What is Endometriosis?

Endometriosis is a condition where tissue similar to the lining of the uterus grows outside of it, causing pain and discomfort.

Endometriosis is a persistent medical condition where tissue that resembles the lining of the uterus is located outside of the uterus. This tissue is typically linked with monthly menstruation and is known for causing abnormally heavy and painful periods, pelvic pain, severe cramping, and discomfort during sex (dyspareunia). The growths are typically non-cancerous, inflammatory, and stem-cell driven, and their progression can depend on estrogen levels.

Around 176 million women globally are affected by endometriosis, making it a significant cause of chronic pelvic pain and infertility. Endometriosis has been associated with other health issues, such as certain autoimmune diseases, cancers, fibroids, adenomyosis, and interstitial cystitis. It is also a leading reason for laparoscopic surgery and hysterectomy in the United States. The disease has a substantial economic impact, with businesses losing billions of dollars each year due to compromised productivity and absenteeism caused by endometriosis.

Endometriosis (Image source: Blausen Medical, 2014)

Where Does Endometriosis Occur?

Endometriosis occurs when tissue similar to the lining of the uterus grows outside of the uterus, often in other areas of the pelvis such as the ovaries, fallopian tubes, bowel, bladder, or the lining of the pelvis itself.

It is frequently found on the top of the vagina (anterior cul-de-sac) and in the peritoneal cavity between the rectum and the posterior wall of the uterus (posterior cul-de-sac).

In some exceptional instances, it may spread to other areas of the body, including the diaphragm, lungs, kidney, appendix, and even the gastrocnemius muscles in the calf.

Causes of Endometriosis

The exact cause of endometriosis is not yet fully understood, but there are several theories.

One theory suggests that it may occur due to retrograde menstruation, where menstrual blood and endometrial tissue flow back through the fallopian tubes and into the pelvis during menstruation.

Another theory suggests that it may be caused by genetics or a problem with the immune system that allows the endometrial tissue to grow outside the uterus. Hormonal factors, such as excess estrogen production, may also contribute to the development of endometriosis.

However, the precise cause or causes of endometriosis remain a subject of ongoing research.

Symptoms of Endometriosis

Endometriosis can manifest in various symptoms, with pain being the primary indicator. This pain may vary from mild to severe and typically affects the abdomen, pelvic region, and lower back.

While some individuals with endometriosis may not experience symptoms, others may encounter:

painful menstrual cramps
abdominal or back pain during and in between periods
pain during intercourse
heavy bleeding
spotting between periods
infertility
painful bowel movements.

The severity of the symptoms does not necessarily correspond with the extent of the endometriosis; a person with limited patches may experience severe pain while someone with severe endometriosis may not have much discomfort.

Stages of Endometriosis

Endometriosis can be classified into four stages or types, based on the location, size, and depth of the endometrial tissue growth:

Minimal or Stage 1: In this stage, there are small lesions or shallow implants on the surface of the ovary and pelvic lining.
Mild or Stage 2: In this stage, there are more lesions and deeper implants in the pelvic lining and on the ovary.
Moderate or Stage 3: This stage involves deep implants on the pelvic lining and ovaries, as well as the formation of adhesions (scar tissue) between organs.
Severe or Stage 4: This is the most advanced stage of endometriosis, in which deep implants and adhesions are widespread throughout the pelvic cavity, affecting multiple organs such as the bladder, rectum, and intestines.

It is important to note that the stage of endometriosis does not necessarily correlate with the severity of symptoms, as individuals with minimal endometriosis may experience significant pain while those with severe endometriosis may be asymptomatic.

Diagnosis of Endometriosis

What is the Initial Step in Diagnosing Endometriosis?

To determine whether imaging tests are necessary, it is recommended to first consult with a GYN physician who is experienced in diagnosing endometriosis and can perform a thorough pelvic exam, including a discussion of your symptoms and medical history.

What Imaging Test are Available?

There are several imaging tests that can be used to help diagnose endometriosis. These include transvaginal ultrasound, magnetic resonance imaging (MRI), and computed tomography (CT) scan.

Transvaginal Ultrasound is a type of imaging test that may be used to diagnose or evaluate endometriosis. It involves inserting an ultrasound wand into the vagina to create images of the reproductive organs and surrounding structures. This can help to identify the presence of endometriotic cysts or lesions in the ovaries or other areas. However, it is important to note that not all cases of endometriosis can be detected through ultrasound, and other imaging tests or diagnostic procedures may be necessary.
Magnetic resonance imaging (MRI) can also be used to diagnose endometriosis. This imaging technique uses a powerful magnet and radio waves to create detailed images of the inside of the body. It can provide information on the location and extent of endometriosis lesions, as well as identify any potential complications such as cysts or adhesions. An MRI can also be useful in ruling out other conditions that may be causing similar symptoms. However, MRI is not typically used as a first-line diagnostic tool for endometriosis and may be more expensive and time-consuming than other imaging tests.

