Another month, another painful period. Or maybe that menstrual pain never goes away. For some women, it’s a painful life as usual. But what could be the cause of these painful cycles?

Endometriosis may be the culprit. And while the condition generally isn’t dangerous, it can be quite debilitating.

With endometriosis, the endometrial tissue that lines the inside of the uterus begins to grow outside of it in clumps called implants. The most common places for these implants are the ovaries, the fallopian tubes, the outer wall of the uterus and other pelvic areas. (It’s possible, though rare, for endometrial implants to spread beyond the pelvic area.)

Despite being relocated outside the uterus, the migrated endometrial tissue behaves as it should: thickening, breaking down and bleeding during each menstrual period. But if this tissue and associated bleeding have no manner in which to leave the body, pain and inflammation can result. Left untreated, endometriosis can have significant unwanted side effects — the most common being an increased risk of infertility, scarring of the fallopian tubes and severe pain with intercourse. But the good news is that women don’t have to suffer.


What Symptoms Am I Looking for?

Although many patients with endometriosis experience pain, the intensity of that pain isn’t a reliable indicator of just how severe or extensive the condition is. Some women have pain all the time; some experience only mild discomfort.

It’s not uncommon for symptoms to increase in severity just before and during your menstrual period. Some of the most common symptoms include:

  • Painful periods, including severe menstrual cramps and pelvic pain
  • Pain during or after intercourse
  • Pain during bowel movements, especially during your period
  • Abnormal bleeding, such as blood in the urine or stool

Another common symptom of endometriosis is infertility: Approximately 20%-40% of infertile women have endometriosis. In fact, many women are first diagnosed with endometriosis when they have trouble starting a family. Although it’s not known why endometriosis may cause infertility even in the absence of scar tissue involving the ovaries and/or fallopian tubes, there are several theories, including:

  • Scar tissue develops near the implants, changing the shape or function of the ovaries, fallopian tubes or uterus.
  • Implants alter the chemicals or hormones found in the fluid surrounding abdominal organs, preventing pregnancies or altering menstrual cycles.

Just as it’s impossible to predict who will have mild or severe symptoms, it’s also impossible to predict if an individual’s symptoms will increase or decrease in severity — or simply stay the same — over time.


How Do I Know if I Have Endometriosis?

Symptoms alone aren’t enough to formally diagnose endometriosis, and they’re occasionally mistaken for other conditions, like ovarian cysts and irritable bowel syndrome. If you suspect you have endometriosis, talk with your OB-GYN about having them perform a laparoscopy — it’s the only way for your doctor to diagnose the condition and know for sure.

You’ll be under general anesthesia during the laparoscopy procedure, while the doctor uses a long, thin, telescope device (a laparoscope) to look inside the abdomen for scarring on your uterus, ovaries, fallopian tubes and other organs. If the doctor does find signs of endometriosis, they may be able to remove scarring during the procedure. But it’s nearly impossible to get all the endometriosis, since many of the implants may be microscopic or buried from view.


What Causes Endometriosis (and Can I Prevent It)?

There’s currently no way to prevent endometriosis. And while doctors aren’t sure what causes endometriosis, they have some ideas:

  • Retrograde menstruation, in which menstrual blood flows back through the fallopian tubes and into the pelvic cavity. The endometrial cells in the blood may then stick in the pelvic area, grow, thicken and bleed during each cycle.
  • Embryonic cell transformation. Hormones may cause embryonic stem cells — which are capable of becoming almost any tissue in the body — to change into endometrial cell implants. This change occurs when a woman is actually in her mother’s womb, but it erupts into active disease during puberty.
  • Immune system disorder. A problem with the immune system may render the body unable to recognize and destroy endometrial tissue that’s growing outside the uterus.


Are There Any Complications of Endometriosis?

Unfortunately, endometriosis can cause more than just pain and discomfort. Endometriosis may also cause:

  • Fertility issues. Endometriosis may physically prevent the sperm from uniting with the egg.
  • Ovarian cancer. While the average risk of ovarian cancer is about 1 in 100, some studies suggest this risk increases in women with endometriosis — especially in women older than 60.
  • Ovarian cysts. Endometrial cysts of the ovary, also called ovarian endometriomas, can be a common complication of endometriosis. They can fill with a little more blood during each menstrual cycle and even burst with sudden movements or during sexual intercourse. Such ruptured cysts can cause severe pain and further spread the disease.


What Is the Standard Treatment for Endometriosis?

While there is no cure for endometriosis — symptoms can even remain even after menopause — there are endometriosis treatment options that can help with both pain and infertility.

  • Medication. Birth control hormones or pain medications might be enough to control pain, while birth control hormones may even prevent pain symptoms from intensifying. Nonsteroidal anti-inflammatory medications — like aspirin, ibuprofen and naproxen — can help with the associate pain and menstrual cramps.
  • Other treatments. Regular exercise and the application of heat to the area of discomfort might also alleviate pain.
  • Surgery. This may be a consideration if other treatments don’t work and implants begin to affect other organs. In the most severe cases, hysterectomies and oophorectomies are options. But these are considered the last course of treatment and can have long-term effects on a woman’s health.


You Do Have Treatment Options

If any of these symptoms sound familiar, we encourage you to get a formal diagnosis through your OB-GYN. And if you do receive a diagnosis of endometriosis, don’t feel like your treatment options are limited.

