Endometriosis and Pelvic pain are some of the most confusing and poorly managed areas in medicine.
It is frustrating that the majority of gynecologists don’t understand the nuances of this disease continuum and its management (by virtue of gynecological training). Laparoscopic laser vs cautery "spot treatment," or medical therapy with lupron, are used by 99% of the gynecology world to treat endometriosis. Surgery is the only effective treatment, but to cure the disease it must be completely excised laparoscopically to achieve the desired outcome.
There are fewer than 20 practices in the US that offer comprehensive excisional surgery for all stages of endometriosis. In a patient without prior disease, there is no consistent way to predict the severity of the disease before surgery because symptoms and the amount or nature of disease are poorly correlated. For example, most infertility patients with endometriosis have very little, if any, pain. At JCRM, all causes of pelvic pain are considered and often at surgery we are addressing 3 or more different sources of pain. Without such a comprehensive approach, patients are left with residual endometriosis and often continue with pain since other common causes of pain are not addressed.
General symptoms of endometriosis can include:
- Extremely painful (or disabling) menstrual cramps; pain may get worse over time
- Chronic pelvic pain (includes lower back pain and pelvic pain)
- Pain during or after sex
- Intestinal pain
- Painful bowel movements or painful urination during menstrual periods
- Heavy menstrual periods
- Premenstrual spotting or bleeding between periods
- Infertility (not being able to get pregnant)