Center for Endometriosis and Female Pelvic Pain – Patient Care and Treatment
Endometriosis means that tissue similar to the inner lining of the uterus, known as the endometrium, is found outside of the uterus — often in the fallopian tubes, ovaries, appendix, bowel or diaphragm. It can lead to adhesions, interstitial cystitis, irritable bowel syndrome, and chronic pain in the pelvis and lower abdomen. These symptoms can be severe and can greatly decrease quality of life. They can keep you from doing the things you need and want to do and living the life you want to live.
Symptoms of endometriosis can vary widely and may include:
- Painful or heavy periods
- Frequent pelvic pain
- Pain during sex
- Lower back pain
Endometriosis can also affect the bowels and bladder:
- Diarrhea or constipation (especially during your period)
- Cramping, blood and pain with bowel movements
- Painful urination
- Blood in the urine
- Bladder pain and loss of function
Diagnosing endometriosis can be challenging. The role of imaging is limited, as most lesions are small and aren’t visible with ultrasound, magnetic resonance imaging (MRI) or computed tomography (CT or CAT) scan.
Staging for endometriosis usually requires laparoscopic surgery. There are four stages, representing minimal, mild, moderate or severe disease. Staging is based on the type, size and location of the lesions, as well as the extent of adhesions and other factors.
Deeply infiltrating endometriosis is defined as a nodule of endometriosis measuring more than 5 millimeters deep. These lesions are often found along the uterosacral ligaments, posterior cul-de-sac (between the uterus and rectum), vagina, bowel, bladder and ureter. These deep lesions need to be completely removed, as complete excision has been shown to decrease pain and symptoms. The lesions can be densely adherent, or “sticky,” and are often near vital organs and structures.
Keep in mind that the severity of your symptoms may not relate to the stage of the disease. Our goal is to manage your symptoms so you can live your life.
Treating endometriosis through excisional surgery takes a high degree of skill and experience. Our surgeons use minimally invasive laparoscopic and robotic surgery when possible. We are skilled in fertility-sparing restoration of normal pelvic anatomy.
If you don’t plan to have any children after treatment, hysterectomy is a viable option. Often, the ovaries can be spared to prevent early menopause. However, women who have a complete oophorectomy (removal of ovaries) are less likely to need additional surgery for endometriosis in the future. Our team will talk to you about your options and their possible benefits or disadvantages.
Treating Endometriosis requires a comprehensive approach that goes beyond just surgical management. Medical treatment may involve medications for hormonal suppression to decrease pain and inflammation related to menstruation and ovulation. Anti-inflammatory medication and diet modifications may also work to suppress endometriosis pain with bowel and bladder components.
Treatment plans are individualized and complimentary. It’s not only about medication for Endometriosis symptoms, but you have to consider the whole person and patient in the plan of care. Medications to reduce pain and inflammation, along with diet, exercise, and medication alternatives all can be working together to improve the quality of life for patients with Endometriosis.
Most importantly, you have to work with the patient to reassess the effectiveness of the treatment plan over time, and work with patients and families to adapt the individual’s plan of care to best improve the patient’s quality of life.
Teaming up on endometriosis
Successfully managing endometriosis — and finding new and better ways to do so — takes a multidisciplinary team approach. That’s why we’re committed to interdisciplinary management and collaborative research.
Consult and referrals
Our team works with primary care physicians and other health care professionals to ensure consistent, effective care. We also work closely with other specialists and departments within Penn State Health, such as:
- Adolescent Medicine
- Anesthesia Chronic Pain
- Clinical Nutrition Department
- Colorectal Surgery
- Family and Community Medicine
- Female Pelvic Medicine and Reconstructive Surgery
- General Surgery
- Internal Medicine
- Minimally Invasive Gynecologic Surgery
- Minimally Invasive Surgery
- Physical Therapy
- Psychiatry and Behavioral Medicine
- Reproductive Endocrinology and Infertility