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Endometriosis is the presence of endometrial glands and
stroma outside of the uterus, or where the tissue that's normally
inside of the uterus is found outside.
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The symptoms of endometriosis are quite variable.
They can range anywhere from severe pain to no symptoms at all.
The most common symptoms are pain with periods,
pain outside of periods, pain with intercourse,
pain with bowel movements, pain with urination.
Often we find endometriosis incidentally during an evaluation
for other gynecologic problems or during an evaluation for
infertility.
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Endometriosis can only be diagnosed definitively with surgery and
biopsy.
Endometriosis can have variable appearances inside the abdomen.
That being said, because we think someone might have endometriosis,
we don't take everyone to the operating room just to make that
diagnosis, because surgery carries many risks.
So we often start with just medical therapy before
going to the OR to definitively diagnose.
[MUSIC] We more often see endometriosis in
a infertility population, but
endometriosis does not equal infertility.
We don't fully understand all the ways in which endometriosis may
impact your ability to become pregnant.
In cases of severe endometriosis there's often scarring
inside the abdomen, which may impact the ability of an egg
to make it from the ovary into the uterine cavity.
In more mild cases of endometriosis,
we think that there may be factors that are produced
by endometrial implants that can impact the ability
of implantation or embryo development.
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There are many treatment options available for
endometriosis which range from medical to surgical.
Within the medical options, most of these are hormonally based.
So combination birth control pills or progesterone only methods, such
as a progesterone pill, progesterone injections, such as Depo-Provera.
Also an IUD that releases progesterone.
There are additional medical options that occasionally are used as well,
such as aromatase inhibitors, or GNRH agonist,
which are medicines that can put you into temporary menopausal state.
Within the surgical treatment options,
it really depends on the stage of disease, and
also someone's symptoms and childbearing wishes.
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Endometriosis often recurs.
We know from looking at studies that occasionally,
endometriosis will regress on its own.
Other times it can maintain and be stable, and
other times it can progress.
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Minimally invasive surgery and open surgery are different routes of
achieving the same outcome for the treatment of endometriosis.
At Johns Hopkins, we have a group
that specializes in minimally invasive gynecologic surgery.
We approach most of our endometriosis surgeries via
minimally invasive route with laparoscopy or robotic surgery.
Because minimally invasive surgery has improved outcomes for
patients in terms of decreased pain,
a faster return to daily living, decreased blood loss,
decrease adhesion formation, and other benefits as well.
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If a woman suspects she may have endometriosis, the first step would
be going to her primary gynecologist to discuss her symptoms.
Additional testing, ultrasound, an exam would be done.
Often, first line of treatment is just medical therapy with
something like birth control pills.
If pain persists or symptoms persist,
then it might be worthwhile at that point to see someone who specializes
in the treatment of endometriosis.
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At Johns Hopkins, we have a group of surgeons who've been
specially trained in minimally invasive gynecologic surgery.
This is especially important for
endometriosis surgery for multiple reasons.
In early stage disease, endometriosis can often have
variable appearances that can be quit subtle.
If someone does not know exactly what they might be looking for,
then often these lesions and treatment can be missed.
In advanced stage disease,
the surgeries are often quite technically complex.
Endometriosis often likes to implant in places that are tricky, so
over the bowel, over the bladder, over the uterus, and
someone needs to be comfortable operating in these areas.
Lastly, in cases of very severe endometriosis,
we often require collaboration with our colleagues in urology,
colorectal surgeon, or a plastic surgery to
adequately treat all aspects of the disease.
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