Pelvic Pain and Endometriosis

Pelvic pain is a problem we encounter with our patients all too often.

Pelvic pain frequently occurs in young women within a year or two after periods start. Pain can be from many sources, and treatment is typically started for painful periods with NSAIDs (medicines like ibuprofen) and birth control pills. This treatment can be very effective in controlling what doctors call primary dysmenorrhea (painful periods without other abnormalities), but if pain is not substantially improved, it deserves additional investigation as it may be due to endometriosis or other pain inducing conditions. In fact, two-thirds of young women with pain unresolved by medical therapy will be diagnosed with endometriosis when they undergo laparoscopic surgery. This number may also be an under estimate as many times endometriosis in young women has an atypical appearance that varies from the classic lesions found in non-adolescent women. Unfortunately, pelvic pain due to endometriosis can go unrecognized or under-treated for years.

Endometriosis is a condition that involves the growth of a normal tissue (the endometrium is the normal glandular lining of the uterus) that is growing in an abnormal location. Most commonly, endometriosis is diagnosed using laparoscopy, a minimally invasive surgery technique allowing careful inspection of the pelvis, and if necessary, complete removal of involved regions.  Endometriosis glands are as active as the glands in the uterus, only outside their normal environment, causing inflammation, bleeding and pelvic pain. Endometriosis leads to scarring and fibrosis of the normally smooth surfaces of the pelvic organs and walls. It can lead to pain with periods, sexual intercourse, bowel movements, and urination, as well as causing infertility. Left unmanaged, pelvic pain due to endometriosis becomes constant and persistent, not just occurring during the time of periods (and the week or so prior).

Accepted treatments for endometriosis include hormonal management, attempting to suppress growth of endometriosis lesions. Some medical treatments can be fraught with significant side effects, and can be difficult to tolerate. Surgical management may be a more useful management strategy. This is clearly true for women attempting to conceive, and many specialists (including me) believe that when surgical excision is done correctly (with removal of all areas showing evidence of abnormal tissue) pain relief is more complete, and disease resolution is more likely.

If you have questions or concerns about pelvic pain or endometriosis, please feel free to contact us and speak to one of our endometriosis specialists.