Endometriosis affects 10% (190 million) of women and girls globally. It is a chronic disease associated with severe, life-impacting pain during periods, sexual intercourse, bowel movements and/or urination, chronic pelvic pain, abdominal bloating, nausea, fatigue, and sometimes depression, anxiety, and infertility. Treatment is usually aimed at controlling symptoms. Treatment depends on the extent of the disease, symptoms, and whether there is desire to preserve fertility. Endometriosis may be treated with medication, surgery, or both.
Melissa Money, a registered nurse and case manager in the emergency room at Kaiser Permanente Fontana Medical Center, had always experienced bad periods, “debilitating periods where I felt like I could not walk.” Her monthly periods continued to get worse. “The trigger for me finally going to the ER was when I started having bad rectal pressure and stabbing pain.”
Endometriosis occurs when the endometrium, lining of the uterus, forms outside the uterus. Marisol Flores, MD, Assistant Area Medical Director at Kaiser Permanente San Bernardino County, says, "Many women with endometriosis have no symptoms. Women without symptoms often learn they have endometriosis when they cannot get pregnant or when they are having surgery for something else.”
She cared for Melissa following her visit to the emergency department. Following ultrasound, Melissa was diagnosed with a pelvic mass, and then underwent diagnostic laparoscopy, according to Dr. Flores. Melissa underwent surgery to remove an endometrioma cyst, and lysis of adhesions.
Almost 4 in 10 women experiencing infertility have endometriosis, and inflammation from the condition may interfere with fertilization or movement of a fertilized egg through the fallopian tubes and into the uterus. In severe cases of endometriosis, the fallopian tubes may be blocked by adhesions or scar tissue.
Melissa talks about her conversations with Dr. Flores regarding endometriosis pain management and surgeries. “When I went in for surgery consultation, it was a possibility that depending on what the outcome was that I would need to have a hysterectomy at some point, and I would lose the ability to carry a child. I was only 29. That is not something that anybody at that age wants to figure out.”
The monthly chance of getting pregnant is approximately 10-20%, while those with surgically documented endometriosis have a chance of only 1-10%.
Melissa's journey living with endometriosis has had her ups and downs. She shares “when you are going through it with endometriosis and you are not finding any relief, I would encourage people to still be proud of themselves. You can be proud of yourself for just getting out of bed; that is an accomplishment when you are in pain and going through something so horrible. If you are in that dark tough place, give yourself some grace and be proud of the little things that you can get done. Remember that the pain is not going to last forever. There will be relief one day, or at least I hope there will be.”
Endometriosis is far more common than is recognized. The cause of endometriosis is unknown, and there is no known way to prevent it. There is no cure, but its symptoms can be treated. To learn more about endometriosis treatments and pain, make an appointment with your doctor.