Endometriosis Excision Specialist in Palo Alto, California
Severe pain with your periods? You might have endometriosis
What Is Endometriosis?
Endometriosis is a chronic estrogen dependent disease that can cause incapacitating pain, organ failure, infertility, and other severe medical consequences if not adequately treated. It was described in medical literature more than 300 years ago and was even alluded to in ancient medical texts from nearly 4,000 years ago. And, far from being a rare disease, it’s estimated that as many as 200 million women and pubescent girls from around the world have endometriosis.
For centuries the symptoms of endometriosis have been dismissed as a supposedly normal part of womanhood, nothing more than painful periods or cramps. However, endometriosis is a serious disease which can lead to serious medical consequences if inadequately treated. In fact, endometriosis actually shares many features with non-fatal cancers, such as the ability to metastasize throughout the entire body, potentially causing irreparable damage and disability. Recently, one study even cited endometriosis as one of the top ten most painful medical conditions. While it’s true that extreme, incapacitating pain with menstruation is one of the most common symptoms of endometriosis, it can also cause chronic and disabling pain in essentially any region of the body and at any time during the month. Subfertility/infertility, excruciating pain during sexual intercourse, silent kidney loss, searing lower back, hip and leg pain, and severe bowel and bladder dysfunction are among other symptoms experienced by women with endometriosis.
Endometriosis develops when endometrial-like cells similar to those lining the inside of the uterus (endometrium) begin growing in other areas or organs of the body.
Like many other diseases, endometriosis can be a chronic condition, with symptoms ranging from mild to severe. In an attempt to distinguish these different phenotypes of endometriosis, the American Society of Reproductive Medicine (ASRM) established a classification system comprising 4 stages: Minimal Disease (Stage 1), Mild Disease (Stage 2), Moderate Disease (Stage 3), Severe Disease (Stage 4). However, this system often does not correlate to the pain symptoms that women can have. For example, patients classified with only minimal disease (Stage 1) can still experience debilitating pain, while those diagnosed with severe stage 4 disease sometimes have no pain symptoms at all.
Diagnosing endometriosis can be difficult for a non-specialist because symptoms can vary widely and the only way to definitely diagnose endometriosis is by undergoing a surgical procedure called laparoscopy. Because of these and other diagnostic obstacles, unfortunately many women and girls with endometriosis experience an average of about 6-10 years delay before being accurately diagnosed.
While theories abound, the causes of endometriosis are unknown and, sadly, there is still no cure.
Although symptoms can vary considerably, the most common are:
extremely painful periods
pain just before or after your period
pelvic pain at any time during the month
pain during or after sexual intercourse
difficulty getting pregnant (infertility)
nausea and vomiting
severe abdominal bloating
pain during ovulation
pain or bleeding with bowel movements
other bowel symptoms (ie, pain with bowel movements/ constipation/ diarrhea intestinal pain/upset stomach)
other bowel/gastrointestinal symptoms (acid reflux, loss of appetite, nausea with eating)
pain or bleeding with urination
other bladder symptoms (difficulty voiding/urgency/frequent urination/ incontinence)
pain in the lower back
pain in the groin area
more frequent periods
other, irregular bleeding
fainting/falling unconscious (due to pain)
pain that mimics appendicitis
pain that mimics celiac disease
pain that mimics Crohn’s Disease and/or irritable bowel syndrome
pain that mimics interstitial cystitis
Did you know?
Endometriosis is one of the top three causes of female infertility
An estimated 8.5-10 million women in the US and 200 million (that’s 200,000,000) worldwide are believed to be affected
Extremely painful menstruation, endometriosis’ most commonly known symptom, is the leading cause of missed work and school in young girls and women, according to one NIH study
Endometriosis commonly goes undiagnosed or misdiagnosed, with women experiencing about 6-10 years delay before being correctly diagnosed
Endometriosis is also frequently undiagnosed in teenage girls, due to persistent medical myths, like the false belief that pain with periods is normal or that teenagers rarely get endometriosis
Atypical Or Less Well-Known Symptoms
It’s important to note that some women, pre-teen, and teenage girls may not consistently experience the most well-known symptom of endometriosis: extremely painful periods. Women and girls may also experience acyclic chronic pelvic pain; that is, pain at any time during the month. In other cases, women and girls have no symptoms and don’t know they have the disorder until years later when they’re experiencing fertility issues. Complicating matters further is the fact that endometriosis can affect every organ or area of the body (except the spleen). As a result, pain can manifest essentially anywhere in the body. In this sense, endometriosis should really be considered a potentially systemic disease, rather than just a gynecological one. Because of these and other atypical symptom profiles, it’s important to know that you might have endometriosis even if you don’t have all of the so-called classic symptoms.
