Endometriosis is a condition where endometrial tissue that normally lines the inside of the uterus, grows outside the uterus and attaches to other organs in the abdominal cavity, such as the ovaries and fallopian tubes.
Endometriosis is a progressive disease that tends to get worse over time and can recur after treatment.
Symptoms include painful menstrual periods, abnormal menstrual bleeding, pain during or after sexual intercourse, and infertility.
The cause of endometriosis is unknown, though there are a few theories that suggest possible causes.
Alan Martinez, MD is here to discuss what an endometriosis diagnoses means to you.
Endometriosis: Symptoms and Treatments
From the Show: RSC NJ - Fertility Talk
Summary:
Air Date: 1/27/16
Duration: 10 Minutes
Transcription:
Melanie Cole (Host): Endometriosis is a painful, chronic disease that affects at least 6.3 million women and girls in the US. My guest today is Dr. Alan Martinez. He’s a specialist in reproductive endocrinology and in fertility at the Reproductive Science Center in New Jersey. Welcome to the show, Dr. Martinez. What is endometriosis?
Dr. Alan Martinez (Guest): Thank you for having me today. I appreciate the opportunity to talk. So, endometriosis is a condition that affects approximately 3-10% of reproductive-aged women and it is where you have the presence of endometrial cells that are normally found in the uterus in parts of the pelvis, meaning the tubes, the ovaries, or the intestines or other parts of the abdominal cavity.
Melanie: So, then, what are the complications that happen if somebody is diagnosed with endometriosis?
Dr. Martinez: Most commonly, they may have pain with their periods. It’s called “dysmenorrhea”. They can also have pain with intercourse and they can also present with infertility.
Melanie: Do we know the cause, Dr. Martinez, of endometriosis?
Dr. Martinez: There are some leading theories on this. One of the primary causes is that there may be what we call “retrograde menstrual flow”. Instead of coming out of the vaginal canal in normal menses, there are cells that go in the opposite direction, up into the fallopian tubes, and out into the pelvis and kind of the cells seed different areas and kind of make implants and then this is responsible for the disease. That's one theory. Another theory is that it could result from changes in blood flow. It could be transferred through the blood vessels themselves. There's also another theory that potentially cells in the pelvis change over time into the endometriosis cells themselves.
Melanie: How do you diagnose it?
Dr. Martinez: This is a very good question. Oftentimes, the suspicion of endometriosis is diagnosed by the symptoms that I was talking about. So, the painful periods, infertility; but, the only way that you can really diagnose endometriosis is if you actually go in and do surgery and you either have the presence of the endometriosis lesions within the different aspects of the pelvis or if you take a biopsy and you find that those are endometriotic cells.
Melanie: So, if a woman has endometriosis, does she also suffer from some comorbidity? Things that go along with it?
Dr. Martinez: Well, for the most part then endometriosis is primarily a quality of life issue and/or infertility. So, that is where most of the issues are, so it affects the reproductive-age women because their body makes more estrogen. It's less commonly found in the older population and, primarily, it's quality of life and the issues with infertility.
Melanie: So, then, what can you do for that? Is there a cure, as it were, or is it mostly symptom management?
Dr. Martinez: For the most part, it's symptom management. So, what commonly happens is that women will be placed on birth control pills which kind of take over the normal hormonal changes that happen throughout their menstrual cycle and that can help alleviate some of the common pain symptoms. In some cases, there are other medications that are taken to completely shut down the body's production of estrogen which then can help out with their symptoms. In the patient that is suffering from more severe pain symptoms, then the consideration of surgery is sometimes carried out in order to address sort of endometriosis pathology itself and to help out with their symptoms.
Melanie: Does it run, in fact, in families, doctor?
Dr. Martinez: Yes, it does have a genetic component. We believe that it does run in families and it's more common in families where you have a history of endometriosis. It can also run more common in people that may have issues with adhesions in the uterus where the menstrual flow cannot go in its normal direction. So, people that have developmental issues with the vaginal canal and some other rare conditions can pre-dispose people to getting endometriosis.
Melanie: So, if a woman has it, do you recommend that you keep an eye on her daughter for some of those similar symptoms?
Dr. Martinez: Well, it's going to be an individualized case. So, if you have an adolescent who has painful periods and has some of the more classic symptoms of endometriosis, then definitely a family history should be taken. If that's the case, then that patient should be considered in that context and potentially the opportunity for the young female to have medications earlier on to maybe help out with her quality of life and her symptoms can become more important. So, you should definitely have your ears perked up if that's the case.
Melanie: How does it affect fertility and pregnancy or getting pregnant or maintaining a pregnancy?
