Cedars-Sinai Blog

Endometriosis Q&A with Dr. Kelly Wright

Because many doctors have a hard time diagnosing and treating endometriosis and pelvic pain in general, patients should look for a specialist who has extra training in treating the condition.

March is National Endometriosis Month. We sat down with Dr. Kelly Wright, associate professor of Obstetrics and Gynecology and a minimally invasive gynecologic surgeon at Cedars-Sinai, to talk about this often-misunderstood condition.

Headshot for Kelly N. Wright, MD

Kelly N. Wright, MD

Minimally Invasive Gynecologic Surgery
Guerin Children’s Provider

Kelly N. Wright, MD

Minimally Invasive Gynecologic Surgery
Guerin Children’s Provider
Guerin Children’s Provider
In-person & Telehealth Visits

Q: What is endometriosis and who gets it?

Dr. Kelly Wright: Endometriosis is a condition in which cells similar to the inside of the uterus or endometrial lining grow outside the uterus and attach to other organs. The tissue can respond to hormones like a menstrual cycle, which can cause a lot of inflammation inside the abdomen, leading to a multitude of symptoms.

Endometriosis can grow in the lining of the abdomen (the peritoneum), the fallopian tubes, the ovaries (endometrioma cysts), the bowel or the bladder—or even within the uterine muscle itself, a condition called adenomyosis.

Most patients who have symptoms of endometriosis have periods, but endometriosis has also been found in girls who haven’t yet started their periods and in some postmenopausal patients, as well. Because the symptoms and types vary, it’s also very difficult to study.

"To reduce inflammation and prevent endometrial tissue from becoming stimulated and inflamed, many patients use hormonal birth control."

Q: What are some common symptoms?

KW: Common symptoms—which range from mild to severe—include painful or heavy periods, pain during sex, problems with bowel movements or trouble getting pregnant.

Q: How do I get diagnosed?

KW: Endometriosis can be hard to diagnose and treat, and some patients experience years of pain and frustration before they find good care.

Typically, a doctor will suspect endometriosis based on a detailed history, pelvic exam and pelvic ultrasound. To get diagnosed, patients undergo a laparoscopic procedure where a doctor looks inside the abdomen with a small camera to see if there are any spots that look like endometriosis outside of the uterus.

Any visible areas of endometriosis, or even areas of suspected microscopic endometriosis, are fully removed, or “excised.” These pieces of tissue are sent to a pathologist to be looked at under a microscope to confirm the diagnosis.

Q: Is there a cure for endometriosis?

KW: Endometriosis does not have a cure. After menopause, most patients find relief due to a lack of periods. However, if the endometriosis has never been adequately treated or removed, pain or other symptoms can persist.

Q: I've been diagnosed. What's next?

KW: For patients who are still having periods, treatment depends on symptoms and goals. Most treatment plans involve surgical and nonsurgical options, and patients may try different approaches before finding what works for them.

During a laparoscopy, all unwanted tissue that is found outside the uterus is removed. Even after surgery, pain can come back every time a person has a period. Therefore, we typically add other types of treatment after surgery.

"Most women with endometriosis can become pregnant on their own."

To reduce inflammation and prevent tissue from becoming stimulated and inflamed, many patients use hormonal birth control. Successful treatments include birth control pills, hormonal IUDs, a hormonal implant or a shot. This is particularly important for patients with adenomyosis, as the disease cannot be fully removed without removing the uterus.

Many patients will also use NSAIDs such as ibuprofen to treat pain. These medications come in prescription-strength doses, and when taken at the very onset of a period, can prevent inflammation from building.

Pelvic floor physical therapy may also be recommended because endometriosis can cause the pelvic floor muscles to tense up, which can result in pain even after the endometriosis is treated.

Patients will often be referred to a gastrointestinal specialist, as symptoms such as gastritis (upper abdominal pain), constipation and bowel pain are common.

Q: Is there a link between fertility and endometriosis?

KW: Yes. However, most patients with endometriosis can become pregnant on their own. Fertility rates increase in the year following laparoscopic surgery.

Severe endometriosis that causes scarring can block the tubes and prevent the egg and sperm from reaching each other. Some patients with severe endometriosis need to pursue options like in-vitro fertilization (IVF) if they wish to become pregnant.

Q: Should I have a hysterectomy?

KW: Patients who do not wish to become pregnant or are past their childbearing years may choose to have a hysterectomy

This may be particularly effective for patients who have adenomyosis. Many patients without adenomyosis may also experience significant pain reduction from a hysterectomy because the inflammation associated with menstrual cycles decreases.

However, some patients may continue to have pain even after a hysterectomy, particularly if they have endometriosis in other parts of their body. It is important that a hysterectomy is done by an endometriosis specialist, so that all other endometriosis can be removed at the same time.

Q: Is there anything else I should know?

Dr. Wright: Because many doctors have a hard time diagnosing and treating endometriosis and pelvic pain in general, patients should look for a specialist who practices minimally invasive gynecologic surgery (MIGS) and has extra training in treating endometriosis. Look for a physician who takes your symptoms seriously and offers a treatment plan composed of different treatment options.

At Cedars-Sinai, we have three faculty doctors—Dr. Matthew Siedhoff, vice chair of Gynecology; Dr. Mireille Truong, assistant professor of Obstetrics and Gynecology; and me—who are fellowship-trained in MIGS and routinely treat patients with endometriosis, along with a multidisciplinary team of specialists who care!

If you experience endometriosis, Cedars-Sinai’s Endometriosis Peer Support Network can connect you with people who understand.

Learn more about the Endometriosis Program at Cedars-Sinai.