Talking endometriosis with U of M

MINNEAPOLIS/ST. PAUL (03/04/2024) — March is National Endometriosis Awareness Month — a time to put the spotlight on an overlooked disease that can cause chronic pain and fertility issues. According to the Office on Women’s Health, more than six million people in the United States have endometriosis. 

Leah Henke, MD, with the University of Minnesota Medical School and M Health Fairview, explains endometriosis symptoms, prevalence and treatment.

Q: What is endometriosis? 

Dr. Henke: Endometriosis is a condition where the lining of the uterus attaches and grows outside the uterus. This can cause inflammation, pain and scar tissue to form. There are several theories as to how endometriosis forms. The most widely accepted is that endometrial lining travels backward through the fallopian tubes and out into the abdomen. Genetic and hormonal factors then allow this tissue to attach to other structures and grow and shed with the menstrual cycle. 

Q: What are the symptoms of endometriosis? 

Dr. Henke:  While symptoms can vary, the most common symptoms are pelvic pain that occurs around the time of menstruation and pain with intercourse. Depending on the location of endometriosis, some people may also experience pain or bleeding with bowel movements or urination, heavy menstrual bleeding and difficulty becoming pregnant. Inflammation from endometriosis can cause scar tissue to develop in the abdomen. Some people are incidentally diagnosed with endometriosis during another surgical procedure due to the appearance of the condition but do not have symptoms, whereas others have debilitating symptoms but mild visualized disease on surgical exploration. Many symptoms of endometriosis overlap with other conditions. If you have symptoms that align with endometriosis, your gynecologist may recommend additional tests or treatment to help determine the cause. 

Q: How common is endometriosis? 

Dr. Henke:  Endometriosis occurs in 6-10% of people with female reproductive organs. It is more common in people with infertility or chronic pelvic pain. People with an immediate family member with endometriosis are at a 7 to 10 times higher risk of having the disease.

The prevalence of endometriosis may be even higher due to difficulty with diagnosis. Definitive diagnosis is made through biopsy of a lesion outside the uterus. Because surgery is needed for a definitive diagnosis, the first treatment options are usually medications. 

Q: What are the treatment options for endometriosis? How can this condition be managed? 

Dr. Henke:  Treatment options for endometriosis can vary based on a patient’s symptoms, medical and surgical history and fertility goals. The objective of most treatment options is to reduce endometriosis growth and inflammation. This can be achieved through a variety of medications that affect the hormones, specifically estrogen and progesterone. These medications are also sometimes used with additional drugs to help treat inflammation. Interestingly, exercising more than four days a week has been found to be protective against endometriosis.

For those with worse symptoms during menstrual bleeding, medications can help suppress menstruation. If initial treatment is not helpful, other treatment options such as diagnostic laparoscopy — surgery through small incisions in the abdomen — may be pursued to help confirm the diagnosis. Surgical treatment where endometriosis lesions are removed or destroyed can decrease pain. However, many patients may see symptoms return within several months to years, especially without continued medical treatment after surgery. Definitive surgical treatment of endometriosis is removal of the uterus and both ovaries, which is only considered if other options don’t work, as it results in loss of fertility, surgical risks and long-term consequences from the early loss of ovarian hormones.

Q: What are you doing to advance the field of obstetric and gynecologic care?

Dr. Henke: As a teaching physician at the University of Minnesota, I work with our patients to help teach medical students and residents how to provide evidence-based and compassionate care to women and gender-expansive individuals with gynecologic or obstetric needs. I work in the clinic, hospital and operating room settings. We have many ongoing research studies that patients can engage with to help expand the field of knowledge. I have a personal interest in global health disparities and serve as the advisor for the OB-GYN residency track in global women’s health. I also perform minimally invasive surgeries with the robotic platform and enjoy learning new and innovative techniques to make surgery safer.

Dr. Leah Henke is an assistant professor with the U of M Medical School and an obstetrician/gynecologist with M Health Fairview. Her clinical interests include global women’s health, advocacy for equitable care, minimally invasive surgery, integrative care and health education.

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