Endometriosis affects approximately 6.5 million women in the U.S. The condition causes chronic pain and fertility issues, but is often overlooked and underdiagnosed.
For National Endometriosis Awareness Month in March, Leah Henke, an assistant professor at the University of Minnesota Medical School and OB-GYN with M Health Fairview, shares information about endometriosis symptoms, prevalence and treatment.
Q: What is endometriosis?
Dr. Henke: Endometriosis is a condition where the lining of the uterus attaches and grows outside the uterus. This can cause inflammation, pain and scar tissue to form. There are several theories as to how endometriosis forms. The most widely accepted is that endometrial lining travels backward through the fallopian tubes and out into the abdomen. Genetic and hormonal factors then allow this tissue to attach to other structures and grow and shed with the menstrual cycle.
Q: What are the symptoms of endometriosis?
Dr. Henke: While symptoms can vary, the most common symptoms are pelvic pain that occurs around the time of menstruation and pain with intercourse. Depending on the location of endometriosis, some people may also experience pain or bleeding with bowel movements or urination, heavy menstrual bleeding and difficulty becoming pregnant. Inflammation from endometriosis can also cause scar tissue to develop in the abdomen. Some people are incidentally diagnosed with endometriosis during another surgical procedure due to the appearance of the condition, whereas others have debilitating symptoms but mildly visualized disease on surgical exploration. Many symptoms also overlap with other conditions. If you have symptoms that align with endometriosis, your gynecologist may recommend additional tests or treatment to help determine the cause.
Q: How common is this condition?
Dr. Henke: Endometriosis occurs in 6-10% of people with female reproductive organs. It is more common in people with infertility or chronic pelvic pain. People with an immediate family member with endometriosis have a seven to 10 times higher risk of having the disease. The prevalence of endometriosis may be even higher than is reported due to difficulty with diagnosis. A definitive diagnosis is made through biopsy of lesions outside the uterus. Because surgery is needed for a definitive diagnosis, the first treatment options are usually medications for those suspected to have the condition.
Q: What are the treatment options?
Dr. Henke: Treatment options vary based on a patient’s symptoms, medical and surgical history and fertility goals. The objective of most treatment options is to reduce endometriosis growth and inflammation. This can be achieved through a variety of medications that affect the hormones, specifically estrogen and progesterone. These medications are also sometimes used with additional drugs to help treat inflammation. Interestingly, exercising more than four days a week has been found to be protective against endometriosis.
If initial treatment is not helpful, other treatment options such as diagnostic laparoscopy — surgery through small incisions in the abdomen — may be pursued to help confirm the diagnosis. Surgical treatment to remove or destroy endometriosis lesions can decrease pain. However, patients may see symptoms return within several months to years after removal, especially without continued medical treatment after surgery. Definitive surgical treatment of endometriosis is removal of the uterus and both ovaries, which is only considered if other options don’t work, as it results in loss of fertility, surgical risks and long-term consequences from the early loss of ovarian hormones.
Q: What are you doing to advance a healthier Minnesota?
Dr. Henke: As a teaching physician at the University of Minnesota, I work with our patients to help teach medical students and residents how to provide evidence-based and compassionate obstetric and gynecologic care. I work in the clinic, hospital and operating room settings. We have many ongoing research studies that patients can engage with to help expand the field of knowledge. I have a personal interest in global health disparities and serve as the advisor for the OB-GYN residency track in global women’s health. I also perform minimally invasive surgeries with the robotic platform and enjoy learning new and innovative techniques to make surgery safer.
Leah Henke is an assistant professor with the U of M Medical School and an obstetrician/gynecologist with M Health Fairview. Her clinical interests include global women’s health, advocacy for equitable care, minimally invasive surgery, integrative care and health education.
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