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Endometriosis
Endometriosis affects over 15% of the women population. If we then consider women who have symptoms of pelvic pain, endometriosis is present in over 70% of these women. Endometriosis is one of the leading causes of pelvic pain and it could also be the cause of infertility due to the fact it creates inflammation in the pelvis making it difficult for the egg to survive. It could also cause chronic scarring that leads to blocked tubes which could then make it difficult for the tubes to pick up the egg. Sometimes it is not a direct cause of infertility, but endometriosis and infertility are both consequences of a dysfunctional fallopian tube.
Endometriosis & Pelvic Pain: Finding Relief
Endometriosis occurs when tissue similar to the uterine lining grows outside the uterus, frequently causing debilitating pelvic pain, excruciating periods, and painful intercourse. This inflammatory condition can lead to scarring, nerve irritation, and muscle tension that persists throughout your cycle. We often see patients that are not accurately diagnosed and their pain is treated with ineffective options that do not address the endometriosis directly. While pain levels don't always match disease severity, effective treatment options are available. Medical management may include hormonal therapies (like birth control pills or progesterone) as a first line. Often mare focused medications will suppress endometrial growth (GnRH agonists:
Orilissa and MyFembree) (GnRH agonists:
Lupron and others) (Off label medications:
Letrozole or Naltrexone).
For nerve-related pain, pelvic floor physical therapy can provide significant relief. When conservative measures aren't enough,
minimally invasive excision surgery by an endometriosis specialist, like Dr. Coussons, offers the gold standard for pain relief while preserving fertility. Don't settle for temporary fixes—consult a provider skilled in all available medical, surgical, and integrative approaches to develop your personalized pain management plan.
Endometriosis & Fertility: Protecting Your Reproductive Potential
Endometriosis can impact fertility through multiple mechanisms: distorting pelvic anatomy, creating a toxic inflammatory environment, or reducing egg quality. Caution is critical with surgical treatment—while properly performed excision surgery can improve fertility outcomes almost immediately, poorly executed surgery may worsen ovarian reserve or create new scar tissue. The first surgery is your best chance for optimal results, so it's essential to choose a surgeon with advanced skills in fertility-sparing endometriosis techniques. For those trying to conceive, surgery planning to optimize for fertility is key. The initial goal of surgery is to restore normal anatomy for normal conception especially if IVF is not an option. If IVF is an option, surgery may include removing damage tubes to improve IVF success rates and repositioning the ovaries to make egg retrieval safer and more accessible. In select cases, combined laparoscopic excision followed by IVF yields the best outcomes. If you're considering pregnancy, consult a dual-trained endometriosis and fertility specialist who can strategically balance disease management with reproductive preservation. Do not go into a "diagnostic laparoscopy" without proper preparation by an expert prepared to treat endometriosis with an eye toward optimized fertility and a plan for after surgery.
Take the Next Step: If endometriosis is affecting your quality of life or family-building goals, schedule a consultation with Dr. Coussons, an endometriosis specialist who has treated both pain management and fertility preservation with a comprehensive plan based on your needs and longitudinal plan for fertility. We develop evidence-based treatment plans tailored to your unique needs—because you deserve care that looks at your whole health, not just one symptom.
More About Endometriosis
Accurate diagnosis of endometriosis requires surgery, unless it is very severe with endometriomas in the ovary. Surgery is not only for diagnosis, but also for treatment. Many women see multiple physicians before being accurately diagnosed with endometriosis. Also women may undergo multiple laparoscopies with less aggressive and less effective treatment. The endometriosis may be cauterized, but many studies show that excision of endometriosis improves the outcome with fertility as well as reducing pain. Repetitive surgery leads to more scarring and when the surgery is incomplete it is not effective at improving fertility and offers only short-term pain relief. Endometriosis causes pelvic pain because the monthly bleeding leads to inflammation. Over many months scar tissue also leads to pain particularly between menstrual cycles or with intercourse. Medical treatment with targeted hormonal medications is the primary treatment for pelvic pain related to endometriosis, although complete excision of endometriosis by expert surgeons provides longer-lasting pain relief.
Patients should understand that endometriosis effects women from the time of puberty until menopause (12 years old up to 51 years old.) Even after laparoscopy, endometriosis may recur due to incomplete treatment, or it may develop again. As long as patients are having periods, endometriosis may cause pain and infertility. But with the right treatments, both medical and surgical, endometriosis can be managed, pain can be controlled, and fertility can be improved. Because of the importance of medical treatment, Dr. Coussons can manage endometriosis many times with remote testing, and ongoing medical treatment. His knowledge and experience will help you gain control of this chronic debilitating condition. He tries to avoid surgery in the management of pelvic pain, but ultimate definitive treatment is only accomplished with the reduction of estrogen. Menopause can be natural at 47-52 years old, or it can be surgical with complete hysterectomy. Prior to definitive treatment, medications can lower estrogen and manage the disease, buying time in preventing major surgery. With the right treatment, fertility can be achieved in most patients diagnosed with endometriosis and pelvic pain relief can be significant with the right combination of surgery and medical treatment.
Patients Speak from
Personal Experience
"Dr. Coussons is the best doctor around! He is the most knowledgeable doctor I know and his talent or gift for robotic surgery is incredible! Definitely would recommend him to family or friends because he is the best in the business! I feel confident with my health with being under his care."
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