Each woman with endometriosis has her own unique combination of symptoms. While many suffer severe or even debilitating menstrual pain, a small percentage of women experience little or even no discomfort. Some women experience pain during sex. Although many have fertility issues, others have no problem conceiving and giving birth.
In this podcast, Dr. David Galland, an OB-GYN at MarinHealth Medical Center, discusses the symptoms, causes, and treatment of endometriosis. Listen to learn more about new medications, hormone treatments, and other approaches to managing a chronic condition that can seriously impact your quality of life.
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Endometriosis: Individualized treatment for a complex condition
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Learn more about David B. Galland, MD
David B. Galland, MD
David Galland is a board certified Obstetrician-Gynecologist practicing in Larkspur for the past 29 years. He is a member of the American Association for Gynecologic Laparoscopists, the North American Menopause Society, the American Institute of Minimally Invasive Surgery and the American Institute of Ultrasound in Medicine. He received his undergraduate degree in Biology from the State University of New York at Stony Brook, attended the L’Universite Catholique de Louvain in Belgium, and received his MD from the University of Rochester School of Medicine. After enduring several winters in Rochester, NY, he did his internship and residency at UCLA.Learn more about David B. Galland, MD
Transcription:
Bill Klaproth (Host): Endometriosis is an often-painful disorder especially during a woman’s period and fertility problems also may develop. Fortunately, effective treatments are available. And here to talk with us about endometriosis is Dr. David Galland, an OB-GYN at Marin General Hospital. Dr. Galland, thank you for your time. So, first off, can you give us an overview of endometriosis? What is it and how does it develop?
David B. Galland, MD (Guest ): Endometriosis is a noncancerous benign condition that occurs when material that resembles the inside lining of the uterus that comes out every month with a woman’s period grows outside of the uterus, on the outer surface of the uterus, tubes, ovaries, intestines, bladder. it tends to swell each month during the menstrual period and bleed a little bit and it creates chemicals that cause the – serious pain and cramps. It also can induce scar tissue so that things inside the pelvis that normally aren’t attached scar and attach to each other.
Host: So, I guess the good news is, it is noncancerous, it is a benign condition, but it really can cause problems. So, who is at risk for this?
Dr. Galland: So, endometriosis can start with the start of menstrual periods, prior to that, it doesn’t create any problems. And then for most women when their periods end in menopause, the symptoms of endometriosis diminish and go away. So, it is during the reproductive years.
Host: And what are the primary symptoms?
Dr. Galland: They are enormously varied, but the most common is severe menstrual cramps that often start prior to the flow of the menses and continue and get worse during the menses. Now not all menstrual cramps are due to endometriosis, but most women with endometriosis have that. There also can be pain at other times of the month. Sometimes pain with intercourse and it can as you indicated for some women affect fertility.
Host: So, at what point should a woman see the doctor if she’s experiencing these symptoms?
Dr. Galland: Well, if she has mild cramps that occur with the flow and are well-treated with over-the-counter products like ibuprofen or Naprosyn or Tylenol; there’s probably no need. But if they have very severe cramps that cause them to miss school or work; I think it’s a very good idea to come in and be checked.
Host: So, when they do come in to be checked, how do you ultimately diagnose this as endometriosis?
Dr. Galland: Well, it’s really not a simple thing. first of course, is a careful pelvic examination and then sometimes we do an ultrasound that looks in with sound waves. Some women with endometriosis will develop fluid-filled areas in the ovaries called cysts that have old blood inside of them and those are easily seen with ultrasound, although many women with endometriosis don’t have that. Unfortunately, the only way to make a certain diagnosis is through surgery. And we do a minimally invasive operation called laparoscopy in the hospital under anesthesia. We go in with a small scope through the belly button and see the endometriosis and at that time, it can often be removed or treated.
Host: So, you can remove it at that time. So, if a woman is diagnosed with endometriosis, right then and there you can take care of it. Are there other treatment options or medications to help treat this?
