Dr. Patrick Yeung has a message for women: “Killer cramps are not normal.” Yet women who suffer from endometriosis may assume their pain is par for the course and fail to seek treatment. Yeung, a SLUCare Physician at SSM St. Mary’s Health Center, specializes in minimally invasive gynecologic surgeries, specifically endometriosis with laser excision, and notes that this is one disease that women don’t have to suffer in silence.
“When I hand patients their pathology results saying that they have endometriosis, that alone is therapeutic because they have some confirmation that they’re not crazy,” Yeung says. “This disease is under-recognized, under-treated and should be looked for in patients with significant pain and difficulties getting pregnant.”
Endometriosis develops when tissue that normally lines the uterus and is shed during menstruation grows outside of the uterus, often on the ovaries, bowel or lining of the abdominal cavity. “The main theory behind how this happens is ‘retrograde menstruation,’ or menses going backward through the fallopian tubes instead of out through the cervix,” says Dr. Sharon Sung, and obstetrician/gynecologist at St. Luke’s Hospital. “Other theories suggest that pieces of lining travel through the blood or lymph systems or that endometriosis is a result of the transformation of other tissue.”
Symptoms typically include abdominal and pelvic pain, painful periods, pain during intercourse and abnormally heavy periods. However, some women have no symptoms at all, only being diagnosed when seeking help for infertility.
“The diagnosis of endometriosis can only be made with certainty with direct visualization, usually with laparoscopy,” says Dr. Bruce Bryan, an obstetrician/gynecologist with BJC Medical Group of Missouri and on staff at Missouri Baptist Medical Center. “Sometimes a presumptive diagnosis of endometriosis is made based on imaging studies, physical examination and symptoms.”
The good news is that endometriosis is treatable, and fertility can often be restored following successful treatment. “The main treatments for endometriosis are hormonal methods, such as birth control pills,” Sung says. “Birth control pills help control the hormone levels that stimulate the lining of the womb to grow and also stimulate the endometriosis. Along the same lines, injectable medication that basically creates a chemical menopause can help with endometriosis pain.”
For women who are having trouble getting pregnant or who aren’t doing well with medical treatments, surgery can remove endometriosis and the scar tissue it creates, she adds. “Endometriosis is a complicated condition. Some women can control the pain by taking ibuprofen, while others have so much pain they ultimately choose to have a hysterectomy.”
Yeung uses a laparoscopic surgical technique in which he completely removes endometriosis. Other approaches ablate (or burn) the endometriosis, sometimes failing to remove all the tissue or leaving charred remains that can cause additional complications. “My approach is to cut around it and cut under it to get the whole thing out and get down to normal tissue,” he says. “We advocate early diagnosis and complete excision as the best way to improve quality of life, but also potentially to restore or preserve fertility.”