Learning about endometriosis
By Carla Slavey
Women are used to experiencing a certain amount of pain when it comes to their menstrual cycle , but an unusual amount of pain might be a warning sign that there could be issues with one ’ s uterus – problems that could lead to larger complications on down the line .
March is Endometriosis Awareness Month , a great time for women to learn more about their reproductive health and learn about when it ’ s a good idea to discuss menstrual pain with their doctors .
Dr . Amy Diaz is an Obstetrics and Gynecology physician with the Lake Cumberland Regional Hospital . She works with women through the various stages of their reproductive health , and she explained why endometriosis is something women should educate themselves on .
“ Endometriosis is a condition usually characterized by severe pelvic pain ,” she explained . “ It can definitely be worse with your menstrual cycle , but you can have pelvic pain outside of that as well . Often times you can have pelvic pain with bowel movements and with sex .”
Dr . Diaz said there are several theories as to what causes endometriosis , but the end result is the same . “ The inside layer of the uterus ends up elsewhere ( in the body ), not inside your uterus ,” she said , like the pelvic floor , along the walls of the abdomen , or behind the vaginal area close to the rectum . Because of that last one , some people might have pain with bowel movements .
“ It settles ( in those places ) and that tissue is activated just like your uterus would be during a menstrual cycle ,” Diaz said . “ It becomes inflamed , and it obviously causes pain . Over time , without treatment , that can cause severe scarring as well , which is why some women with chronic symptoms of endometriosis may have trouble with fertility .”
Dr . Diaz urged women who are having abnormal pain in their abdomen to look into the cause of that pain . “ A lot of people kind of have a presumed idea of endometriosis , and I feel like it ’ s important to get to the bottom of why the pain is happening , and not necessarily assume , ‘ This is in my family history , this is just how it ’ s going to be .’ I feel like sometimes women just accept it as it is , or ( accept it ) as normal . And it ’ s not ,” she said .
Also , many may think when they hear the diagnosis of endometriosis that it automatically means they will have to have their ovaries removed . While that is the most definitive way to halt the disease , there are other options for those who still want to have children .
“ There are other treatments that are fertility sparing , and that ’ s what we go for first ,” Diaz said . “ Typically what I tell my endometriosis patients is the first thing to go to is hormonal birth control , mostly because it ’ s the hormones that control the ovaries that then causes the activation of that tissue and inflammation .”
She continued : “ Even though a lot of us hate birth control and hate dealing with the side effects , it ’ s definitely the primary treatment . It doesn ’ t have to be the regular ol ’ birth control that people get prescribed . There are other options that are in pill form that are just progesterone or that act on different areas of your brain that will help calm down and quiet the ovaries essentially ,” she said .
If the patient gets to the point where those medications no longer prevent the pain , then she said it ’ s time to talk about the potential of surgery .
The first type of surgery would be to go in and scrape out the offending tissue , she said , rather than to remove the ovaries entirely . However , there are risks with that .
Plus , while it removes the tissue that is already outside the uterus , it doesn ’ t prevent more uterus tissue from migrating outward . That means the problems will return .
“ We kind of try to avoid surgery as the first-line treatment , mostly because over the course of time multiple surgeries can put you at risk ,” she said .
She added , “ I ’ d say that may gain two to five years of pain relief . But then we ’ re right back to square one .”
Of course , there may be some women who simply choose not to take treatments at all .
“ Let ’ s say someone opts to not to be on medication ,” Diaz said . “ It ’ s just untreated , and they decide to ride out the pain . That ’ s fine , that ’ s their choice . But ultimately it could lead to scarring that then may cause other issues . The one thing that sticks in my mind is this lady who had let her endometriosis go , in the sense that she was untreated , and ended up having a bowel obstruction . She had to have a piece of her bowel removed . So it can lead to greater consequences or complications later on in life that you wouldn ’ t think would happen . That scarring can affect other organs and people kind of forget about that fact .”
Dr . Diaz urged women who think they may have issues with endometriosis to talk with their OBGYN . “ I feel that an OBGYN might be better equipped to have that discussion as to what ’ s available out there . … I think a general practitioner should be able to do the basic workup , and possibly do a trial of birth control pills as long as you ’ re a candidate for them , but the OBGYN will be able to offer you more options .”
March 2025 SEKY - Southeast Kentucky Life • 17