Endometriosis

Endometriosis happens when tissue similar to the lining of your uterus (endometrium) grows outside of your uterus. With endometriosis, you can experience:

• Painful period cramps.
• Long-term pain in your lower back and pelvis.
• Pain during or after sex.
• Stomach pain.
• Bleeding between periods.
• Painful bowel movements.
• Difficulty becoming pregnant (infertility).
• Digestive problems.

If you think you may have endometriosis, it may be time to make an appointment. At your visit, our specialists may diagnose endometriosis using several methods, including:

• Medical history: We listen to you during your visit, taking time to hear your history, concerns and lifestyle goals.
• Pelvic exam: Your provider does a pelvic exam. We may be able to feel cysts or adhesions (scar tissue that can connect your organs) behind your uterus.
• Ultrasound: We may do a transvaginal ultrasound. During the ultrasound, your provider inserts a probe into your vagina to look for ovarian cysts, nodules or adhesions caused by endometriosis.
• Advanced imaging: Your provider may order an MRI. This imaging test lets us see detailed information about the locations and sizes of the endometriosis lesions.

Treatment for endometriosis is highly personal. The conversations we have at the beginning of this process help us understand your goals and guide how we craft a treatment plan that’ll fit your life. When it comes to treatment, we offer nonsurgical and surgical options. How much pain you’re in and if you want to become pregnant in the future also guide the treatment plan we recommend for you.

Our compassionate team supports you every step of the way. During treatment, you may meet with our:

• Nurse practitioners.
• Radiologists.
• Ultrasound technicians.
• Nurse coordinators.
• Surgeons.
• Surgical schedulers.
• Pelvic floor therapists.
• Pain psychologists.
• Chronic pelvic pain specialists.

Medications

One thing your provider may do is prescribe medications to help with painful symptoms of endometriosis. Medications aren’t a cure for endometriosis, but they can decrease your symptoms, so you feel better.

Hormonal birth control and pain relievers may help reduce pelvic pain during your period. This isn’t a one-size-fits-all process. Your provider may talk to you about several hormone therapies and pain medications to find the right one for you.

Laparoscopic endometriosis surgery

If you have painful endometriomas (ovarian endometriosis) or endometriosis lesions, surgery may help relieve your discomfort. If you’ve had trouble getting pregnant because of endometriosis, you may conceive following surgery.

At Cleveland Clinic, we offer a minimally invasive approach to endometriosis surgery to remove these lesions. Using advanced imaging, your surgeon can precisely map out the endometrial lesions. This process helps us to talk with you in detail about the condition, how it affects you, your goals for surgery and lets us put together your surgical team. We make sure that the treatment lines up with what you want.

During laparoscopy, your surgeon inserts a thin instrument called a laparoscope through a small incision around your belly button. Then, we remove the endometriosis lesions or cysts. Typically, our surgeries are minimally invasive and you’ll go home the same day.

Hysterectomy

As you’re talking to your provider about your treatment options, the topic of hysterectomy might come up. You might think, “you need to remove my whole uterus to make me feel better?” It might be a lot to take in. But know that when our providers talk to you about a possible hysterectomy, it’s because it’s an option that might improve your everyday life.

There are a lot of factors that go into the discussion of whether or not a hysterectomy might be a good choice for you, including:

• How much endometriosis you have.
• Whether or not you have other conditions like adenomyosis.
• How much pain you’re experiencing.
• If you want to get pregnant in the future.

Your provider will explain the procedure, how it can help and what it will mean for your life moving forward. It’s important to know that after a hysterectomy, you won’t be able to become pregnant. Together, you can decide if this is the right choice for you.

Follow-up care

We won’t forget about you after treatment. We check in on you and provide ongoing care to make sure your symptoms have gotten better. This follow-up care can happen virtually or in person.

During your follow-up appointments, we ask about how much pain you’re having and adjust your treatment if needed. Your provider may add in other pelvic pain specialists to your care plan, such as our chronic pelvic pain specialists, physical therapy and psychology experts.

Taking the Next Step

When you live with things like cramps, back pain, bloating and infertility for a long time, you might just accept them as a part your life. You might try changes to your meal plans, exercises or any number of other things. But you might also just give in to the frustration and think this is just what it is. At Cleveland Clinic, we want you to bring your concerns to us. Together, we’ll look at your whole list of symptoms and assemble the pieces so we see the whole picture. If you have endometriosis, there are treatment options we can try. You don’t need to just live with the discomfort, pain and stress of endometriosis — we can help.