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Could it be Endo?

Symptoms of endometriosis can vary greatly from person to person, and the severity of symptoms does not necessarily correlate with the severity of the disease.

The most common symptoms are:

  • Painful periods (menstrual cycle), heavy periods, more frequent periods, bleeding between periods
  • Chronic pelvic pain (includes lower back pain and pelvic pain)
  • Pain during or after sexual intercourse
  • Difficulty getting pregnant (infertility)
  • Painful bowel movements and/or painful urination during your period

Pain related to endometriosis can be extensive and debilitating. While pain during the menstrual cycle is the most common symptom, it may not be limited to that time frame. Patients with endometriosis can have chronic or cyclic pain located in the pelvic region, abdomen, chest, lower back, and paint that radiates down the leg. In addition to pain, bowel and bladder symptoms are common. Bowel endometriosis can cause pain and/or bleeding with bowel movements, constipation, diarrhea, intestinal pain or upset, acid reflux, abdominal bloating and discomfort, and loss of appetite. Urinary tract endometriosis is related to pain and/or bleeding during urination, difficulty urinating, frequency and/or urgency with urination, and incontinence.


Endometriosis Myths

Myth – All women have pain during their period.

While many women experience some discomfort or pain during their period, it is not normal to have severe or debilitating pain. In fact, the majority of women do not have any pain or only minimal discomfort during their period.

A common symptom of endometriosis is pain during the menstrual cycle.


Myth – Endometriosis is rare.

It is estimated that endometriosis affects over 6 million women in the US and another 70-80 million women world-wide. It is the third leading cause of gynecology-related hospitalizations in the US. The prevalence of endometriosis in women experiencing pain, infertility or both is as high as 50%.


Myth – Teens and young women do not get endometriosis.

Often, women are not diagnosed with endometriosis until they are trying to become pregnant and encounter difficulty. When teens and young women do seek help for painful periods, it is often dismissed as normal or attributed to non-gynecologic causes. A 2011 study on the impact of endometriosis on quality of life it was found that as many as two-thirds of women with endometriosis sought help from their doctor for their symptoms before the age of 30 and one-fifth of these women were below the age of 19.



Myth – You cannot get pregnant if you have endometriosis.

Some women with endometriosis have no or minimal difficulty becoming pregnant, however infertility is a common symptom of endometriosis. Fortunately, with appropriate treatment and planning, it is absolutely possible to conceive and have children even if you have endometriosis.


Myth – Hysterectomy cures endometriosis.

Many women are told that they must have a hysterectomy to cure endometriosis. It is important to understand that there is no cure for endometriosis. Approximately 20% of the hysterectomies performed in the US annually are due to endometriosis. However, if the endometriosis is not treated at the time of hysterectomy there are likely to be continuing or recurring symptoms.


Myth – Surgery cures endometriosis.

There is no cure for endometriosis. The two main factors correlated with successful surgical outcomes are the skill and experience of the surgeon and utilization of proper instrumentation to remove endometriosis. An endometriosis specialist has the experience to safely and thoroughly perform the advanced procedures required in endometriosis surgery. Also, because endometriosis can exist in very subtle forms, those with limited experience often fail to recognize all lesions.

In addition to the skill and experience of the surgeon, the severity of disease influences recurrence rates. For example, studies suggest that, women with more severe, deeply-infiltrating disease (stage IV) have the highest rates of recurrence.  Therefore, if surgeons only perform surgery on patients with stage I-III endometriosis, they may appear to have a higher success rate.


Myth – Excision surgery is the best treatment of endometriosis.

There are several surgical techniques that can be used to treat endometriosis, including excision and vaporization. Excision means cutting out tissue. Vaporization uses electrosurgery to eliminate diseased tissue. A combination of both surgical techniques can be used depending on the depth of the disease and the location of the endometriosis in relation to vital organs. The overall goal of comprehensive treatment of endometriosis is to remove the disease with safe, fertility-sparing techniques.


Types of Treatment

Surgical treatment of endometriosis aims to remove all visible areas of pelvic endometriosis and restore anatomy, as well as relieve pelvic pain, dyspareunia, painful bowel movements, and lower urinary tract symptoms caused by endometriosis.

It is essential to note that performing hysterectomy and bilateral salpingoophorectomy alone is inadequate definitive therapy. Surgery for the treatment of endometriosis includes several options:

– Vaporization / Ablation with electrosurgery, laser, or neutral argon plasma
– Excision

Excision -Vs- Vaporization

The heading of this section implies that one should choose either excision or vaporization for treating endometriosis. In fact, several physicians will claim one method is superior or even the only surgical treatment of endometriosis. However, this is not correct! Proper treatment will utilize a combination of excision and vaporization.

Excision (also known as a resection) is the surgical removal of tissue by cutting. Vaporization (also known as ablation) is the surgical removal of lesions with a form of electrosurgery, laser or neutral argon plasma. Dr. Nezhat utilizes both techniques depending on the location of the endometriosis lesion, depth of penetration and extent of the disease. Excision has been declared the superior method of treatment for endometriosis. However, when used inappropriately it can cause unnecessary damage to tissue and negatively impact fertility. Vaporization is commonly used for superficial lesions and on sensitive tissues, such as the fallopian tubes. This is very important for patients who desire to have children in the future.

Dr. Ceana Nezhat: The Leading Specialist in Endometriosis Surgery

As one of the leading, highly specialized endometriosis gynecologic surgeons, Dr. Nezhat is capable of performing both excision and vaporization of endometriosis in order to successfully remove lesions from the body completely. The decision of whether to perform the procedure through either method of excision (resection) or vaporization (ablation) at the time of surgery will be based on whether either approach is the best option for the patient in terms of the outcomes in removing the disease.

Dr. Nezhat will be able to asses the benefits of either approach and whether one will be more effective over the other. For example, if the patient is known to have severe endometriosis and no longer desires to bear children, and meanwhile fibroids (benign tumor of womb which may cause heavy menstrual bleeding and cramps) are found on her uterus, then hysterectomy along with excision or vaporization of all endometriosis should be recommended for the patient. Throughout the years and with his extensive experience and expertise, Dr. Nezhat has performed countless laparoscopic surgeries for multi-stage endometriosis with excellent results utilizing both techniques without removing either normal uterus or ovaries.


Endometriosis Research

Expression Analysis of Endometriotic Tissue
2009 to present
In conjunction with Dr. Shannon Hawkins, Department of Obstetrics & Gynecology, Baylor College of Medicine

The purpose of this study is to learn about the pathogenesis of endometriosis at a molecular level, examining microRNAs, mRNAs, and genomic DNA changes. Many of the tissues obtained from Northside Hospital will be used to determine molecular differences in endometriotic phenotype based on anatomical location, either endometriomas, endometriotic implants, or rectovaginal nodules.

The Role of Endometriosis in Infertility
2009 to present
In conjunction with Neil Sidell, PhD, Interim Director, Division of Research, Department of Gynecology & Obstetrics, Emory University School of Medicine

Currently, a diagnosis of endometriosis can only be made by performing surgery to see the endometriotic lesions. We do not yet have a simple, non-invasive test to diagnose endometriosis. By studying uterine biopsies, blood and peritoneal fluid from women with endometriosis, we hope to find substances unique to endometriosis that can be useful diagnostic tools.


  • Nezhat Medical Center
    5555 Peachtree Dunwoody Road,
    Suite 276

    Atlanta, Georgia 30342
  • Phone 404.255.8778
    Fax 404.255.5627
    Email Info@Nezhat.com