Endometriosis, a condition where tissue similar to the uterine lining grows outside the uterus, impacts approximately 1 in 10 women of reproductive age. However, the disabling symptoms of endometriosis often go undiagnosed for years and are usually dismissed at normal period pain. This may result in patients being inadequately treated for chronic pelvic pain and infertility and experiencing poor quality of life.

To learn more about this chronic condition and its treatment options, we spoke with CU Medicine provider Dr. Megan Orlando. Dr. Orlando specializes in complex benign gynecology and minimally invasive gynecologic surgery. She provides insights on recognizing endometriosis symptoms, navigating treatment choices and how surgical techniques like minimally invasive endometriosis excision can provide relief when other therapies have failed.

What is endometriosis?

Endometriosis is a condition in which tissue that resembles uterine lining tissue starts to grow outside of the uterus, most commonly on the ovaries, fallopian tubes and tissue lining the pelvis. Sometimes the tissue can be located near the bowels, urinary tract and even in the upper abdomen and thoracic cavity.

How would someone know they have endometriosis?

The hallmark symptom of endometriosis is pain. “That can include pain with menstruation, sex, bowel movements and urination. It can also contribute to infertility and general reductions in quality of life. It can be a very severe disease,” explains Dr. Orlando.

Endometriosis symptoms:

• Pain with menstruation
• Pain with sexual intercourse
• Pain with bowel movements or urination
• Excessive bleeding during or in between periods
• Infertility

It’s important to note that there are other causes of pelvic pain and conditions that overlap with endometriosis. These conditions include but are not limited to:

• Adenomyosis
• Myofascial or musculoskeletal sources of pain
• IBS (irritable bowel syndrome)
• Painful bladder syndrome (interstitial cystitis)

What are the treatment options for endometriosis?

When it comes to treating endometriosis, medical and surgical treatments are the mainstays.

Medical therapies for endometriosis often involve hormonal suppression. “It’s generally a progesterone-based hormonal suppression. It can treat the endometriosis lesions themselves by preventing them from continuing to grow. It can also suppress periods, which are often one of the major sources of pain for people,” explains Dr. Orlando.

Other medical therapies can suppress ovulation- or stimulation of the ovaries. This helps slow the growth of ovarian endometriomas.

When talking about surgical treatments for endometriosis, Dr. Orlando shares, “when we move to surgery there (are) a host of treatments available, many of which are conservative therapies, meaning that we remove the endometriosis and preserve the reproductive organs for future pregnancies or other reasons.”

The gold standard for surgery is minimally invasive excision of endometriosis.

“There’s also an option to ablate or burn the endometriosis lesion, but this is only for superficial forms of the disease,” shares Dr. Orlando. Superficial endometriosis represents shallow lesions along the peritoneum (membrane that lines the abdominal cavity.)

In addition to excision and ablation, there’s also the option for patients to remove the uterus, cervix, tubes and/or ovaries. Dr. Orlando notes, “that option is usually based on the patient’s goals and extent of disease.”

Minimally invasive excision of endometriosis

Because endometriosis lesions can develop throughout the pelvis and beyond, including on the bowels, ovaries and other vital structures, minimally invasive surgery allows precise excision of endometriosis tissue while sparing unaffected areas. This helps preserve the structure and function of delicate organs in the pelvis.

“Taking our time is important because endometriosis can distort normal anatomy, so we really have to maximize safety and maximize the amount of the disease we remove,” explains Dr. Orlando.

Recovering from minimally invasive excision of endometriosis

Incisions involved in minimally invasive excision of endometriosis are generally smaller and easier to heal from than open surgery.

Dr. Orlando specializes in minimally invasive gynecologic surgery and shares, “most people do quite well after minimally invasive excision of endometriosis. By 1-2 weeks people usually feel that their pain control and post-operative symptoms are reduced significantly. However, we usually recommend patients reduce activity like heavy lifting for about 6 weeks after surgery.”

Advocating for yourself when you have pelvic pain

The first place to start if you think you have the signs and symptoms of endometriosis is to bring your concerns to your primary care physician or gynecologist.

Dr. Orlando offers parting advice by saying, “it can really be helpful for patients to advocate for themselves and explain what their concerns are to their healthcare team. That they’re experiencing pelvic pain, are concerned they may have endometriosis and would like to see someone that is well-versed in those conditions.”

Dr. Megan Orlando treats patients at CU Medicine Obstetrics and Gynecology – Central Park and specializes in minimally invasive gynecologic surgery. Schedule an appointment with your primary care provider or with a gynecologist today if you are experiencing pelvic pain..