Shining Light on Endometriosis: Insights, Misconceptions, and Hope with Dr. Hannah Ashitey

As spring arrives, so does Endometriosis Awareness Month, a crucial time dedicated to illuminating the challenges faced by millions of women. Highlighting the power of awareness, education, and empathy, we are honored to feature insights from Dr. Hannah Ashitey, MD, MPH. An expert in women’s health, Dr. Ashitey’s deep understanding and commitment bring a new depth to our exploration of endometriosis.

What exactly is Endometriosis?

Endometriosis is a benign condition where the tissue of the uterine lining (endometrial glands and stroma) are noted outside the uterine cavity. The lesions can be found in the pelvis, bladder, bowel, diaphragm, and even sometimes the lung.

What are the most common symptoms of Endometriosis, and how can women differentiate them from regular menstrual discomfort?

The symptoms for endometriosis can range from no symptoms to severely debilitating ones. Most common symptoms include abdominal pain with no relation to menstruation(however the pain can be worse during menses), pain during urination, pain during defecation, pain with sexual intercourse, and heavy menstrual bleeding. 

Are there any misconceptions about Endometriosis that you often encounter, and what clarifications would you offer?

  • “Do I need to have surgery to be diagnosed with endometriosis?”
    • No, endometriosis can be diagnosed clinically based on your symptoms. Although surgery is the gold standard to diagnose and treat, many patients can be diagnosed clinically and managed medically.
  • “Will I be able to get pregnant if I have endometriosis?”
    • Yes, although endometriosis can cause infertility, it is possible to get pregnant and carry the baby to term.
  • “Is endometriosis considered cancer?”
    • No, endometriosis is a benign condition. It can increase your risk of ovarian cancer; however the disease itself is not cancerous.
  • “Can I have endometriosis without any symptoms?”
    • Yes, some patients may not have any symptoms and may be diagnosed when having surgery for another reason. Others may be diagnosed when undergoing work up for infertility.

How is Endometriosis diagnosed, and what steps should women take if they suspect they may have the condition?

If you suspect you may have endometriosis based on your symptoms, make an appointment with your OBGYN. They will assess your symptoms and rule out other causes. This may include a physical exam (pelvic), imaging such as ultrasound, or surgery.

What are the risk factors associated with Endometriosis, and are there ways to mitigate or reduce the risk?

Risk factors include family history, early onset of menses, late menopause, heavy menstrual bleeding, uterine anomalies that obstruct menstrual flow. 

    • Factors associated with decreased risk include late onset of menses, extended lactation, multiple births. This is mainly due to decreased number of menstrual cycles. 
    • Currently there are no ways to prevent endometriosis; however, we know that higher levels of estrogen can increase your risks because of the effect of estrogen on endometrial tissue.

Can Endometriosis impact fertility, and what options are available for women who wish to conceive despite having the condition?

Yes, women with endometriosis have a higher risk of infertility due to the inflammatory nature of the disease that can block the fallopian tubes or interfere with ovulation, fertilization or implantation of the embryo. Those with infertility caused by endometriosis are referred to a fertility specialist to discuss their options. Fertility specialist may recommend surgery to remove endometriosis lesions and or assisted reproductive technology (ovulation induction, intrauterine insemination, or in-vitro fertilization).

Are there effective treatment options for Endometriosis, and what factors influence the choice of treatment?

Treatment options include medications (non-steroidal analgesics, hormonal contraceptives, gonadotropin-releasing hormone (GnRH) analogs, and aromatase inhibitors) and surgery to remove the lesions or fulgurate them. The treatment options involve shared decision-making with your provider based on your symptoms, side effects, costs, preference, and availability. 

What lifestyle changes or self-care practices can women adopt to manage Endometriosis symptoms?

Individuals with pelvic pain can try OTC analgesics such as NSAIDs, heating pad, or pelvic floor therapy. Although more studies are needed in the dietary recommendations for patient with endometriosis some have found plant based diets with anti-inflammatory properties to be helpful in managing symptoms.

Is surgery ever necessary for treating Endometriosis, and what should women expect if surgery is recommended?

Surgery may be recommended when someone does not respond to medical therapy or if they present with severe symptoms.

How does Endometriosis impact mental health, and what support or resources are available for women dealing with both physical and emotional challenges?

Endometriosis can impact one’s quality of life due to the debilitating symptoms. Some patients may even end up missing work or school which can lead to other mental health issues such as depression and/or anxiety. The goal of treatment is to help those individuals with endometriosis improve their reproductive health and have a better quality of life.

  • American College Of Obstetricians and Gynecologists 
  • American Society for Reproductive Medicine
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