Endometriosis

Name: Endometriosis Care at The University of Kansas Health System
Creator: The University of Kansas Health System

Endometriosis is a disease that affects 1 in 10 women. It often causes severe pain and can affect fertility.

On average, it takes 7-10 years for patients with endometriosis symptoms to be diagnosed, and surgery is often required to get an accurate diagnosis.

While pelvic pain is a very common endometriosis symptom, it can usually be managed by your OB-GYN. If your symptoms are not well-controlled, or you feel like you are being dismissed by your physicians, you should seek an endometriosis specialist. You should also consult a specialist if you are considering surgery to evaluate or to remove the disease. Finally, talk with a specialist if you’re experiencing infertility.

Getting a surgical consultation can give you confidence in your diagnosis and treatment plan. Call 913-588-1227 for a second opinion.

What is endometriosis?

Endometriosis is a chronic inflammatory disease that occurs when tissue from the uterus grows where it does not belong, such as the ovaries, fallopian tubes, intestines or lining of the pelvic cavity. It commonly causes bleeding, inflammation, scarring and pelvic pain.

Endometrial tissue attaches to the peritoneum, or abdominal cavity lining.

Endometrial implants are more widespread and may invade deeply into the tissue.

There are many deep endometriosis implants and small cysts on one or both ovaries. Adhesions, or clumps of scar tissue, may also be present.

There are many deep endometriosis implants, large cysts on one or both ovaries, dense scar tissue and disease outside the pelvis.

Endometriosis symptoms and risks

Endometriosis can cause a wide variety of symptoms, depending on where tissue has grown outside of the uterus. Common symptoms are pain with periods, pain with sex, infertility, bowel and bladder problems, and chronic abdominal and pelvic pain.

You may be at higher risk for endometriosis if you:

Have never given birth
Have an immediate family member with endometriosis
Started getting periods before age 11
Have heavier periods or a shorter interval between periods
Have been diagnosed with an abnormal uterus

If endometriosis goes untreated, it can lead to cancer or infertility.

Dr. Austin Findley:

Definitely, it affects fertility. Some of those things we just mentioned, like when it causes significant scarring of the fallopian tubes, the fallopian tubes then do not function normally, so the egg cannot travel from the ovary to the uterus. And then just the presence of the disease itself can have a negative impact on fertility. So the tissue of the endometriosis releases these inflammatory cytokines that sometimes prevent ovulation from occurring and prevent sperm motility, and can also just make it more difficult to conceive, just by the disease being present in general.

The production of inflammatory markers created by the disease creates a chronic inflammatory state within the body. So it's not considered an autoimmune disease, but it does affect the immune system, and women who have endometriosis do have a higher risk for cardiovascular disease like heart attack and stroke, probably related to that chronic inflammatory state that occurs within the body.

What that study showed is that women who have more significant endometriosis, like endometriosis cysts of the ovaries, what we refer to as endometriomas, are more likely to develop a specific type of ovarian cancer. It's not the most common type of ovarian cancer, and what that study showed is that there is a higher risk associated with women with severe disease. But what I like to talk to people about is even though it showed a tenfold increased risk in ovarian cancer, that sounds very scary. What that equates to is about 10 more patients per every 10,000 women with endometriosis. So overall, that risk is not severely high.

Frequently asked questions

Unfortunately, pelvic pain can be associated with several gynecologic issues, so pelvic pain on its own is probably not a good reason to undergo surgery to diagnose endometriosis. If you are experiencing pelvic pain in addition to other symptoms, like infertility, a consultation is recommended.
Yes. While symptoms of endometriosis are most common, or most severe, during a menstrual period, they are not exclusively tied to it. You may experience pain during bowel movements, urination and intercourse, for example, at any time.

Endometriosis diagnosis and screening

Endometriosis typically can’t be diagnosed with imaging studies such as a CT scan, MRI or ultrasound, although these may be used to look for signs of the disease.

To diagnose, a gynecologist will first review your history and symptoms, perform a pelvic exam and review any imaging studies. If endometriosis is suspected, a surgical procedure called laparoscopy may be recommended. During surgery, a small amount of tissue is removed. This is then biopsied to confirm the presence of endometriosis.

The University of Kansas Health System is a leader in minimally invasive gynecologic surgery for endometriosis.

Endometriosis treatment

Treatment for endometriosis depends on the extent of the disease, your symptoms and your goals. It can be treated with medication, surgery or both.

The gold standard is minimally invasive surgical excision of the disease with long-term management of symptoms. This does not require complete removal of the uterus and ovaries, which is often what people are told. Excision surgery is a special type of care that is not available through your primary OB-GYN.

Follow-up treatments include physical therapy, nonopioid pain medications and behavioral health therapy.

Why choose us for endometriosis

The health system has the only comprehensive minimally invasive gynecologic surgery (MIGS) program in Kansas under the direction of a fellowship-trained, board-certified physician. We practice evidence-based medicine and are up to date on all the latest technology, like minimally invasive surgery procedures to treat endometriosis.

The disease can cause significant scarring and distortion of normal anatomy, and these surgeries can be more challenging than many cancer surgeries. There are very few centers and surgeons that are qualified to do this. We do them here." Austin Findley, MD
Minimally invasive gynecologic surgeon

Our team recognizes that surgery is a big step. That’s why we provide individualized management plans (including nonsurgical options) focused on patient education and shared decision-making.

Finally, we provide many different treatment options and multidisciplinary care for endometriosis.

Your endometriosis care team

High-quality surgical removal of endometriosis often involves collaboration with a colorectal surgeon or a urologist.

Physical therapists will work on musculoskeletal dysfunction.

Additionally, endometriosis can take a mental and emotional toll on you. Our psychiatrists can help address those issues.