Endometriosis

What is endometriosis?

Endometriosis is a fairly common disorder that affects over 10% of American women during their childbearing years. It causes painful periods, and most patients I diagnose with it are between 30 and 40 years old.

I have more patients than I could ever count who come to me after seeing a dozen or more doctors, all of whom failed to diagnose them properly. It is one of the tragedies of modern women’s health that so many must suffer needlessly for years from painful periods.

Here is something extremely important to remember: painful periods are not normal! 

Because endometriosis is so difficult for most doctors to diagnose, most women who come to me for a diagnosis and care have been suffering for an average of eleven years before being properly diagnosed!

What are common endometriosis symptoms?

For most women, common symptoms of endometriosis include severe PMS symptoms, such as:

• Chronic pelvic pain and cramping, especially before and during your period
• Heavy bleeding
• Painful sexual intercourse
• Painful bowel movements or urination (due to endometrial tissue hampering organ function)
• Bloating
• Diarrhea or constipation
• Urinary frequency
• Lower back pain
• Fatigue

Possibly the most serious symptom of endometriosis is infertility.

Don’t let symptoms worsen—early treatment can preserve fertility and prevent further complications.

What are the risk factors of endometriosis?

Some of the risk factors associated with endometriosis include:

• Never giving birth.
• Early onset of menstruation: Women who start menstruating early (before age 11) may have a higher risk of developing endometriosis.
• Late-onset menopause.
• Menstrual cycle length: Women with shorter menstrual cycles (less than 27 days) are at higher risk.
• Heavy or prolonged menstrual periods.
• High levels of estrogen.
• Family history: Women with a family history of endometriosis are at a higher risk of developing the condition.

Some women with endometriosis also have immune system disorders. However, doctors are uncertain whether there is a correlation between the two.

How do doctors diagnose endometriosis?

If you’re experiencing pelvic pain and heavy bleeding, schedule a consultation with me for an examination. Many conditions can present with similar endo symptoms (ovarian cysts, to name just one). We will carefully review your medical history during your appointment and conduct a thorough physical and pelvic examination.

The only way to diagnose endometriosis with absolute certainty is to examine your pelvic organs and endometriosis tissue via a surgical laparoscope. During this minor laparoscopy procedure, I insert a thin, flexible, lighted instrument through a tiny incision in your abdomen.

The laparoscope allows me to closely examine your pelvic organs and see any endometrial implants up close from various angles. I can also take a biopsy of any suspicious-looking tissue to send it out for further testing.

Why is endometriosis so hard to diagnose?

It’s infuriating that the average woman living with endometriosis in the United States suffers from symptoms for 11 years before she is correctly diagnosed. I believe that the medical profession has failed to support women adequately.

Diagnosing endometriosis is complicated because many symptoms can be due to other gynecological conditions. The truth is that endometriosis is pretty wily because the symptoms that patients experience don’t always correlate to the locations of the endometrial implants (endometrial tissue growing outside the uterus). GI symptoms appear just as often as gynecological symptoms in women with endometriosis.

Over 80% of women I diagnose with endometriosis describe their primary symptom as abdominal bloating. Alternatively, they may experience symptoms such as periodic bloating and altered bowel habits, including diarrhea, constipation, painful bowel movements, nausea, and vomiting. Many women experiencing these symptoms will go to a GI specialist, who, unfortunately, can lead to an erroneous presumptive diagnosis of IBS (irritable bowel syndrome) after lengthy and invasive diagnostic testing fails to turn up anything.

Another confounding overlap between endometriosis and GI conditions is that many women who suffer from endometriosis also suffer from SIBO (small intestine bacterial overgrowth). When gut bacterial growth becomes imbalanced, it can cause diarrhea, gas, bloating, and abdominal cramping — symptoms also associated with endometriosis.

Because up to 75% of women with IBS also have SIBO, many GI doctors will quickly diagnose a woman as having IBS, overlooking the possibility that she might have endometriosis. Luckily, a rapid breath test can be done at your primary doctor’s office to rule out SIBO: known as the lactulose hydrogen breath test.

