Endometriosis is a condition in which cells similar to those found inside the uterus (womb) grow in places where they shouldn’t. These cells may spread to other organs in the pelvis, such as the ovaries or fallopian tubes. They may even grow on the bowel or bladder. These cells cause chronic inflammatory lesions (growths) that can be painful and may affect your ability to have a baby.
Endometriosis is a fairly common medical condition. “About 10 percent of women of reproductive age have endometriosis,” said Jon I. Einarsson, MD, MPH, chief of the Division of Minimally Invasive Gynecologic Surgery at Brigham and Women’s Hospital. “And about 40 percent of women with infertility have it.”
In spite of its high prevalence, endometriosis presents unique challenges that make its care quite complex and highly personalized. To meet those challenges and provide the best possible care to all women, including those with complex endometriosis, the Brigham has launched the Center for Endometriosis.
Raymond Manohar Anchan, MD, PhD, of the Center for Infertility and Reproductive Surgery and Louise Perkins King, MD, JD, of the Division of Minimally Invasive Gynecologic Surgery will serve as center co-directors.
The Brigham has offered comprehensive care for endometriosis for many years. However, creating a Center for Endometriosis is making it much easier for patients to access high-quality treatment. “Now it’s even more seamless than before,” Dr. Einarsson said.
“Endometriosis is a lifelong condition that does not have a cure,” said Antonio Rosario Gargiulo, MD, a reproductive endocrinologist and infertility specialist in the Department of Obstetrics and Gynecology. “However, it can be managed quite successfully with many different kinds of targeted treatments.”
A multidisciplinary team of experts
A gynecologic surgeon is the primary care provider for patients with endometriosis. However, the best way to treat endometriosis is almost always through a multidisciplinary team approach. This means that different kinds of specialists work together to provide care.
“In our new center, highly trained subspecialists from a variety of specialties will be communicating under one umbrella to offer more coordinated, personalized care. In addition, we’ll have a patient coordinator so that patients always have a point of contact. We’ve consulted with multiple patient advocates in designing the center and will continue to consult with them to ensure our focus remains on the patient experience.”Louise Perkins King, MD, JD
The Center for Endometriosis team is led by gynecology subspecialists who work together with a range of other specialists, including:
- Physical therapists
- Pain specialists
- General surgeons
- Social workers
“In our new center, highly trained subspecialists from a variety of specialties will be communicating under one umbrella to offer more coordinated, personalized care,” said Dr. King. “In addition, we’ll have a patient coordinator so that patients always have a point of contact. We’ve consulted with multiple patient advocates in designing the center and will continue to consult with them to ensure our focus remains on the patient experience.”
The Center for Endometriosis will also conduct extensive research into managing the condition. “This is crucial because endometriosis care is evolving so rapidly,” Dr. Gargiulo said.
Women of any age can have endometriosis. But it is most often diagnosed between the ages of 30 and 40, which is when many women try to start a family. In fact, some women first discover they have endometriosis when they realize that they can’t get pregnant.
Although some women with endometriosis have no symptoms, most do have symptoms — some of which can be quite devastating. They may include:
- Heavy bleeding during periods
- Pain during or after sex
- Chronic pelvic pain
- Pain while going to the bathroom
- Bloating, constipation and diarrhea
- Chronic fatigue and physical deconditioning
- Depression and social isolation
Although endometriosis is common, care providers don’t always recognize it. “For the vast majority of patients, it can take seven to 10 years to be diagnosed with endometriosis. But the new Center for Endometriosis will help patients receive an earlier diagnosis,” Dr. King said. “The center will also bring a heightened awareness of endometriosis to the Mass General Brigham system, allowing for earlier referrals to the correct specialists, leading to an earlier diagnosis.”
Even though imaging and even some blood tests can help find endometriosis, the only sure way to know if you have it is to have a procedure known as a diagnostic laparoscopy.
During a laparoscopy, which is a minimally invasive procedure, your surgeon inserts a thin, lighted scope into your belly through a tiny incision (cut). If endometriosis is found, surgeons from our center will remove lesions.
Endometriosis can be challenging to treat and manage. “Surgical treatment can be very complex and can involve many different organs,” Dr. Einarsson said. “That’s why it’s important to go to a provider who is very experienced and a hospital that has all of the different expertise that is required.”
The type of treatment that is right for you depends on several factors. These include your symptoms, the amount and location of your endometriosis lesions and whether you’ve completed your family.
The goal of endometriosis treatment is to address symptoms and, for women who would like to become pregnant, to preserve fertility. Treatment options may include:
- Hormonal medication: Various types of hormonal drugs may help reduce symptoms and reduce the risk of needing repeat surgery. Our research is ongoing to broaden therapeutic options.
- Surgery: Our surgeons are experts at removing endometriosis. We perform endometriosis surgery using the minimally invasive laparoscopic or robotic approach. This is done through a few tiny cuts rather than one larger cut. This results in quicker recovery time, less bleeding and smaller scars than traditional surgery.
“The goal of surgery is to physically remove endometriosis from the body and restore functional anatomy, with the goal of decreasing pain, and preserving fertility where needed,” Dr. Gargiulo said.
Because endometriosis can be so complex, it’s crucial to have experienced specialists doing your surgery. “Very few surgeons can develop the expertise and specialized skills to adequately treat endometriosis,” Dr. Gargiulo said. “But our patients can come to our hospital knowing they will get the very best endometriosis care. Here at the Center for Endometriosis, we are treating endometriosis with what we know to be the best treatments available.”