Women's Health

Endometriosis - What You Should Know

woman clutching stomach

Many women suffer through the symptoms of endometriosis — pelvic pain or painful, heavy periods — without seeking help. Scott A. Dinesen, DO, of Dinesen OB/GYN & Infertility, urges women to talk to their doctors about their symptoms: “We, as women’s healthcare providers, should be able to help alleviate the pain and manage endometriosis.”

What Is Endometriosis?

Endometriosis occurs when tissue similar to the inner lining of the uterus (the endometrium) starts to grow outside of the uterus. This condition can cause pain, heavy periods, chronic fatigue and, in some cases, infertility. According to Vivian Yeh, MD, of Doylestown Women’s Health Center, endometriosis may affect more than 10% of the U.S. female population during their reproductive years.

Endometrium grows outside of the uterus — commonly in the pelvic region surrounding the uterus, ovaries or fallopian tubes. The tissue, though not in the uterus, still builds up blood cells during each menstrual cycle. The blood cells have no way to exit the body, resulting in pressure, pain and inflammation.

There are no known causes for endometriosis, nor proven cures or lifestyle remedies. However, Dr. Yeh promotes healthy eating and regular exercise as a way to ameliorate symptoms.

Stages of Endometriosis

Endometriosis is categorized into four different stages, with Stage IV typically being the most painful.

  • Stage I- small amounts of extra tissue lesions
  • Stage II- more extra tissue, deeper implants
  • Stage III- many extra tissue lesions and possibly endometrial cysts on the woman’s ovaries
  • Stage IV- large endometrial cysts on at least one ovary, many deep extra tissue lesions

Another mystery of the disease, Dr. Yeh notes, is that some women with Stage IV endometriosis have no pain.


While some women with endometriosis may not experience pain, likewise not every woman with painful periods has endometriosis. Further, Dr. Dinesen estimates that about half of patients with pelvic pain and half of those reporting infertility issues will be diagnosed with the condition. If you experience any of the symptoms below, it is important to talk to your physician, regardless, to determine the best solution for any discomfort.

Symptoms can include:

  • Chronic fatigue
  • Painful menstrual cramps
  • Significant abdominal, pelvic or lower back pain
  • Painful bowel movements or painful urination during your period
  • Irregular, painful or unusually heavy periods
  • Pain during or after sex
  • Difficulty getting pregnant


Compiling a thorough history of symptoms and a pelvic exam to check for scar tissue or uterine cysts can result in a reasonable diagnosis in many cases. But Dr. Dinesen points out, “The only definitive way to diagnose endometriosis is via minimally invasive laparoscopic surgery.”


While there is no known cure for endometriosis, your doctor will work with you to manage symptoms. “Currently, we try to manage pain with medications: NSAIDs like ibuprofen, birth control pills, more directed medications such as GnRH antagonists [affecting estrogen and progesterone production],” says Dr. Yeh. “However, surgery allows us to get a biopsy if endometriosis is seen and permits reducing the amount of disease.”

Dr. Dinesen adds that “When medical therapy is not working, when the diagnosis is not clear, when infertility is involved, or when abnormal masses such as endometriomas or enlarged ovarian cysts are found, laparoscopy should be discussed. Laparoscopy can more closely examine affected areas and/or remove affected tissue, allowing for both diagnosis and treatment.”

Pregnancy and Endometriosis

Endometriosis is a top cause of infertility in women. The condition may lead to adhesions, scarring and inflammation in the pelvic region. Further, the associated hormonal alterations caused by the condition can affect a woman’s eggs and their implantation.

However, pregnancy is still possible with endometriosis. Some women need help, some do not. Consult your OB/GYN to determine the best plan of action for a successful, healthy pregnancy.


Doylestown Health Obstetrics and Gynecology

Doylestown Health's expert OB/GYN physicians and certified nurse midwives provide skilled and compassionate health care throughout all stages of a woman's life, from adolescence through menopause and adulthood. And for families welcoming new babies, Doylestown Health's VIA Maternity Center offers labor, delivery and postpartum care in a state-of-the-art, family-centered facility — complete with a Level II Neonatal Intensive Care Unit staffed round-the-clock by CHOP neonatologists.

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