Dr. Galland: Yes, absolutely. So, there are a number of different medications that can treat endometriosis and we often will start with the medications. Simplest for many women are birth control pills. and in women with severe menstrual cramps we will often prescribe it a little differently than for other women. We have them take it so they are taking an active pill every single day avoiding having a menstrual period. And for particularly for young women, who need birth control and for some young women who are simply having a lot of pain; this works out very well over the long-term. There are a number of other medications that work for endometriosis. there’s a medication that can be given that causes temporary menopause. Since endometriosis is stimulated by the natural hormone estrogen made in the ovaries; by lowering the estrogen level, the endometriosis becomes quiescent. So, we can create temporary menopause at which time the pain diminishes and that can be stayed on for about a year. there’s also a progesterone containing IUD that can be used for some women that has been shown to help with endometriosis pain for at least a couple of years and another birth control method called Depo-Provera which tends over time to stop menstrual periods and again help with the symptoms.
Host: So, you were just talking about diminishing the pain. So, through treatment is that all you can do is diminish it, you can’t forever eliminate it? It sounds like this is a condition that a woman has to manage over time, is that right?
Dr. Galland: Absolutely. It’s not a condition where we can intervene once and cure it lifelong. It tends to be a chronic condition that is managed in any one person often with a variety of different methods at different times in her life certainly, the one thing I didn’t mention is we do sometimes find endometriosis by accident in a woman who has no symptoms whatsoever. So, I have had the occasion of a woman who is 40 and had three children and came in for tubal ligation, did the same type of scope procedure and found endometriosis all over and she had light painless periods and no problems getting pregnant. So, it’s a very curious condition.
Host: So, what is the long-term prognosis then for someone with endometriosis?
Dr. Galland: it’s again very variable. So, some women, it affects fertility. Some it doesn’t. For some women it creates a lot of pain, for some it’s manageable. The good news, especially as women get older, is when they do go through menopause and hormone levels drop; the symptoms of endometriosis tend to go away.
Host: And that is the good news. And Dr. Galland is there anything else we should know about endometriosis?
Dr. Galland: Well I think the important thing is that it’s rarely life threatening or very dangerous. The symptoms vary a lot from person to person and that we have a large variety of ways of treating this, both to make women more comfortable and those who are having issues getting pregnant to help them to get pregnant.
Host: Well that’s really good information and advice. Dr. Galland, thank you so much for your time today. We appreciate it and for more information please visit www.maringeneral.org, that’s www.maringeneral.org. This is the Healing Podcast brought to you by Marin General Hospital. I’m Bill Klaproth. Thanks for listening.
Bill Klaproth (Host): Endometriosis is an often-painful disorder especially during a woman’s period and fertility problems also may develop. Fortunately, effective treatments are available. And here to talk with us about endometriosis is Dr. David Galland, an OB-GYN at Marin General Hospital. Dr. Galland, thank you for your time. So, first off, can you give us an overview of endometriosis? What is it and how does it develop?
David B. Galland, MD (Guest ): Endometriosis is a noncancerous benign condition that occurs when material that resembles the inside lining of the uterus that comes out every month with a woman’s period grows outside of the uterus, on the outer surface of the uterus, tubes, ovaries, intestines, bladder. it tends to swell each month during the menstrual period and bleed a little bit and it creates chemicals that cause the – serious pain and cramps. It also can induce scar tissue so that things inside the pelvis that normally aren’t attached scar and attach to each other.
Host: So, I guess the good news is, it is noncancerous, it is a benign condition, but it really can cause problems. So, who is at risk for this?
Dr. Galland: So, endometriosis can start with the start of menstrual periods, prior to that, it doesn’t create any problems. And then for most women when their periods end in menopause, the symptoms of endometriosis diminish and go away. So, it is during the reproductive years.
Host: And what are the primary symptoms?
