Jackie Johnstone, CNM

You have heard about endometriosis and know friends and family who may have it. What is it exactly?

What is endometriosis?

It is a very common health problem in which tissue that normally lines the uterus (the endometrium) grows on the outside of the uterus.

Common places where the tissue is found: around the ovaries, fallopian tubes, bladder, intestines, ureters, rectum, and behind the uterus. Rare cases have shown it to be in the lung, brain, and other soft tissue.

How common is endometriosis?
It is estimated to be found in 6-10% of women of reproductive age and 25-35% of women who have infertility problems.

What causes endometriosis?

The exact cause of endometriosis is unknown. Some theories suggest retrograde menstruation is responsible for the abdominal tissue growth. This means once the lining of the uterus sheds during menstruation the tissue then passes through the fallopian tubes. Once it is in the pelvic cavity the tissue implants into surrounding tissues.

Other theories suggest that there is a genetic component. A few studies have found that 7-9% of women with endometriosis have a first-degree relative that are diagnosed with endometriosis. There are other theories that exist, but none have been proven.

How exactly does endometriosis affect women?

The tissue that has grown outside of the uterus responds to hormonal changes just as does the tissue inside the uterus. The tissue implants, grows, and bleeds just as the lining of the uterus does during the menstrual cycle. The breakdown and bleeding of the tissue can cause adhesions which in turn may cause pain, especially during menstruation. Endometriosis can cause infertility by interfering with the fallopian tubes and causing adhesions within the tubes. 40% of women with endometriosis have infertility problems.

What are the symptoms of endometriosis?

The most common symptom of endometriosis is pelvic pain before and/or during menses. Heavy bleeding may also occur. If the tissue is connected to the bowel, one can experience diarrhea or constipation around the time of menses. The tissue can also be connected to the bladder resulting in urinary issues. In some instances, women will experience painful intercourse.

How is it diagnosed?

Endometriosis is diagnosed by a laparoscopic procedure where a small incision is made into the abdomen or pelvis, and the surrounding tissue and organs are evaluated.

More often than not medical management is the first line of treatment for endometriosis before a laparoscopic procedure is carried out. Thus, the symptoms are most often treated before the actual diagnosis being made.

How is endometriosis treated?

Treatment is individualized based on symptoms. Many times the pain is relieved by medications such as Ibuprofen and or hormonal therapies such as birth control pills, progesterone only methods, and medications that block the production of estrogen. Hormonal methods slow the growth of the tissue and can help keep hormonal levels steady so that the tissue does not go through hormonal fluctuations which then in turn cause symptoms. Often, if these methods do not help, a laparoscopic procedure is carried out, and the tissue can be removed. It is not guaranteed that the tissue will not grow back. Surgery can improve pain and fertility. As a last resort, a hysterectomy can be considered. Endometriosis is less likely to come back if the ovaries are removed.

Helpful Patient Resource: Visit endofactpro.com website.

Text Message Appointment Reminders

Beginning Monday, July 30, 2018, patients will receive a text message and possibly an automated phone message appointment reminder. Patients will continue to receive the online check-in email asking patients to complete paperwork and check in electronically.  Patients will receive a text reminder two (2) days  prior to their appointment.  If they do not respond to the text, they will receive an automated phone message one (1) day prior to their appointment.  We hope our patients find the online check-in and text message reminders helpful.

Ovarian Cyst

Audra Zachman, DNP-BC

Sometimes the finding of an ovarian cyst can be concerning to patients; however, a brief discussion can help to clarify this sometimes confusing diagnosis. Ovarian cysts are common for women during childbearing years. The ovaries can form one or several cysts that may vary in size. It is a normal process to form an ovarian cyst monthly. These are often simple or benign in nature.

This finding can be an indication of a correctly functioning ovulation process. The cyst may grow to an appropriate size and rupture, releasing an egg causing ovulation during the middle of a menstrual cycle sometimes feeling brief discomfort. Most cysts will go away within 2 to 6 weeks and do not cause any symptoms.

However, when a cyst grows to a size that is larger than expected, multiple cysts are seen, or cysts appear solid on ultrasound, the finding of an ovarian cyst may lead to various conversations with your provider. The discussions may include a diagnosis of polycystic ovarian syndrome (PCOS), a dermoid cyst, ovarian cancer, endometriosis, or a simple cyst that is too large and poses the risk for torsion or twisting. Repeated ultrasounds, blood work, or surgery can be a possible next step in some cases. Your provider may discuss short term and long term interventions including “watchful waiting”, birth control pills, or surgery.

Ovarian cysts can be a common and sometimes expected diagnosis. Although most are harmless and will resolve on their own, your provider may want to keep track of some cysts that are found to confirm that they do not cause any concerns (ACOG, 2015).

American College of Obstetrics and Gynecology (July 2015) Patient Education Pamphlet: Ovarian Cysts