March is National Endometriosis Awareness Month and doctors at Atrium Health Navient want women to know that treatment is available for painful periods.
Endometriosis is a problem affecting a woman’s uterus. The uterus is lined with tissue (endometrium), and endometriosis occurs when the kind of tissue that normally lines the uterus grows somewhere else. It can grow on the ovaries, behind the uterus, on the bowels or on the bladder. These cells swell and bleed under hormonal influence, causing scarring and pain.
It is estimated that 1 in 10 women have endometriosis, whether they are diagnosed or just dealing with the symptoms. While the cause of endometriosis is unknown, risk factors include having a mother, sister or daughter with endometriosis; starting your period before age 11; short monthly cycles of less than 27 days; and menstrual cycles that are heavy and last more than seven days.
“There is good data that most women see anywhere from three to five physicians before a diagnosis is made. It has to do with the fact that symptoms can be similar to other issues that they face,” said Dr. R. Edward Betcher, OB-GYN department chair for Atrium Health Navicent and a specialist in minimally invasive gynecological surgery. “There’s a hereditary component and so a lot of women think that what they experience is normal and are reluctant to discuss it. Studies say a third of women find it difficult to discuss it with a provider.”
Symptoms of endometriosis may sound familiar to many women. They include pelvic pain, infertility, painful menstrual cramps, pain during or after sex, spotting or bleeding between periods and pain with bowel movement or urination, especially during your period.
“A lot of the time, symptoms are dismissed as normal, like bad cramping with periods, pelvic pain and pain with intercourse. Endometriosis doesn’t respect boundaries and can implant on other structures in the pelvis such as the bowel, rectum, bladder and lining of abdominal cavity. This can cause other symptoms like pain with urination, pain with bowel movements and constipation issues,” Betcher said. “When you think about the pelvis, it’s like a neighborhood. When one neighbor isn’t happy, the rest are unhappy. Sometimes if we’re dealing with endometriosis, other structures in same vicinity are upset too.”
Betcher urges women to speak to their provider if they are experiencing any of these symptoms.
“You are not alone. Just because you may know other women with these symptoms, it doesn’t mean that it’s normal,” Betcher said. “Not too many folks are thrilled about having a period, but if it’s difficult to manage, that’s not something women have to put up with. If it’s an impact to their lives, they need to talk with their provider.”
With a complete exam and imaging of the affected area, a gynecologist can develop a treatment plan.
“It used to be that the only way women could prove they had endometriosis was through a biopsy. Now, because we realize the impact it has on so many women, we can identify endometriosis based on symptoms, an exam, imaging and a response to treatment,” Betcher said.
While there is no cure for endometriosis, successful treatment options include pain relievers and hormone therapy. For most patients, it’s a condition doctors manage long-term. GnRH antagonists are drugs that suppress hormone production and lead to the suppression of endometriosis. Doctors can also excise implants of endometriosis, which is a minimally invasive procedure, with most women going home the same day.
“We may start women on medication that hormonally would affect the endometriosis and make their periods better, less painful, lighter and shorter. If things improve, that’s great. But if they come back, we evaluate on a higher level through laparoscopy or surgery,” he said.
If left untreated, long-term effects of endometriosis include infertility, increased pain during periods, pain during intercourse, scarring of the uterus, and scarring of other areas like the bowels.
“Endometriosis is a major cause of infertility,” Betcher said. “Because the disease causes significant pelvic scarring, it affects the ability for an egg to reach the fallopian tube, and creates an inflammatory environment that can affect the egg. If women are having these symptoms and infertility, they need to be evaluated for endometriosis.”
The first step is not being afraid to start a conversation with your doctor.
“The important thing to know is that we believe you. If you tell us you’re having these issues, we will evaluate you and treat the issues. Don’t feel like you can’t talk about it with your OBGYN, or that there’s nothing that can be done and you have to live with it. That’s just not true,” Betcher said. “We take the approach that this is a long-term condition that needs to be managed throughout a woman’s life, not just something we treat once and that’s it. Many women don’t realize it’s something we can make better, and that’s our goal.”
Betcher said he and the team of trained physicians at Atrium Health Navicent have the experience and expertise in dealing with patients who have spent years battling the pain of endometriosis, and it’s something they take seriously.
“Atrium Health Navicent is invested in women’s health,” he said. “And there’s a lot of ways to improve quality of life for women with endometriosis.”
Did you know that top-quality obstetrics and gynecology services are now being offered in Forsyth? Atrium Health Navicent Women’s Care OBGYN is located at 120 N. Lee St., Suite C, in Forsyth. To schedule an appointment, call (478) 633-1821. To find a doctor, visit NavicentHealth.org and click “Find A Doctor.”