Endometriosis Q&A with Dr. Kelly Wright

Kelly N. Wright, MD

In the Newsroom: Endometriosis Awareness Month: One Woman's Long Journey to Wellness

Q: What is endometriosis and who gets it?

Dr. Kelly Wright:Endometriosis is a condition in which cells similar to the inside of the uterus or endometrial lining grow outside the uterus and attach to other organs. The tissue can respond to hormones like a menstrual cycle, which can cause a lot of inflammation inside the abdomen, leading to a multitude of symptoms.

Endometriosis can grow in the lining of the abdomen (the peritoneum), the fallopian tubes, the ovaries (endometrioma cysts), the bowel or the bladder-or even within the uterine muscle itself, a condition called adenomyosis.

Most patients who have symptoms of endometriosis have periods, but endometriosis has also been found in girls who haven't yet started their periods and in some postmenopausal patients, as well. Because the symptoms and types vary, it's also very difficult to study.

Q: What are some common symptoms?

KW: Common symptoms-which range from mild to severe-include painful or heavy periods, pain during sex, problems with bowel movements or trouble getting pregnant.

Read: Mapping Endometriosis: A Vast Cellular Atlas Is Created

Q: How do I get diagnosed?

KW: Endometriosis can be hard to diagnose and treat, and some patients experience years of pain and frustration before they find good care.

Typically, a doctor will suspect endometriosis based on a detailed history, pelvic exam and pelvic ultrasound. To get diagnosed, patients undergo a laparoscopic procedure where a doctor looks inside the abdomen with a small camera to see if there are any spots that look like endometriosis outside of the uterus.

Any visible areas of endometriosis, or even areas of suspected microscopic endometriosis, are fully removed, or "excised." These pieces of tissue are sent to a pathologist to be looked at under a microscope to confirm the diagnosis.

Read: Demystifying Mammograms

Q: Is there a cure for endometriosis?

KW: Endometriosis does not have a cure. After menopause, most patients find relief due to a lack of periods. However, if the endometriosis has never been adequately treated or removed, pain or other symptoms can persist.

Read: Should I Get a Second Opinion for Endometriosis?

Q: I've been diagnosed. What's next?

KW: For patients who are still having periods, treatment depends on symptoms and goals. Most treatment plans involve surgical and nonsurgical options, and patients may try different approaches before finding what works for them.

During a laparoscopy, all unwanted tissue that is found outside the uterus is removed. Even after surgery, pain can come back every time a person has a period. Therefore, we typically add other types of treatment after surgery.

Q: Is there a link between fertility and endometriosis?

KW: Yes. However, most patients with endometriosis can become pregnant on their own. Fertility rates increase in the year following laparoscopic surgery.

Severe endometriosis that causes scarring can block the tubes and prevent the egg and sperm from reaching each other. Some patients with severe endometriosis need to pursue options like in-vitro fertilization (IVF) if they wish to become pregnant.

Read: What You Need to Know About Your Fertility

Q: Should I have a hysterectomy?

KW: Patients who do not wish to become pregnant or are past their childbearing years may choose to have a hysterectomy

This may be particularly effective for patients who have adenomyosis. Many patients without adenomyosis may also experience significant pain reduction from a hysterectomy because the inflammation associated with menstrual cycles decreases.

However, some patients may continue to have pain even after a hysterectomy, particularly if they have endometriosis in other parts of their body. It is important that a hysterectomy is done by an endometriosis specialist, so that all other endometriosis can be removed at the same time.

Read: OB-GYN Surgery: The Minimalist Revolution

Q: Is there anything else I should know?

Dr. Wright: Because many doctors have a hard time diagnosing and treating endometriosis and pelvic pain in general, patients should look for a specialist who practices minimally invasive gynecologic surgery (MIGS) and has extra training in treating endometriosis. Look for a physician who takes your symptoms seriously and offers a treatment plan composed of different treatment options.

At Cedars-Sinai, we have three faculty doctors-Dr. Matthew Siedhoff, vice chair of Gynecology; Dr. Mireille Truong, assistant professor of Obstetrics and Gynecology; and me-who are fellowship-trained in MIGS and routinely treat patients with endometriosis, along with a multidisciplinary team of specialists who care!

If you experience endometriosis, Cedars-Sinai's Endometriosis Peer Support Network can connect you with people who understand.