Gold Standard for Diagnosing Endometriosis

Laparoscopy is a surgical procedure that is commonly used to diagnose and treat endometriosis. During a laparoscopy, a surgeon makes a small incision near the navel and inserts a thin, lighted instrument called a laparoscope into the abdomen. The laparoscope allows the surgeon to view the pelvic organs and look for signs of endometrial tissue outside the uterus. If endometriosis is found, the surgeon may also remove the tissue during the same procedure.

Laparoscopy is considered the gold standard for diagnosing endometriosis.

Surgical Methods for Endometriosis Treatment

There are several surgical methods for treating endometriosis, including laparoscopic excision, robotic-assisted laparoscopy, and laparotomy. The specific method used depends on the severity and location of the endometrial tissue, as well as the patient’s overall health and preferences. In general, the goal of surgery for endometriosis is to remove the affected tissue while preserving healthy tissue and organs as much as possible.

Laparoscopic Excision

Laparoscopic excision is a surgical procedure that can be used to remove endometriosis tissue from the body. It involves making small incisions in the abdomen and inserting a laparoscope (a thin, lighted tube with a camera) to visualize the internal organs. Surgical instruments are then used to remove the endometrial tissue. This procedure is considered the gold standard for diagnosing and treating endometriosis.

The cost of laparoscopic excision of endometriosis can vary depending on the location, healthcare provider, and type of insurance. It’s recommended to request an appointment with New York Gynecology Endometriosis (NYGE) to obtain an accurate estimate of the cost.

Robotic-Assisted Laparoscopy

Robotic-assisted laparoscopy is a type of laparoscopic surgery that uses a computer-controlled robot to perform the surgery. It is a minimally invasive surgical option that can be used to diagnose and treat endometriosis. The cost of robotic-assisted laparoscopy for endometriosis will vary depending on factors such as the hospital or surgical center, surgeon fees, and insurance coverage.

However, in general, robotic-assisted laparoscopy is often more expensive than traditional laparoscopy due to the use of the robot and the associated technology.

Laparotomy

Laparotomy is a surgical procedure that involves making a large incision in the abdominal wall to gain access to the pelvic organs. It is used to diagnose and treat a variety of conditions, including endometriosis. During laparotomy for endometriosis, the surgeon will make an incision in the abdominal wall, and then carefully remove the endometrial tissue. Laparotomy is a more invasive surgery than laparoscopy and is typically reserved for cases where the endometrial tissue is widespread or in hard-to-reach areas.

However, it may also be recommended in cases where a woman has a large mass or adhesions that need to be removed. The recovery time for laparotomy is longer than that for laparoscopy.

The cost of laparotomy can vary depending on the location, healthcare provider, and individual circumstances.

Non-surgical methods for endometriosis treatment

Although non-surgical treatments like NSAIDs, progestin-only birth control pills, and GnRH analogs can alleviate some symptoms of endometriosis, they are usually temporary and do not provide a complete cure for the disease. The most effective approach to treating endometriosis involves undergoing laparoscopic deep excision surgery and a comprehensive multidisciplinary treatment plan.

Pankaj Singhal, MD, MS, MHCM

Master Surgeon in Robotic Surgery

Dr. Pankaj Singhal, a globally recognized endometriosis surgeon, possesses over 25 years of expertise in laparoscopic excision surgery, enabling him to tackle even the most challenging endometriosis cases with confidence. Dr. Pankaj treats patients with diverse endometriosis-related conditions, ranging from ovarian endometriomas to severe deep infiltrating endometriosis that affects the bowels and other organs.

Dr. Pankaj prioritizes minimally invasive surgery and provides comprehensive personal care. Additionally, he is the owner and founder of New York Gynecology and Endometriosis (NYGE), and has dedicated his life to advocating for, respecting, and treating women suffering from this little-known disease. He is one of the few surgeons in the entire United States who have completed over 5,718 robot-assisted gynecologic surgeries.

We Accept Most Major Insurance Plans

Convenient Billing Options for Comprehensive Coverage.

Surgeries are typically covered by health insurance. However, the extent of coverage can vary depending on the specific insurance plan and policy. Some insurance plans may cover a broad range of surgical procedures, including both elective and necessary surgeries, while others may have limitations or exclusions for certain procedures.

In some cases, certain insurance plans or programs may fully cover the cost of surgery, leaving the patient with no financial responsibility.

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