- My name is Cara King, and I'm part
of the minimally invasive gynecologic surgery section.
So endometriosis is when tissue very similar
to the lining of the uterus,
so endometrial glands and stroma,
they implant outside of the uterus.
So normally this tissue should only live
on the inside lining of the uterus
and when it implants outside, normally in the pelvis,
meaning outside of the uterus, tubes,
but other things in the pelvis, such as bladder, bowel,
or even diaphragm or pleura.
If it grows in that location,
then it's called endometriosis.
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The majority of my patients do fall
within the reproductive age group
because that's when endometriosis tends
to be most prevalent,
but endometriosis can also impact patients after menopause.
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The gold standard for diagnosis of endometriosis
is through histologic examination.
And what that means is typically through surgery,
most commonly laparoscopy, where we go in,
look at everything and then actually excise those areas
that appear to be abnormal areas
that we think are endometriosis.
Unfortunately, there's no other ways
that we can confirm endometriosis,
meaning there's no blood test that can confirm it
at this time.
With that being said,
there are ways that we can have a pretty good idea
if somebody has endometriosis and things that we consider
are if they come in with certain clinical symptoms,
things such as pelvic pain or pain with urination,
pain with bowel movements, pain with intercourse.
Another is our physical exam.
So if we do an exam and we palpate areas that seem firm
or nodules or areas that elicit pain,
that also makes us feel endometriosis may be involved.
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We actually have found that endometriosis is genetic.
It does run in families.
And what we have found is that if you have
a first degree relative with endometriosis,
you have a seven to 10 fold increased risk
of also having endometriosis.
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A lot of patients ask me,
"What is normal in regard to period cramps?"
And my short answer is that if your period cramps
are impacting your quality of life, they are not normal.
You should not be debilitated by your pain.
You should not be calling into work or missing school
because of pain with periods.
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No, absolutely not.
Endometriosis cannot be transferred through sex at all.
So unfortunately, endometriosis can impact fertility.
50% of patients who present with infertility
oftentimes have a level of endometriosis.
Endometriosis, we think, can cause some fertility
by, number one, causing anatomic distortion.
And what I mean by that is that endometriosis
can cause severe scarring of the ovaries
and of the fallopian tubes.
If there's scarring of the fallopian tubes,
it doesn't allow the sperm and the egg to actually meet.
So if the fallopian tubes are dilated
or if they're kinked because of the scarring,
the egg and sperm can't meet,
and that can obviously lead to some fertility.
With that being said, we also think
that even when there isn't anatomic distortion,
the peritoneal environment of patients with endometriosis
can actually lead to damage of sperm.
And we also know that endometriomas,
when there's those ovarian cysts,
it also decreases ovarian reserve.
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Another topic that we oftentimes discuss with our patients
is a desire for future fertility.
And a lot of patients wonder if we have to do a hysterectomy
to adequately treat endometriosis
and the answer is typically no.
Oftentimes, we can preserve the uterus
and we can preserve the tubes and the ovaries
and just excise all of the other areas of endometriosis.
Now, with that being said,
if you have endometriosis and you undergo
just a hysterectomy but don't have full excision,
you will most likely still have pain afterwards.
So it's very important that you discuss these topics
with your surgeon and regarding your priorities
and your symptoms to make sure the right surgery
is performed for you.
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