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Endometriosis is a common condition that affects between 6 – 10% of all women. It is one of the most frustrating causes of lower-abdomen and pelvic pain in women; the average woman with endometriosis has typically seen 6-7 gynecologists over a 10-year span before finally being diagnosed. The condition refers to very small implants of tissue that closely resembles the normal uterine lining (endometrium) in abnormal locations elsewhere in the body. These implants are stimulated to grow by the circulating hormones normally made during a woman’s menstrual cycle.

Dr. Gary Goldman is a board-certified OB/GYN and NYC Endometriosis Specialist who takes the time to hear your story and uses cutting-edge technology as well as a holistic approach to diagnose and reduce your endometriosis symptoms. Located on the upper east side in Manhattan, Dr. Goldman provides you with a personalized evaluation and treatment plan. Call today to schedule your appointment or book online now.

Endometriosis Q&A

What are the Symptoms of Endometriosis?

It is difficult for many women as well as gynecologists to recognize the symptoms of endometriosis. Often, the condition is finally discovered when painful symptoms become severe, or due to infertility. In some cases of endometriosis, you may not have side effects or symptoms, and it is only found coincidentally. Other times, the condition causes severe disabling pain in the lower abdomen, typically during your period, with ovulation, or with intercourse. The pain may be isolated to your abdomen and pelvis or may radiate to your back and legs. Some women have no pain and are only discovered to have endometriosis during a workup for infertility. The degree of endometriosis and the degree of pain often do not correlate.

Common signs and symptoms of endometriosis include:

  • Abnormally heavy periods (menorrhagia)

  • Chronic pelvic pain

  • Menstrual pain and severe cramps (dysmenorrhea or “killer cramps”)

  • Mid-cycle pain associated with ovulation (mittelschmerz)

  • Pain with sex (dyspareunia)

  • Abdomen pain and bowel dysfunction, including diarrhea, bloating, gassiness, and painful bowel movements.

  • Bladder dysfunction, painful urination

  • Back pain and leg pain

  • Infertility

  • Weakness, pain or numbness in nerves (neuropathy)

  • Fatigue

  • Personality changes (depression, apathy, stress)

What Causes Endometriosis?

There is still no consensus as to the cause of endometriosis. There is good lab evidence and epidemiologic evidence to support a wide variety of theories including:

  • Retrograde Menstruation. This refers to endometrial cells from the uterine lining being shed during the menstrual cycle, washing out through the fallopian tubes into a woman’s pelvis and implanting there, rather than flowing out through the cervix into the vagina.

  • Metaplasia. In this theory, menstrual flow washes into the pelvis through the fallopian tubes and irritates the normal cells lining the pelvis (peritoneum), causing those cells to transform into endometriosis implants.

  • Embryonic cell stimulation. Some studies suggest there are cells scattered throughout the pelvis that are present since birth which becomes stimulated to grow into endometriosis once extra hormones are produced during adolescence.

  • Immune System Dysfunction. Since 90% of women experience some degree of retrograde flow, and only about 10% of women develop endometriosis, this theory suggests the reason is a defective immune system that can’t recognize endometriosis implants and eradicate them.

  • There are also cases reported where endometriosis is found in distant areas of the body, potentially carried there through the bloodstream (Hematogenous Spread) or through the lymph vessels (Lymphatic Spread). Sometimes surgical scars can develop endometriosis implants, presumably by Local Seeding

Risk Factors for Endometriosis

Some women who develop endometriosis have a number of risk factors, while others do not apparently have any. In general, the greater your number of risk factors, the greater the chance of your developing endometriosis. Risk factors include:

  • A family history of endometriosis, bad menstrual cramps or infertility

  • Earlier age at the time of the onset of your menstrual periods Earlier age at the time of the onset of your menstrual periods

  • Older age at the time of menopause

  • More frequent menstrual cycles More frequent menstrual cycles

  • A larger amount of flow during your menstrual period

  • Uninterrupted menstrual cycles, such as never using the birth control pill, or never being pregnant

  • Increased use of alcohol

  • Exposure to various toxins such as dioxin

  • Abnormal blockage of menstrual outflow due to congenital or post-surgical alterations of the uterus or cervix

How to Test for Endometriosis

Endometriosis Diagnosis is first suspected due to a patient’s history. A full and comprehensive physical exam and sonogram (also called ultrasound) may contribute to our ability to find:

• Diminished organ mobility
• Firm pelvic nodules
• Point tenderness
• A particular type of ovarian cysts called endometriomas.
• The gold standard method of diagnosis is a surgical procedure called laparoscopy. In laparoscopy for endometriosis, a very small fiber-optic scope is placed through the abdomen wall and the implants can be directed visualized. At the same time, those implants are removed by sharp, deep excision. Excision is considered the most effective surgical method to remove endometriosis lesions, and also allows for confirmation of the diagnosis through biopsy of the lesions. The extent of involvement is also graded by Stage, from the smallest (Stage 1) to the greatest (Stage 4).

Endometriosis Treatment

While some women may have complete resolution of their symptoms after laparoscopy, recurrence is common and may require long-term management. Dr. Goldman performs the initial diagnosis of endometriosis as well as the long-term therapy of recurrent symptoms. There is no cure for endometriosis at this time. There non-surgical and surgical options for symptom management and for preservation and improvement of fertility.

Traditional long-term endometriosis pain and symptom relief therapies can include:

• Pain medications
• Birth control pills
• The progesterone IUD
• Other hormonal medications, including progesterone, Danazol (Danocrine), Lupron and Orilissa
• Laparoscopic excision of endometriosis – the most common endometriosis surgical procedure. Only surgery has been found to improve fertility.
• Additional surgery can include removal of the fallopian tubes, ovaries and/or uterus (Hysterectomy) based on the degree of symptoms, age, and reproductive goals.

Endometriosis Natural Treatment

Through his unique background in functional medicineDr. Goldman also enlists additional long-term natural treatments for symptom management, including:

  • Acupuncture

  • Plant-based supplements

  • Meditation

  • Massage

  • Antioxidant diet to control endometriosis inflammation

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