, MRI, or CT scan.  A diagnosis can be presumptive and interventions can be attempted with medication to alter hormones in order to alleviate symptoms. 

2 key points to remember about Endometriosis:

1) There is no correlation between the symptoms the person is experiencing and whether endometriosis is present.  (You may have severe cyclical pain that seems like it is endometriosis, but it is not).

2) There is no correlation between the severity of the symptoms and the extent of endometriosis present. (You may have extensive endometriosis and have pain that is tolerable or managed by medical interventions.  Conversely, you may have only a few endometriosis lesions and experience debilitating pain with periods.)

For these reasons, laparoscopic surgery may be the best way to have definitive diagnosis and/or treatment. 


Is there a connection between endometriosis and ovarian cancer?

(CAUTION: Hardcore Science-y stuff ahead.  But it is very useful to understand.)

Every organ has different tissue types. Each tissue type within an organ can produce tumors, benign and malignant.

The ovary has 3 tissue types:

1) Eggs and follicles (aka cysts) produce germ cell tumors

2) Connective tissue (aka the tissue that holds the ovary together) produce stromal tumors

3) Epithelial tissue (aka covering over the outer surface of the ovary)  produce epithelial tumors. Approximately 70% of all ovarian tumors are epithelial. Epithelial tumors can be serous, mucinous, clear cell, or endometrioid.

These subtypes are based on how the tumors look under the microscope.

There is evidence in the medical literature that clear cell and endometrioid ovarian tumors may develop from endometriosis. Literature review shows only a mild association between endometriosis and the development of ovarian cancer. The relationship of endometriosis and ovarian cancer is not confirmed.

A literature review published in early 2014 using the keywords “endometriosis” and “ovarian” found 1 prospective cohort study, 10 retrospective cohorts, and 5 case-control studies. All of these studies, except for one, did not include operative confirmation of endometriosis. Authors found a consistent association between endometriosis and clear cell and endometrioid cancer, but the authors concluded that the association linking endometriosis and ovarian cancer is not sufficient to impact current clinical practice.

Therefore, to summarize what is known at this time, there is an association between epithelial cancers of the ovary and endometriosis, but there is currently not enough evidence to warrant alteration in endometriosis treatment.

Is my pain endometriosis?

Pain is always real. Often, we can find what is causing the pain.  In many of these patients, we can alleviate the pain. When the source of the pain is not immediately found, we work to exclude the most deleterious diagnoses at first.  A klist of possible diagnoses is generated and then we sequentially rule out diagnoses until we have a more specific idea s to the cause and thus, a clearer picture of what can help.

Endometriosis can present as menstrual pain, pain intermittently throughout the month, or continuous pain. Response, or lack of response, of symptoms to medications, such as hormonal modifiers and contraceptives does not necessarily rule in or rule out the presence of endometriosis.  However, they can help to identify when the cause of the pain is hormone dependent. 

Ready to take the first step towards personalized pelvic health care? Fill out our simple form below to schedule a consultation with Dr. Romeo Lucas, and embark on your journey to relief and well-being.


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