Dr. Galland: They are enormously varied, but the most common is severe menstrual cramps that often start prior to the flow of the menses and continue and get worse during the menses. Now not all menstrual cramps are due to endometriosis, but most women with endometriosis have that. There also can be pain at other times of the month. Sometimes pain with intercourse and it can as you indicated for some women affect fertility.
Host: So, at what point should a woman see the doctor if she’s experiencing these symptoms?
Dr. Galland: Well, if she has mild cramps that occur with the flow and are well-treated with over-the-counter products like ibuprofen or Naprosyn or Tylenol; there’s probably no need. But if they have very severe cramps that cause them to miss school or work; I think it’s a very good idea to come in and be checked.
Host: So, when they do come in to be checked, how do you ultimately diagnose this as endometriosis?
Dr. Galland: Well, it’s really not a simple thing. first of course, is a careful pelvic examination and then sometimes we do an ultrasound that looks in with sound waves. Some women with endometriosis will develop fluid-filled areas in the ovaries called cysts that have old blood inside of them and those are easily seen with ultrasound, although many women with endometriosis don’t have that. Unfortunately, the only way to make a certain diagnosis is through surgery. And we do a minimally invasive operation called laparoscopy in the hospital under anesthesia. We go in with a small scope through the belly button and see the endometriosis and at that time, it can often be removed or treated.
Host: So, you can remove it at that time. So, if a woman is diagnosed with endometriosis, right then and there you can take care of it. Are there other treatment options or medications to help treat this?
Dr. Galland: Yes, absolutely. So, there are a number of different medications that can treat endometriosis and we often will start with the medications. Simplest for many women are birth control pills. and in women with severe menstrual cramps we will often prescribe it a little differently than for other women. We have them take it so they are taking an active pill every single day avoiding having a menstrual period. And for particularly for young women, who need birth control and for some young women who are simply having a lot of pain; this works out very well over the long-term. There are a number of other medications that work for endometriosis. there’s a medication that can be given that causes temporary menopause. Since endometriosis is stimulated by the natural hormone estrogen made in the ovaries; by lowering the estrogen level, the endometriosis becomes quiescent. So, we can create temporary menopause at which time the pain diminishes and that can be stayed on for about a year. there’s also a progesterone containing IUD that can be used for some women that has been shown to help with endometriosis pain for at least a couple of years and another birth control method called Depo-Provera which tends over time to stop menstrual periods and again help with the symptoms.
Host: So, you were just talking about diminishing the pain. So, through treatment is that all you can do is diminish it, you can’t forever eliminate it? It sounds like this is a condition that a woman has to manage over time, is that right?
Dr. Galland: Absolutely. It’s not a condition where we can intervene once and cure it lifelong. It tends to be a chronic condition that is managed in any one person often with a variety of different methods at different times in her life certainly, the one thing I didn’t mention is we do sometimes find endometriosis by accident in a woman who has no symptoms whatsoever. So, I have had the occasion of a woman who is 40 and had three children and came in for tubal ligation, did the same type of scope procedure and found endometriosis all over and she had light painless periods and no problems getting pregnant. So, it’s a very curious condition.
Host: So, what is the long-term prognosis then for someone with endometriosis?
Dr. Galland: it’s again very variable. So, some women, it affects fertility. Some it doesn’t. For some women it creates a lot of pain, for some it’s manageable. The good news, especially as women get older, is when they do go through menopause and hormone levels drop; the symptoms of endometriosis tend to go away.
Host: And that is the good news. And Dr. Galland is there anything else we should know about endometriosis?
Dr. Galland: Well I think the important thing is that it’s rarely life threatening or very dangerous. The symptoms vary a lot from person to person and that we have a large variety of ways of treating this, both to make women more comfortable and those who are having issues getting pregnant to help them to get pregnant.
Host: Well that’s really good information and advice. Dr. Galland, thank you so much for your time today. We appreciate it and for more information please visit www.maringeneral.org, that’s www.maringeneral.org. This is the Healing Podcast brought to you by Marin General Hospital. I’m Bill Klaproth. Thanks for listening.