R. Wayne Whitted MD, MPH

8740 North Kendall Dr.

Suite 101

Miami, Florida 33176-2212

Phone: 305-596-3744

Fax: 305-596-3676

www.drwhitted.net

Raymond Wayne Whitted MD,

MPH

...dedicated to healthy lifestyles and safe, state-of-the-art

surgery for women of all ages.

Endometriosis

Www.4woman.gov; www.endometriosisassn.org

Endometriosis is a common disease that can affect

any menstruating woman from the time of her first

period to menopause. Sometimes, the disease can

last after menopause. There is no cure for endo-

metriosis and it can be hard for a health care pro-

vider to figure out if a woman has it. It can also be

hard to figure out the best way to treat it if a

woman has the disease. Endometriosis can affect

a woman in many ways, such as her ability to work

and have children, and her relationships with her

partner, children, friends, and co-workers. Re-

searchers are working to find out both causes and

ways to manage this disease, so that women who

have it can lead full lives.

What is Endometriosis?

When a woman has endometriosis, the tissue that

lines her uterus, called the endometrium, grows

outside of the uterus. No one is sure why this hap-

pens. This ectopic tissue is mostly found in the

pelvic cavity, usually in one or more places: on or

under the ovaries, behind the uterus, on the liga-

ments that hold the uterus in place, or on the bow-

els or bladder. In extremely rare cases, endome-

triosis can grow in the lungs or other parts of the

body.

Endometriosis is microscopic in its early phase.

As it grows it can create ovarian cysts and perito-

neal implants. These are benign most often and

can cause mild-severe pain, infertility (inability to

become pregnant), and heavy periods.

When a woman has endometriosis, the implants

(which are like the lining of the uterus) can bleed

just like the lining bleeds during a period. This

blood creates inflammation and scar tissue wher-

ever endometriosis is implanted.

Dr. Whitted is dedicated to safe, state-of-the-art,

innovative surgeries and healthy lifestyles for

women of all ages. In a nurturing environment,

the physicians and staff strive to promote a part-

nership in your healthcare and make every effort

to bridge the sterile science of diseases with your

emotional, physical, and spiritual needs. Every-

one is confronted with difficult healthcare deci-

sions at one time or another. You’ll want your

physician and staff to have the knowledge, experi-

ence, and sensitivity to guide you safely through

the decision-making process.

Dr. Whitted provides comprehensive gynecologic

office and surgical healthcare. He is certified in

laparoscopy and hysteroscopy and is an expert in

advanced gynecologic surgery. He has been a

national speaker, trainer, and researcher in ad-

vanced surgical techniques. In addition, Doctor

Whitted is a Certified Menopause Clinician who

educates, trains, and has done research in the

science of menopause. Finally, he is certified in

advanced colposcopy.

Doctor Whitted offers expert education and care in

the following areas:

If you need surgery, Dr. Whitted usually performs

minimally invasive surgery (Vaginal, laparoscopy

and hysteroscopy) and has 21 years experience in

these areas.

Abnormal Paps (HPV) Loss of Urine

Abnormal Menstrual Cycles Menopause

Bladder Prolapse Ovarian cysts

Chronic Pelvic Pain Osteoporosis

Endometriosis Rectocele

Ectopic Pregnancy Uterine Prolapse

Family Planning Vaginal Prolapse

Fibroids (Leiomyoma) Well-Woman Visits

***Evaluation and Diagnosis of Gynecologic Cancers

What are the symptoms of endometriosis?

A common symptom of endometriosis is pain, mostly in

the abdomen, lower back, and pelvic areas. The

amount of pain a woman feels is not associated with

the extent of endometriosis. Some women have no

pain even though their disease affects large areas, or

there is significant scarring. Some women, on the

other hand, have severe pain even though they have

only a few small areas of visible endometriosis.

General Symptoms can include (but are not limited

to):

 Extremely painful (or disabling) menstrual

cramps; pain may get worse over time

 Chronic pelvic pain (includes lower back pain

and pelvic pain)

 Pain during sex (dyspareunia)

 Intestinal pain

 Painful bowel movements or painful urination

during menstrual periods

 Heavy menstrual periods

 Premenstrual spotting or bleeding between pe-

riods

 Infertility (can’t get pregnant)

Endometriosis can, also, be associated with Irrita-

ble Bowel Syndrome and Interstitial Cystitis.

