World Endometriosis Month: The Myths and Realities

Written by: Dr. Ally Murji, Assistant Professor with UofT ObGyn, and an endometriosis expert at Mount Sinai Hospital and Women’s College Hospital

Endometriosis is a common condition that affects up to 15% of reproductive age women. This condition can have a significant impact on a woman’s quality of life, therefore it is important to understand the myths and realities associated with endometriosis. March is World Endometriosis Month, created to spread awareness about those living with this condition. Below are some myths and their associated realities:

Myth 1: Endometriosis is a surgical diagnosis

Traditionally patients had to undergo a diagnostic laparoscopy (a surgical procedure to view a woman's reproductive organs) to diagnose endometriosis. The paradigm in endometriosis has changed significantly. There is no longer a place for diagnostic laparoscopy when endometriosis is suspected. Endometriosis is a clinical diagnosis. Secondary dysmenorrhea (painful periods) should be considered endometriosis until proven otherwise. Management of pelvic pain should not be delayed in order to obtain surgical confirmation of disease.

Myth 2: Endometriosis can be cured with surgery

Endometriosis is NOT an acute or sudden condition. Surgery can help alleviate symptoms or facilitate fertility – but recurrence rates can be as high as 55% at 12 months without medical management. Traditionally women would have multiple surgeries for endometriosis – which then results in painful scar tissue and neuropathic pain syndrome. The new paradigm or model is that medical management should be the cornerstone of treatment for endometriosis. If surgery is required, a woman should have ONE surgery that is performed by an endometriosis expert.

Myth 3: Endometriosis is a condition of younger women

Just like other chronic conditions such as diabetes, rheumatoid arthritis or inflammatory bowel disease, endometriosis is a CHRONIC CONDITION. A woman diagnosed with endometriosis has to live with the condition for the rest of her reproductive life. There is a significant impact on her physical, sexual, psychological and social well-being. We have to start thinking about long-term endometriosis management during the entire reproductive life cycle – all the way to menopause.

Myth 4: When the oral contraceptive pill (OCP) does not work to relieve dysmenorrhea (painful periods), it is best to switch to another brand of OCP

Some women with endometriosis will experience improvement in dysmenorrhea with the OCP, especially when taken continuously. However, many women with endometriosis may have a short-lived response to the OCP, likely because the endometriosis implants are stimulated by the estrogen in the OCP, while the OCP progestin is ineffective in antagonizing the estrogen effect. If the first OCP doesn’t work, patients should be switched to another first-line agent such as progestin treatment (oral or intramuscular).

Myth 5: An MRI is the best way to diagnose endometriosis

Endometriosis has different manifestations: superficial disease, endometriomas, adenomyosis, deeply infiltrating disease. It is essential for physicians to understand the extent of disease severity so as to plan treatment accordingly. Basic transvaginal ultrasound can be helpful in screening for endometriosis. However, expert-guided dynamic transvaginal ultrasound is highly specific for endometriomas and can accurately map the extent of deep endometriosis. Expert-guided endometriosis mapping ultrasound should be ordered in patients with:

• known surgical history of endometriosis with recurrent symptoms
• physical examination suggesting deep endometriosis
• symptomatic endometriomas
• symptomatic adenomyosis

As always, patients who have endometriosis or who believe they have this condition should consult with their doctor or their endometriosis specialist to better understand how this may affect their health.

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