Dr. Martinez: Endometriosis is thought to potentially have an affect with more advanced endometriosis. There are four stages of endometriosis and we definitely know that Stages 3 and 4 can definitely contribute to infertility. In those cases, when a patient is diagnosed, usually through surgical means, then that's an indication for fertility treatments. The earlier stages--1 and 2--the association with endometriosis becomes more muddled. We don't exactly understand why endometriosis can cause infertility in these earlier stage patients, but we do know that in more advanced stages of endometriosis, it can actually damage the tubes, it can obstruct the eggs being released and being taken out by the tubes and, again, it creates more structural issues that definitely contribute to the infertility cause.
Melanie: What would you like to tell women about behavior lifestyles, if any, that can help either with their symptoms or possible prevention?
Dr. Martinez: Well, unfortunately, we cannot prevent endometriosis. Once a patient is diagnoses with endometriosis or there's a suspicion for it, then it becomes a management, usually, of their menstrual cycles. So, a few days before their period, if they suffer from pain, they may be encouraged to take an NSAID such as Aleve, or Advil to help out with some of the pain mechanisms. They may be placed on the birth control pills which can help out tremendously in patients. And, in some cases, they may actually be recommended for more aggressive medicines, if need be.
Melanie: And does endometriosis go away after menopause, doctor?
Dr. Martinez: In many patients because of the changes in the function of the ovaries, specifically, and their production of estrogen, it can go into a quiet stage. Many patients that are suffering from the cyclical pain associated with their menstrual periods will often find that resolves. Any damage, however, that's been done to the tubes or the ovaries or other parts of the pelvis--endometriosis can definitely cause adhesion or scarring within the various organs of the pelvis—then, whatever damage has been done is, obviously, not going to be reversed. So, they may have symptoms from that but the endometriosis lesions themselves definitely quiet down and the patients often have an improvement of their symptoms after menopause.
Melanie: In just the last few minutes, doctor, and it's such great information. Tell women listening what you really want them to know about endometriosis and why they should come to the Reproductive Science Center of New Jersey for their care?
Dr. Martinez: Here at the Reproductive Science Center of New Jersey we are a practice that offers personalized care and we treat each patient individually. So, if you come to our office, we sit down with you, we take a detailed history. You have a close connection with all members of the staff and we're here to help you. So, we offer the most advanced treatments if a patient would need surgery or advanced fertility treatment, such as IVF, we can afford that to the patients. We also, because of the unique nature and the individualized care, often patients don't need more advanced treatment so they may be offered more minimally invasive treatment options. Within our practice, it's a warm environment. We are here to help everybody out and help patients with endometriosis and others who have a difficult quality of life. We just want to offer our knowledge and our warm environment to better your life.
Melanie: Thank you so much, doctor, for being with us today. You're listening to Fertility Talk with the Reproductive Science Center of New Jersey. For more information you can go to FertilityNJ.com. That's FertilityNJ.com. This is Melanie Cole, thanks so much for listening.
Melanie Cole (Host): Endometriosis is a painful, chronic disease that affects at least 6.3 million women and girls in the US. My guest today is Dr. Alan Martinez. He’s a specialist in reproductive endocrinology and in fertility at the Reproductive Science Center in New Jersey. Welcome to the show, Dr. Martinez. What is endometriosis?
Dr. Alan Martinez (Guest): Thank you for having me today. I appreciate the opportunity to talk. So, endometriosis is a condition that affects approximately 3-10% of reproductive-aged women and it is where you have the presence of endometrial cells that are normally found in the uterus in parts of the pelvis, meaning the tubes, the ovaries, or the intestines or other parts of the abdominal cavity.
Melanie: So, then, what are the complications that happen if somebody is diagnosed with endometriosis?
Dr. Martinez: Most commonly, they may have pain with their periods. It’s called “dysmenorrhea”. They can also have pain with intercourse and they can also present with infertility.
Melanie: Do we know the cause, Dr. Martinez, of endometriosis?
Dr. Martinez: There are some leading theories on this. One of the primary causes is that there may be what we call “retrograde menstrual flow”. Instead of coming out of the vaginal canal in normal menses, there are cells that go in the opposite direction, up into the fallopian tubes, and out into the pelvis and kind of the cells seed different areas and kind of make implants and then this is responsible for the disease. That's one theory. Another theory is that it could result from changes in blood flow. It could be transferred through the blood vessels themselves. There's also another theory that potentially cells in the pelvis change over time into the endometriosis cells themselves.
Melanie: How do you diagnose it?
Dr. Martinez: This is a very good question. Oftentimes, the suspicion of endometriosis is diagnosed by the symptoms that I was talking about. So, the painful periods, infertility; but, the only way that you can really diagnose endometriosis is if you actually go in and do surgery and you either have the presence of the endometriosis lesions within the different aspects of the pelvis or if you take a biopsy and you find that those are endometriotic cells.
Melanie: So, if a woman has endometriosis, does she also suffer from some comorbidity? Things that go along with it?