How is Endometriosis Diagnosed?

A History and Physical exam performed by a knowl-

edgeable Gynecologist is important. Your doctor may

then recommend an ultrasound and possibly an MRI.

These are tests often performed by a Radiologist.

The only way to know for sure, however, is to have

laparoscopy. This surgery is performed with general

anesthesia and involves inserting a telescope through

you belly button. Usually endometriosis can be diag-

nosed (with a biopsy) and treated in the same laparo-

scopic surgery.

What causes endometriosis?

No one knows for sure what causes this disease.

The two plausible theories include retrograde men-

strual flow (menses backs up through the fallopian

tubes into the abdomen) and genetics. Clearly endo-

metriosis “runs in families”.

Researchers, also, are looking at the role of the im-

mune system and how it either stimulates or reacts to

endometriosis. It may be that a woman’s immune

system does not remove the menstrual fluid in the

pelvic cavity properly, or the chemicals made by en-

dometriosis may irritate or promote growth of more

areas. Women who have endometriosis are more

likely to have other auto-immune diseases such as

fibromyalgia, eczema, etc.

Other research is focusing on hormonal impact on

endometriosis. Still further research is looking at

chemical markers. This could help diagnose endo-

metriosis without surgery. In addition, it would allow a

doctor to follow the success of treatments.

What is the treatment for endometriosis?

There is no cure for endometriosis (it is a chronic dis-

ease). But there are many treatments, each of which

has pros and cons. It is important to build a good

relationship with your doctor, so you can decide what

option is best for you.

 Pain medication: For some women with mild

symptoms, no further treatment other than medi-

cation for pain may be needed. For women with

minimal endometriosis who want to become preg-

nant, doctors are saying that, depending on the

age of the woman and her amount of pain from

the disease, the best thing to do is to have a trial

period of unprotected sex for six months to one

year. Further treatment may be necessary if

pregnancy doesn’t occur.

 Hormone Treatment: There are several hor-

mones used for treatment including BCP (birth

control pills), progesterone pills, Danazol (a weak

male hormone), GnRH agonist (gonadotropin

releasing hormone.

...

dedicated to healthy lifestyles and safe, state-of-the-art, innovative surgery for women of all ages

Birth Control Pills: Usually contain two hor-

mones, estrogen and progesterone. BCPs often

control the growth of the tissue that lines the

uterus and in the same way controls endome-

triosis tissue. BCPs can be taken cyclically (you

will have a menstrual cycle) or continuously (you

likely will not have a menstrual cycle). If a

woman can’t take estrogen then she can take

progesterone only pills or Danazol. All medi-

cines have side effects and for these they in-

clude: weight gain, abnormal bleeding, bloating,

blood clots in the legs, and rarely heart attack

and stroke (usually if used in unhealthy women

who smoke).

Danazol has become more popular than pro-

gesterone only because it may improve PMS

and also significantly reduce the menstrual flow.

The side effects may be oily skin, acne, weight

gain, muscle cramps, headaches, dizziness,

and deepening of the voice.

GnRH Agonist: is a once a month or every

three months injection that prevent ovarian hor-

mone production. As a result a woman doesn’t

have a period and therefore the growth of endo-

metriosis is slowed or stopped. These medica-

tions simulate a temporary menopausal state

and can cause hot flushes, insomnia, mood

swings, memory and concentration loss, possi-

ble bone loss. Usually a person stays on this

medication for 6 months. Usually this medicine

controls the pain of endometriosis which recurs

after the medicine is stopped.

Surgery

It is now believed that surgery combined with

medical therapy is the best combination to have

the greatest success in managing endometriosis

and its symptoms. Surgery is most often per-

formed by Laparoscopy. Endometriosis is ex-

cised and sent for pathologic evaluation. Sur-

gery may be conservative in most cases but

sometimes a woman may elect to remove her

uterus, tubes, and ovaries. This, too, can be

done with laparoscopy.

Women with endometriosis often feel sadness,

fear, anger, confusion, and alone. There is sup-

port available. Talk with your provider.

Raymond Wayne Whitted MD, MPH