Bear in mind, however, that not everyone with extremely painful periods or infertility has endometriosis! There are other conditions which can cause chronic pelvic pain and other symptoms similar to those of endometriosis. Therefore, as mentioned, the only way to definitely diagnose endometriosis is to undergo the surgical procedure of laparoscopy.
The bottom line is; listen to your body and trust your instincts. If you’re in pain, are experiencing unusual symptoms, or simply think that something’s just not right, be sure to seek out a second opinion - or third, fourth, or tenth one - if necessary.
This list is not comprehensive, but a few atypical or less well-known symptoms include:
no pain symptoms
acyclic chronic pelvic pain i.e., pain all the time or anytime, independent of menstrual cycles
groin area pain
nerve pain (sciatic, pudendal, etc)
pain in the shoulders usually coinciding with menstruation
pain on or near the kidneys usually coinciding with menstruation
pain in the upper abdomen usually coinciding with menstruation
pain in the chest area usually coinciding with menstruation
pain on or near the lungs or breathing problems usually coinciding with menstruation
pain on or near the diaphragm or breathing problems usually coinciding with menstruation
pain on or near the liver usually coinciding with menstruation
acid reflux symptoms (GERD) usually coinciding with menstruation
Did you know?
Did you know that women sometimes have to see 3 or more doctors before finally finding one who recognizes her symptoms as signs of endometriosis?
One recent study found that 98% of teenage girls with menstrual pain unresponsive to pharmaceutical treatments had endometriosis
Many infertile women in their 20s, 30s, and 40s with endometriosis had debilitating, painful periods as teens
30% to 40% of women with endometriosis experience infertility issues
A woman who has a mother or sister with endometriosis is much more likely to develop endometriosis than other women. You are also more likely to have endometriosis if you:
Started your period at a young age
Never had children
Have frequent periods or ones that last 7 or more days
Have a closed or otherwise blocked hymen (imperforate hymen, congenital aplasia), which blocks the flow of menstrual blood out of your body during menstruation (also called Mayer-Rokitansky-Kster-Hauser (MRKH) syndrome)
Have other uterine abnormalities such as a double uterus, septate uterus, or bicornuate uterus
- Endometriosis & risk of cancers
- Hormonal treatments risks
- Over-the-counter pain medications risks
- Prescription medications risks
How Common Is Endometriosis?
Endometriosis is fairly common, affecting an estimated 10%-15% of women and girls, usually during their reproductive years. Based on these rough estimates, the latest epidemiological studies suggest that more than 8.5-10 million women in the US and an estimated 200,000,000 worldwide (that’s 200 million) are believed to be affected. However, endometriosis commonly goes undiagnosed. Therefore many experts believe that the incidence is actually higher.
Contrary to popular beliefs, pre-teen and teenage girls can and do get endometriosis.
And, although it’s considered a disorder affecting women and girls during their reproductive years, endometriosis has been found in fetuses, infants, young girls who have not menstruated yet, in post-menopausal women, in women who have had a total hysterectomy with bilateral salpingo-oophorectomy, and in cis and transgender men.
- Laparoscopy Myths
- Robotic Surgery
- Alternatives To Surgery
- Endometriosis Surgery Myths
- Endometriosis Excision Surgery White Paper
- Fibroids Surgery Myths
- Fibroids Surgery Options
- Bowel & Bladder Endometriosis Surgery
- Diaphragm Endometriosis Surgery
- Thoracic Endometriosis Surgery
- Infertility Surgery
- Books and Articles on Surgery
- Reference Library of Surgery Abstracts
- Wikipedia Article about Dr. Camran Nezhat
- The Great Scalpel-Scope Showdown
- History of Endoscopy
Doctor Nezhat /Endometriosis expert bay area/ has trained thousands of surgeons on advanced laparoscopic surgery. These are photos of Doctor Nezhat teaching students in Stanford's laparoscopic surgery simulation lab.
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Doctor Camran Nezhat is the world's best endometriosis surgeon. Doctor Camran Nezhat is one of the world's best known endometriosis excision experts.
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