‘Your pain is real’ — doctors advocate for endometriosis awareness
On average, it takes seven years before a patient living with endometriosis symptoms receives a definitive diagnosis. Oftentimes, the disorder hadn’t even crossed their mind.
Endometriosis is not mentioned enough as we grow up, says Kate Statz, DO, FACOOG, obstetrics and gynecology provider at MultiCare Rockwood Clinic. Teens may not realize it’s unusual to miss school every month because of their period.
In many cases, endometriosis isn’t identified until it’s causing severe symptoms or interfering with other aspects of a person’s health.
“In a large percentage of our infertility patients, endometriosis is the cause,” says Lacey Marks, MD, FACOG, obstetrics and gynecology provider at MultiCare Rockwood Clinic. “It’s a disease mostly of reproductive age women … it would be nice to have those conversations much sooner.”
Drs. Statz and Marks are starting that conversation this March for Endometriosis Awareness Month.
What is endometriosis?
Endometriosis is a disorder in which intrauterine tissue grows outside the uterus on the ovaries, fallopian tubes or surrounding pelvic areas. Over time and with nowhere to go during the menstrual cycle, it forms into scar tissue.
The most common symptoms include pain, heavy periods, infertility or gastrointestinal problems. Symptoms can range from nonexistent to severe. The extent of the endometriosis doesn’t dictate how severe symptoms will be — you could have extensive scar tissue with no pain, and vice versa.
When should I see a doctor?
Just as we track our cycles, Dr. Marks says, it’s important to watch our symptoms over time, too. Those without endometriosis may report heavy periods or intense cramps that dissipate between cycles. But people with endometriosis are more likely to experience a continual worsening of symptoms, to the point that they’re having pain between cycles.
“You’re at a one or two on pain all the time, then nine or 10 with your period,” she says. “Or you’ll notice the pain deep in the pelvis during sex … that’s most often the endometriosis growing and getting larger.”
Prepare for your appointment
Your provider will ask:
- When was your first period?
- How often and long does your period last?
- How many feminine hygiene products do you use in a day?
- When does pain begin/get worse in your cycle?
- Do you have family history of endometriosis?
- How are you currently treating pain?
- Do you have pain with intercourse?
- How severe is your pain and has it changed over time?
- Are you taking any other medications?
- Are you experiencing infertility problems?
- Are you experiencing any other symptoms, such as vaginal discharge or itchiness?
If you have concerns or are curious if what you’re experiencing is out of the ordinary, ask your primary care provider during your annual wellness exam. They will either assess your symptoms or refer you to a specialist.
To diagnose, providers may perform a pelvic exam, ultrasound, MRI or laparoscopy. Once endometriosis is suspected or confirmed, treatment ranges from pain relievers and hormone therapy to surgery to remove scar tissue.
Am I at risk?
There is no singular cause of endometriosis, but the most prominent risk factors include:
- Family history of endometriosis
- Prior surgeries on the uterus
- Poor dietary or lifestyle choices
- Inflammatory markers/smoking
- Hormonal imbalances
The earliest warning signs of endometriosis often appear shortly after a person begins menstruation, but are usually appear as nothing out of the ordinary. For others, though, Dr. Marks says the disorder is not identifiable until their 30s — especially if they’ve been pregnant and are only now experiencing painful periods.
Dr. Statz stresses the importance of staying positive and taking preventive action where we can.
“Knowledge is power,” she says. “You really can implement change if you’re proactive and take it on from multiple angles.”
Along with standard treatment and prevention methods, Dr. Statz emphasizes options like an anti-inflammatory diet, acupuncture, hydrotherapy, herbal supplements for pelvic circulation or stress, pelvic floor physical therapy, yoga and stretching. Always consult your doctor or other health care provider before beginning a new treatment.
In most cases, providers start with more conservative options before opting for surgery. Some patients may avoid surgery altogether by following risk-lowering habits and treating with first-line medications, Dr. Marks says.
But for some, surgery may be the only option.
Your pain is real
It’s not uncommon for endometriosis to be confused with other similar conditions, such as ovarian cysts, pelvic infections, adenomyosis (when intrauterine tissue grows within the muscular walls of the uterus) or, although uncommon, ovarian cancer.
“They come to us and are so frustrated about their pain and the fact they have already seen multiple doctors,” Dr. Statz says. “It’s no wonder they are frustrated by the time they get to us. We hope we can decrease this timeline by having these types of discussions within the community sooner.”
Regardless of the condition you’re facing, Drs. Marks and Statz say your pain is real and they believe you.
“Some women find out they don’t have it and think we’re calling them crazy. But that mind-body connection is real and the pain you get with trauma is significant.”
That sentiment may ring especially true for patients who have survived significant trauma or sexual assault, or who live with post-traumatic stress disorder (PTSD) and may present with endometriosis-like symptoms, Dr. Marks says.
“I want people to realize that even if we go surgically looking for endometriosis and we don’t find it, that doesn’t mean your pain is not real,” she says. “Some women find out they don’t have it and think we’re calling them crazy. But that mind-body connection is real and the pain you get with trauma is significant.”
In such cases, therapeutic treatments are also available to help reduce pain during the menstrual cycle.
Visit MultiCare Obstetrics & Gynecology to learn more and get connected with a provider.