We’re here to help with both the pain and the fertility issues associated with endometriosis. Even better: You may be a candidate for nonsurgical treatment options that are available only at our practice.

If you’ve been diagnosed with endometriosis and want to learn more about the nonsurgical treatment options that may be available to you, contact our Washington, D.C. office at (202) 293-1000 to make an appointment.

Congratulations to the New ISSWSH President

The International Society for the Study of Women’s Sexual Health (, the preeminent organization focusing on the biopsychosocial aspects of women’s sexuality, welcomes Dr. James A. Simon, M.D., Clinical Professor of Obstetrics and Gynecology at The George Washington University School of Medicine in Washington D.C., as its new president.

Dr. Simon’s goals for his two-year term presidency include doubling the ISSWSH membership by expanding the knowledge of physicians (gynecologists, urologists, internists, and other primary care givers), advanced practice nurses (nurse practitioners, midwives, etc.), physician assistants, mental health providers (e.g., psychiatrists, psychologists, psychiatric social workers, certified sexual health counselors and educators), and pelvic floor physical therapists in the oft-neglected field of sexual medicine, a discipline with similar quality of life impact as arthritis, chronic obstructive pulmonary disease, asthma, and irritable bowel syndrome. Further, Dr. Simon vows to pressure the FDA into removing sexually discriminatory barriers to the development of new medications focused on improving women’s sexual health.

Dr. Simon served most recently as the president-elect of ISSWSH. He is also a past president of the North American Menopause Society, and The Washington Gynecological Society.

Dr. Simon is a prolific clinical researcher, holding distinctions for his involvement in reproductive endocrinology and infertility, the earliest advancements of in vitro fertilization, menopause, osteoporosis, and sexual medicine. Dr. Simon’s research has been supported by more than 360 research grants and scholarships from a wide range of sponsors, including the National Institutes of Health, The American Heart Association, The Heinz Foundation and the pharmaceutical industry. He is an author or a co-author of more than 550 peer-reviewed articles, chapters, textbooks, abstracts, and other publications, including several prize-winning papers. Dr. Simon is coauthor of the paperback book “Restore Yourself: A Woman’s Guide to Reviving Her Sexual Desire and Passion for Life.” A short list of his other honors and achievements includes being selected to “Top Washington Physicians,” “America’s Top Obstetricians and Gynecologists,” and “The Best Doctors in America.” Dr. Simon and his care team continue to treat patients from all around the world in his private practice in Washington, D.C.

Have questions regarding medical or women’s sexual health issues? Contact his office at (202) 293-1000.


For media/speaking inquiries, contact:
Nancy Rose Senich (Agency)
Phone/Text: 1-202-262-6996

As the number of postmenopausal women continues to grow — reaching an estimated 1 billion worldwide — patients might believe that doctors have a good sense of the full range of menopausal symptoms and how they affect daily life. But despite numerous studies, detailed information on the full spectrum of menopausal complaints are actually lacking in large randomized trials.

But following a recent study that measured the quality of life in postmenopausal women aged 50-70, researchers hope to more fully identify menopause-related symptoms and help clinicians connect symptomatology with overall health.

The Connection Between Age and Menopausal Symptom Severity

During menopause, women may find themselves experiencing a range of associated symptoms, like hot flashes, night sweats, joint stiffness, vaginal dryness, pain with sexual activity, mood swings and insomnia. Researchers in this study wanted to evaluate the relationship between the severity of these menopausal symptoms and women’s reported quality of life.

The Menopause-Specific Quality of Life-Intervention (MENQOL) questionnaire was given to 932 women enrolled in the Minnesota Green Tea Trial, a larger study that was examining whether green tea extract influences the odds of developing breast cancer. Responses to the questionnaire — which assessed vasomotor, physical, sexual and psychosocial symptoms in the years following menopause — were scored on a range of 1 to 8, with higher scores indicating more severe symptoms.

Initial results suggested that menopausal symptoms — including negative mood, more frequent night sweats and hot flashes, decreased memory, and decreased energy — were reported as most severe in women aged 50-55 and steadily declined in severity as age increased.

While it’s clear that menopause can significantly affect the quality of life, there was some maybe good news reported by these women: There were no reported differences among age groups in the Sexual domain of the MENQOL. Women of all age groups suffered a similar decrease.

What These Findings Mean for Postmenopausal Women

While managing menopause-related symptoms might seem like a challenge, there is a silver lining: As women age past their early 50s, the severity of symptoms seems to lessen significantly. But that doesn’t mean menopausal symptoms should be taken lightly, as they can have significant effects on a woman’s daily life.

And because women are remaining active and productive long after menopause, clinicians like us can offer services tailored to this unique population.

The results of this study continue to inform us as we initiate important conversations with postmenopausal patients about their sexual health and the physical and psychosocial changes associated with aging. Many women are reluctant to talk about vaginal dryness, for example, so health providers must be prepared to discuss sensitive issues like these with their patients and cover symptoms and conditions that might not traditionally be associated with menopause. But we’re here to help you.

By implementing these findings into practical solutions, we can offer their clients helpful, actionable advice for postmenopausal women as they manage their expectations and search for menopause treatment options.

If you have questions about menopause or your sexual health, please call our compassionate staff at (202) 293-1000 to make an appointment.

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