Endometriosis

What are the signs and symptoms of endometriosis?

Many who have endometriosis have no symptoms, but those who do commonly experience:

• Pelvic pain that becomes worse during menstrual periods
• Pelvic pain not relieved with over-the-counter pain medications
• Pelvic pain with urination or bowel movements
• Abnormal menstrual bleeding
• Pain during or after sex
• Infertility

How do we diagnose endometriosis?

A gynecologist who is experienced in diagnosing and treating endometriosis performs the initial diagnosis. The doctor will ask about menstrual periods, cramping, pelvic pain, medical history and therapies patients have tried to relieve the pain.

Doctors might suspect endometriosis when pain is severe and has not been relieved by over-the-counter pain medications or hormonal therapy. Evaluation sometimes includes a pelvic ultrasound, but often endometriosis does not cause ovarian cysts or other changes that are visible on ultrasound in teens and young adults. Our care team may conduct an ultrasound if pain is more severe than is typical with endometriosis or menstrual history suggests that an ovarian cyst is causing the pain.

We can only diagnose endometriosis with absolute certainty with a surgical biopsy, which is done via a minimally invasive surgery called a diagnostic laparoscopy. Many who are suspected to have endometriosis do not need a surgical diagnosis because their endometriosis symptoms are well controlled with medical treatment. We only perform a laparoscopy if medical treatment doesn't resolve endometriosis symptoms.

What to expect from an exam for endometriosis

At Children's Colorado, we approach each potential endometriosis diagnosis individually. We take into account personal medical history, circumstances and goals to create the best care plan.

Medical history is the most important part of an exam for endometriosis. Diagnosis also includes a basic abdominal exam. We rarely perform a traditional pelvic exam in our clinic because we can typically obtain the same information from the medical history and other less invasive techniques.

How do we treat endometriosis?

There is no cure for endometriosis, but treatment can help those with the condition manage their symptoms and significantly reduce endometriosis pain. Endometriosis spreads over time and should be evaluated and treated as soon as possible to minimize long-term pain.

At Children's Colorado, we offer both surgical and nonsurgical approaches to treatment. Our gynecology care team will recommend the best treatment options for each patient.

Nonsurgical endometriosis treatment

While we can't definitively diagnose endometriosis without surgery, we can manage suspected cases with nonsurgical treatment methods, particularly if symptoms are not severe. Nonsurgical treatments are usually the first step for children, teens and young adults who are not currently trying to become pregnant. The most common nonsurgical treatments are hormonal medications that cause endometrial lesions (endometrial tissue outside of the endometrium) to shrink and prevent the further spread of the condition. Hormonal medications include:

• Oral progesterone pills
• Birth control pill, patch, ring or injection
• Intrauterine devices (IUDs) that contain progesterone
• An implant that goes under the skin
• An injection that blocks the production of estrogen

Those who try these types of treatment methods may need several of these medications or will need to use them together to control their endometriosis symptoms. Although many of these treatments are labeled as "birth control," they are effective medical treatments for endometriosis and do not increase the likelihood of sexual activity. Because nonsurgical treatments reduce the spread of endometriosis, they play an important role in protecting the future fertility of those with endometriosis.

Surgical endometriosis treatment

For some, endometriosis surgery is the best option. When surgery for endometriosis is necessary, our experienced team will guide you and your family through the process.

Outpatient laparoscopic surgery for endometriosis can effectively diagnose and treat the condition. Both diagnosis and treatment can take place during the same operation. During surgery, a high-energy heat source, such as a laser, cuts or burns away endometrial lesions (endometrial tissue outside of the endometrium). Treatment is more difficult with advanced disease that involves large areas of the rectum or larger lesions.

More recently, laser ablation with a CO² laser has allowed for more extensive treatment of endometriosis. This technique treats more visible lesions while decreasing risk of injury to surrounding organs. Our experienced gynecologists on the Children's Colorado team have undergone specialized training and certification in endometriosis laser treatment.

Following surgery, our team will provide helpful instructions on how to use hormonal medications to prevent the regrowth of endometriosis.

Why choose Children's Colorado for endometriosis treatment?

Our board-certified pediatric and adolescent gynecologists have specialized training and a wealth of experience in the reproductive health issues of patients of all ages.

We understand that endometriosis can be stressful and are sensitive to your needs. That's why we work to put families at ease by carefully explaining endometriosis, discussing the various treatment options and supporting your family with follow-up visits and consultation with our colleagues in other specialties, such as psychology, chronic pain, urology and gastroenterology, if needed.

In addition to a welcoming setting, we offer expertise in the full range of diagnostic and treatment options for endometriosis from routine exams and medication to surgery.

If you would like to learn more about endometriosis, visit:

• Center for Young Women's Health
• Office on Women's Health