Endometriosis: Symptoms, Causes and Treatments

The abnormal tissue growth can cause inflammation, pain and adhesions, causing symptoms, such as pelvic pain and pain with bladder and bowel functions and intercourse, as well as gastrointestinal issues. And although the “classic” endometriosis symptom is painful periods, it isn’t always present. 

“It’s important to point out that there are often symptoms that are not classically endometriosis,” Lily Tsai, MD, a gynecologic surgeon at Scripps Clinic Encinitas. “Heavy periods are not classically endometriosis, irregular periods are not classically endometriosis but can be signs.”

Tresa Lombardi, MD, an OB-GYN and gynecologic surgeon at Scripps Clinic Rancho Bernardo, echoes this. “Countless patients have said to me, ‘Nobody believed my symptoms,’ which has such a substantial mental impact on a woman. We need better education in health care about this condition.”

While the exact cause is unknown, women who have a family history of endometriosis, painful periods or unexplained infertility are at higher risk of developing it, as are women who start menstruation early, have short menstrual cycles or haven’t given birth. 

Untreated, endometriosis can severely impact a woman’s quality of life, leading to chronic pain, emotional distress and fertility issues. Without proper management, it can cause long-term complications, including infertility and organ damage.

Scripps takes a multidisciplinary approach to treating endometriosis, with comprehensive personalized plans that may include advanced therapies, like hormonal treatments, surgery and lifestyle modifications. 

Both Dr. Tsai and Dr. Lombardi have completed Minimally Invasive Gynecologic Surgery (MIGS) fellowships, which means they have formal training in treating endometriosis. Every day, they work to help women with this disease live full lives.

While an official endometriosis diagnosis requires surgery, Scripps provides treatment to women who haven’t been surgically diagnosed by considering them clinically diagnosed. 

Because endometriosis is an estrogen-dependent disease, hormonal contraceptives that work to negate the effects of estrogen can help. Dr. Tsai is working on a more natural progesterone treatment, while Dr. Lombardi also sees the benefit of pelvic physician therapy.

Dr. Tsai and Dr. Lombardi say they’d recommend surgery if a clinically diagnosed woman doesn’t see improvement from noninvasive treatments, or if she’s trying to get pregnant, as infertility is a side effect. 

“A third reason is that some patients just really want to know. They want to have that label, even if it doesn't change their ultimate outcome,” Dr. Tsai says. “And I think that's reasonable.”

Endometriosis surgery can be minimally invasive, involving a few small incisions in the abdomen. If the doctors found any endometriosis, they’ll cut it away — meaning, ideally, the patient wakes up with all endometriosis growths removed. 

Some women see symptoms disappear completely post-surgery. Others continue needing non-invasive treatments — and continue having pain — as endometriosis is a chronic condition and can grow back. 

Others still don’t notice any symptom change. “I know it’s incredibly discouraging,” Dr. Lombardi says. “But it’s actually really valuable information to help a woman, because now we know her symptoms aren’t happening because of active disease, and we need to treat her differently.”

Both Dr. Lombardi and Dr. Tsai are committed to helping patients through the disease’s ups and downs, which is a form of treatment itself. 

“Women need to feel heard,” Dr. Tsai says.