If you test negative for SIBO, seek a women’s health specialist to determine if you may have endometriosis. If you are diagnosed with SIBO, the treatment is a two-week course of antibiotics. If GI symptoms don’t improve after completing antibiotic therapy, you should seek a qualified endometriosis specialist to determine whether you might have endometriosis.

What’s the exact cause of endometriosis?

The endometrium is the mucus membrane that makes up the uterus lining. During the menstrual cycle, it responds to hormones by thickening blood vessels in preparation for pregnancy.

Every time the egg fails to be fertilized by a sperm, the body clears away the new endometrial tissue inside the uterus, and this elimination is your period.

However, sometimes, the body does not clear away all the endometrial cells, and they accumulate month after month. This accumulated tissue eventually gets pushed outside the uterus and then grows on the fallopian tubes, ovaries, cervix, the external surface of the uterus, intestines, urinary organs, and even the rectum.

The sites of abnormal endometrial tissue growth are known as implants. These endometrial implants respond to hormones like the uterine lining by thickening, breaking down, and shedding. But since this occurs outside the uterus, the tissue becomes inflamed, irritated, and scarred. This scar tissue is called adhesions. Adhesions can cause organs to stick together, which usually causes terrible menstrual cramps and severe pain before and during your period.

Retrograde menstruation may also contribute to endometriosis. Menstrual blood containing endometrial cells flows back through the fallopian tubes and into the pelvic cavity instead of out of the body. These displaced endometrial cells stick to the pelvic organs’ pelvic walls and surfaces, growing and continuing to thicken and bleed throughout each menstrual cycle.

When endometriosis affects the ovaries, cysts known as endometriomas may form.

All of these factors likely interact, making endometriosis a multifactorial disease that requires personalized care. Dr. Aliabadi tailors her diagnostic and treatment strategies based on the complex nature of each patient’s condition.

Can endometriosis cause infertility?

Yes! Unfortunately, endometriosis can also cause fertility problems. In rare cases, infertility may be the only symptom of endometriosis (called “silent endometriosis”). About 40% of women who have difficulty getting pregnant suffer from endometriosis. 

Because endometriosis results in inflammation of the ovaries and fallopian tubes, the fallopian tubes may stick together (known as adhesions), blocking the egg’s path to the uterus. Severe endometriosis can even affect the egg reserve, leading to poor egg quality and, potentially, infertility.

Is endometriosis treatable?

Yes! There are two approaches to endometriosis treatment:

1. Address the symptoms and suppress the spread of the disease.
2. Remove the diseased tissue within the pelvis and reproductive organs via surgery.

I always have a frank discussion about the best course of treatment for you, considering your age, the type and severity of your symptoms, the stage of your disease, and your plans to bear children in the future.

What are the treatments for endometriosis?

There are several treatments for endometriosis, including:

Dr. Thais Aliabadi, an expert in the treatment of endometriosis

Endometriosis affects hundreds of thousands of women each year. If you believe you are experiencing symptoms of, or suffering from, endometriosis or have questions about endometriosis, I encourage you to see your healthcare provider, preferably an endometriosis expert. Painful periods (dysmenorrhea) are not normal, and your quality of life shouldn’t suffer because of endometriosis.

Dr. Aliabadi’s peers frequently recognize her as the best OBGYN in her region, citing her innovative techniques, commitment to patient education, and outstanding outcomes in managing complex endometriosis cases. Her technical expertise and collaborative approach with multidisciplinary teams ensure that patients receive care that is both advanced and compassionate.

To establish care with Dr. Aliabadi, please request an appointment online or call us at (844) 863-6700.

Dr. Thais Aliabadi is a member of the American College of Obstetricians and Gynecologists. Her practice is conveniently located for patients throughout Southern California and the Los Angeles area. We are near Beverly Hills, West Hollywood, Santa Monica, West Los Angeles, Culver City, Hollywood, Venice, Marina del Rey, Malibu, Manhattan Beach, and Downtown Los Angeles.