Endometriosis & Pelvic Pain
Pelvic Pain & Endometriosis

The American Society for Reproductive Medicine (ASRM) states: many women have pain in their pelvis (lower part of the belly) from time to time, usually during their period. However, if you have daily pelvic pain, it could be a sign of a bigger problem with your bladder, bowels, reproductive organs, or pelvic muscles. Many conditions cause pelvic pain, including endometriosis, adhesions, chronic appendicitis, or hernias. Sometimes medication is necessary to treat the problem; other times surgery is needed. 

Endometriosis: Endometriosis can cause daily pelvic pain, painful periods, and pain during bowel movements or sex. Having endometriosis can also make it harder for you to get pregnant.

Pelvic adhesions (scar tissue): Adhesions in and around the pelvic cavity may form if you have endometriosis, a pelvic infection, surgery on your pelvis, a cyst on an ovary, or have had surgery on your pelvis. Scar tissue causes organs that normally are separate from each other to become attached. For example, your ovary can be attached to your bowel, and your doctor will separate the adhesions with laparoscopic scissors to help relieve pain. This seems to work best when the adhesions are not too severe.

Endometriosis is a disorder of the female reproductive system in which endometrial tissue (the normal lining of the uterus) is found outside the uterine cavity. An estimated three to five million American women of reproductive age suffer from endometriosis. This disease is prevalent in women 30-40 years of age, though it can begin in the late teens and early twenties. About 40% of patients with endometriosis will experience some degree of infertility.

The relationship between endometriosis and infertility is not completely understood. The primary cause of infertility resulting from endometriosis appears to be a blockage caused by scarring and adhesions in the tubes. These adhesions can prevent the egg and sperm from meeting or prevent the fertilized egg from moving down the tube normally (resulting in an ectopic pregnancy).

The other connection between endometriosis and infertility is the generalized effect or irritation of the endometrial tissue causing the fimbriae ( fallopian tube fingers which pick up the egg) not to perform properly in allowing the egg and the sperm to meet.

Women with endometriosis often, but not always, have one or more of the following symptoms:

  • dysmenorrhea (painful cramps during menstruation)
  • dyspareunia (painful intercourse)
  • dysfunctional or irregular uterine bleeding, including heavy periods or unusual spotting during their cycle
  • infertility – in about 30% of women, there are no symptoms except infertility.

Diagnosis of endometriosis is made by a combination of tests, including: a careful history of the symptoms and menstrual cycle, a thorough pelvic examination including an ultrasound to look at the ovaries for the possibility of severe endometriosis, and a laparoscopy, which allows the physician to look inside the pelvic and abdominal cavity to view the ovaries, fallopian tubes and other internal structures.

For a woman who wishes to attempt pregnancy, treatment will have two goals: unblocking tubes and removing any adhesions that may affect conception, allowing fertilization and movement of fertilized eggs down the fallopian tubes to the uterus and reducing the inflammation or irritation surrounding the fallopian tubes by suppressing ovulation which stimulates the disease.

Lupron is a medication that was originally used for treating endometriosis to suppress the disease process.

Laser surgery is another option which directly removes the endometrial lesions.

The direct treatment for moderate to severe endometriosis is to bypass the disease process by doing IVF.