Hi, I'm Dr. Megan Wasson,
a minimally invasive gynecologic
surgeon at Mayo Clinic.
I'm here to answer some
of the important questions
that you might have about endometriosis.
What causes endometriosis?
I wish I could tell you the answer to that,
but unfortunately, we don't know.
Currently, we think that the likely source of
endometriosis is actually occurring
during development as a fetus.
So when a baby is
developing inside the uterus of its mother,
that's when we think endometriosis
actually starts.
How do I know if I have endometriosis?
That's a really great question.
So endometriosis is something
that can be a little bit elusive,
but we can suspect it based
on symptoms that you might be experiencing.
If you're having pain with your periods,
pain in your pelvis in general
pain with intercourse, urination,
bowel movements, all of that may point
us to a suspicion of endometriosis.
But unfortunately, the only way
to say 100% If you
do or do not have
endometriosis is to do surgery.
Because during surgery we can remove tissue,
look at it underneath the microscope,
and definitively be able to say whether you
do or do not have endometriosis.
Can endometriosis be seen on imaging?
Unfortunately, most of the time, no.
The vast majority of endometriosis is
superficial endometriosis, meaning that
it's almost like paint spackling on a wall,
that we can't see it unless we
actually go in and take a look surgically.
The exception to that is
if there's endometriosis actually
growing into organs in
the pelvis or the abdomen
like the bowel or the bladder.
That's called
deep-infiltrating endometriosis.
In those scenarios, we can frequently see
that disease either on ultrasound or on MRI.
If I have endometriosis, should I have a hysterectomy?
Not necessarily.
So endometriosis, it's cells similar to
the lining of the uterus
that are growing outside of the uterus.
So it's truly not an issue
with the uterus at all,
which is what we treat with hysterectomy.
That being said, there is
a sister condition to endometriosis
called adenomyosis and that
occurs concurrently in
80 to 90% of patients, and so with adenomyosis,
the uterus itself can be
a source of problems, including pain.
In those scenarios, sometimes we do consider
a hysterectomy at the time
that we're treating endometriosis.
What happens if my endometriosis is left untreated?
The key thing to remember here
is that endometriosis is
a progressive condition, and it will
continue to grow and
may cause progressive symptoms.
So for some patients,
that means that initially the pain
was only with the menstrual cycle.
But over time with
that progression of disease,
the pain can start to occur
outside of the cycle,
so throughout different times of
the month, with urination,
with bowel movements, with intercourse.
So that can prompt us to need to intervene
and do treatment if we
hadn't done anything previously.
But that being said,
even though we know endometriosis is
progressive, for some patients,
it doesn't ever progress to
the point that we would need to do
any treatment because it's more
of a quality of life issue.
And if it's not impacting
the quality of life,
we don't really need to do anything.
Can I become pregnant if I have endometriosis?
100%.
You can absolutely have
children if you have endometriosis.
When we talk about infertility,
those are patients who are struggling
with pregnancy already.
But if we look at
all patients with endometriosis,
everyone with that diagnosis,
the vast majority are able to achieve
pregnancy without any problem whatsoever.
They can get pregnant,
they can carry the pregnancy.
They walk home from the hospital with
a beautiful baby in their arms.
So, yes, unfortunately,
infertility can be
associated with endometriosis.
But the vast majority of the time,
it's truly not a problem.
How can I be the best partner to my medical team?
Being a partner for
the medical team is truly key.
A lot of individuals with
endometriosis have been in
pain for a prolonged period of time,
which unfortunately means that
the body has changed in response.
And pain has almost become like an onion
with endometriosis at the core of that onion.
So we need to work not only
to treat the endometriosis,
but treat other potential sources
of pain that have arisen.
And so I encourage you to educate yourself,
not only so that you can come in
to your health care provider and have
a dialogue and a conversation as
to what you need
and what you're experiencing.
But also so you can be
an advocate and make sure
that you are getting the health care
that you need and that you deserve.
Also talk about it.
Know women have, for
years and decades, been told
that a period is supposed to be painful
and we just have to unfortunately
suck it up and deal with it.
That's not the reality.
The reality is we should not
be laying on the bathroom floor
when we have our period.
We should not be crying during intercourse.
That is not normal.
If you're experiencing it,
speak up. Talk to your family,
Talk to your friends.
Talk to your health care provider.
Let them know what's going on.
Because truly, we are
here to help and together we can
start to make a impact
not only on endometriosis for you,
but endometriosis in society as a whole.
Never hesitate to ask
your medical team any
questions or concerns you
have. Being informed truly
makes all the difference.
Thanks for your time and we wish you well.