Hormones and endometriosis are integrally related. This is not discussed anywhere in the literature, textbooks, and certainly not taught to upcoming OB/GYN residents currently in training.
This is also true of Minimally Invasive Surgery Fellowships. As Reproductive Endocrinologists, we are innately attuned to hormonal complaints from our patients. Observing through years of taking care of endometriosis patients, it is evident that estrogen levels begin to fall on average around age 35 producing intense symptoms to include a characteristic PMS syndrome of mood changes, bloating, and cyclic headaches.
In addition, all of the more typical symptoms of menopause can be evident as well. These symptoms include hot flashes, night sweats, nighttime urination, frequent urination urgency, vaginal dryness, brain fog, anxiety, depression, memory loss, ADD, bone pain, and sleep disturbances just to name some. Many women are all too familiar with these symptoms.
In women without endometriosis, these symptoms would be common starting in the 43-45 age range and would be recognized by some doctors as pre-menopausal. At 30 or 35 however, nobody is thinking about menopause or estrogen, Sadly, most of these patients are placed on anxiety, depression, ADD, and headache medicines and many are on all four when we see them. Most are so devastated by these symptoms and the relief provided by the drugs, that they can’t conceive of coming off even after estrogen has resolved their symptoms.
The low estrogen is caused by premature aging of the ovaries due to endometriosis induced chronic pelvic inflammation. If you know anyone with these symptoms, they need to be carefully evaluated for diminished ovarian reserve and treated appropriately.
Remember, many women with endometriosis have little or no pain and are shocked when we suggest the diagnosis. There are other reasons for low estrogen as well and our world today brings estrogen down in many women who thrive via estrogen supplementation.
Michael D. Fox, MD
Jacksonville Center Reproductive Medicine
Advanced Reproductive Specialists