Dr. Martinez: Well, for the most part then endometriosis is primarily a quality of life issue and/or infertility. So, that is where most of the issues are, so it affects the reproductive-age women because their body makes more estrogen. It's less commonly found in the older population and, primarily, it's quality of life and the issues with infertility.
Melanie: So, then, what can you do for that? Is there a cure, as it were, or is it mostly symptom management?
Dr. Martinez: For the most part, it's symptom management. So, what commonly happens is that women will be placed on birth control pills which kind of take over the normal hormonal changes that happen throughout their menstrual cycle and that can help alleviate some of the common pain symptoms. In some cases, there are other medications that are taken to completely shut down the body's production of estrogen which then can help out with their symptoms. In the patient that is suffering from more severe pain symptoms, then the consideration of surgery is sometimes carried out in order to address sort of endometriosis pathology itself and to help out with their symptoms.
Melanie: Does it run, in fact, in families, doctor?
Dr. Martinez: Yes, it does have a genetic component. We believe that it does run in families and it's more common in families where you have a history of endometriosis. It can also run more common in people that may have issues with adhesions in the uterus where the menstrual flow cannot go in its normal direction. So, people that have developmental issues with the vaginal canal and some other rare conditions can pre-dispose people to getting endometriosis.
Melanie: So, if a woman has it, do you recommend that you keep an eye on her daughter for some of those similar symptoms?
Dr. Martinez: Well, it's going to be an individualized case. So, if you have an adolescent who has painful periods and has some of the more classic symptoms of endometriosis, then definitely a family history should be taken. If that's the case, then that patient should be considered in that context and potentially the opportunity for the young female to have medications earlier on to maybe help out with her quality of life and her symptoms can become more important. So, you should definitely have your ears perked up if that's the case.
Melanie: How does it affect fertility and pregnancy or getting pregnant or maintaining a pregnancy?
Dr. Martinez: Endometriosis is thought to potentially have an affect with more advanced endometriosis. There are four stages of endometriosis and we definitely know that Stages 3 and 4 can definitely contribute to infertility. In those cases, when a patient is diagnosed, usually through surgical means, then that's an indication for fertility treatments. The earlier stages--1 and 2--the association with endometriosis becomes more muddled. We don't exactly understand why endometriosis can cause infertility in these earlier stage patients, but we do know that in more advanced stages of endometriosis, it can actually damage the tubes, it can obstruct the eggs being released and being taken out by the tubes and, again, it creates more structural issues that definitely contribute to the infertility cause.
Melanie: What would you like to tell women about behavior lifestyles, if any, that can help either with their symptoms or possible prevention?
Dr. Martinez: Well, unfortunately, we cannot prevent endometriosis. Once a patient is diagnoses with endometriosis or there's a suspicion for it, then it becomes a management, usually, of their menstrual cycles. So, a few days before their period, if they suffer from pain, they may be encouraged to take an NSAID such as Aleve, or Advil to help out with some of the pain mechanisms. They may be placed on the birth control pills which can help out tremendously in patients. And, in some cases, they may actually be recommended for more aggressive medicines, if need be.
Melanie: And does endometriosis go away after menopause, doctor?
Dr. Martinez: In many patients because of the changes in the function of the ovaries, specifically, and their production of estrogen, it can go into a quiet stage. Many patients that are suffering from the cyclical pain associated with their menstrual periods will often find that resolves. Any damage, however, that's been done to the tubes or the ovaries or other parts of the pelvis--endometriosis can definitely cause adhesion or scarring within the various organs of the pelvis—then, whatever damage has been done is, obviously, not going to be reversed. So, they may have symptoms from that but the endometriosis lesions themselves definitely quiet down and the patients often have an improvement of their symptoms after menopause.
Melanie: In just the last few minutes, doctor, and it's such great information. Tell women listening what you really want them to know about endometriosis and why they should come to the Reproductive Science Center of New Jersey for their care?
Dr. Martinez: Here at the Reproductive Science Center of New Jersey we are a practice that offers personalized care and we treat each patient individually. So, if you come to our office, we sit down with you, we take a detailed history. You have a close connection with all members of the staff and we're here to help you. So, we offer the most advanced treatments if a patient would need surgery or advanced fertility treatment, such as IVF, we can afford that to the patients. We also, because of the unique nature and the individualized care, often patients don't need more advanced treatment so they may be offered more minimally invasive treatment options. Within our practice, it's a warm environment. We are here to help everybody out and help patients with endometriosis and others who have a difficult quality of life. We just want to offer our knowledge and our warm environment to better your life.
Melanie: Thank you so much, doctor, for being with us today. You're listening to Fertility Talk with the Reproductive Science Center of New Jersey. For more information you can go to FertilityNJ.com. That's FertilityNJ.com. This is Melanie Cole, thanks so much for listening.