Endometriosis: Let’s Talk About It

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While one in every 10 women between the ages of 15 and 44 experience endometriosis — a condition that can significantly affect quality of life and even fertility — most don’t realize that severe pain during their periods isn’t normal or that there are treatments to help.

For many women, the path to finding effective relief is met with great challenges. But thanks to one of our foremost experts in the treatment of endometriosis, Steven McCarus, MD, a nationally renowned gynecological surgeon at AdventHealth for Women, there is help and hope for women that suffer from this disease.

Endometriosis Explained

Endometriosis is a condition that occurs when the lining of the uterus (called the endometrium) grows outside of the uterus. Endometrial tissues may grow in the fallopian tubes, around the ovaries, or in other areas of the abdomen.

Even though the endometrial tissue grows outside the uterus, it acts just like it would while in the uterus. During your menstrual cycle, the tissue gets thick, then sheds and bleeds. Since there is nowhere for the blood and lining to go, it stays in your body irritating the cells around it. The irritated cells can form scar tissue and adhesions that cause your pelvic organs to stick together.

You’re Not Alone

“Endometriosis was first reported more than a century ago, yet it remains a very common yet completely misunderstood disease. The ability to diagnose early stages of endometriosis remain an enigma,” explains Dr. McCarus.

Recently, it has been suggested that it can take up to a decade to diagnose and treat this disease once symptoms begin.

Dr. McCarus adds, “Multiple touchpoints are noted to occur once the patient finally complains about pain with menses (the menstrual cycle or monthly bleeding), pelvic pain that can occur any time throughout the month, or dyspareunia (pain with intercourse).”

A Disease with Great Impact

“This disease affects women in the prime of their life in reproductive years. It has a strong association with not only reduction in quality of work but reduction in quality of life because it interferes with sports, exercise, a healthy lifestyle, fertility, and interpersonal relationships,” notes Dr. McCarus.

Furthermore, endometriosis is associated with absenteeism. The average woman with pelvic pain misses six to 10 hours of work per week. And of those that do go to work, many are suffering which leads to “presenteeism” in that their quality of work and ability to work is diminished.

Dr. McCarus says, “This disease is a tremendous burden on society. It’s a chronic debilitating disease affecting many women. As such, it should be more aggressively treated like other chronic diseases such as hypertension and diabetes.”

Symptoms of Endometriosis

Endometriosis can be very painful and worsen during your menstrual cycle. The pain may even get worse over time, with every period you have. You may also experience other symptoms, such as:

  • Bloating
  • Constipation or diarrhea
  • Fatigue
  • Heavy bleeding during periods
  • Infertility
  • Pain when you use the bathroom

If you have heavy, painful periods, it’s important to talk with your doctor about the possibility of endometriosis since early detection may help you achieve better outcomes.

“It’s important for women and providers to realize that diagnosing and aggressively treating endometriosis early can help women prevent surgery. We need to find and treat endometriosis in the earliest stages, not ignore it to the point at which surgery is mandatory,” Dr. McCarus states.

Risks for Endometriosis

While the cause of endometriosis isn’t clear, doctors have identified several factors that may put you at higher risk for the condition. You may be at risk for endometriosis if you have:

  • Menstrual cycles of 27 days or less
  • A mother or sister with the condition
  • Low body mass index
  • Never given birth
  • Started menstruating before age 10
  • Uterine abnormalities

Endometriosis typically develops several years after you start menstruating. And even if you have a few of these risk factors, you still may never develop the condition.

How Doctors Diagnose Endometriosis

If you have symptoms of endometriosis, your doctor may order a diagnostic test like an ultrasound or magnetic resonance imaging (MRI) to look for signs of endometriosis in your pelvis.

Sometimes, endometriosis is diagnosed through laparoscopy, a minimally invasive surgical procedure. During a laparoscopy, a doctor makes a small incision near your belly button and inserts a small, flexible camera that takes images of your tissues for a more accurate diagnosis.

Effective Treatments for Endometriosis

Medical Therapy

“Multiple medical therapies have been and are currently prescribed for pain associated with endometriosis,” states Dr. McCarus.

Until recently, there have not been any FDA-approved medications to treat the disease, and many physicians have no clear-cut treatment pathway that has been proven to help patients.

Drugs like oral contraceptives that contain estrogens, NSAIDS like Advil or Motrin, opioids like Tylenol with codeine, Percocet, Vicodin, high dose progesterone and IUDS all have been tried in the treatment of endometriosis, but many are not FDA-approved or effective.

“Recently, medical therapy with a gonadotropin-releasing hormone (GnRH) agonist has been approved by the FDA to reduce moderate to severe pain associated with endometriosis. I’m seeing great success in many women that are being treated with this therapy,” says Dr. McCarus.

He continues, “As we understand the inflammatory association with endometriosis and known cellular differences between uterus and endometriosis it is incumbent on us to treat the disease more aggressively with medical therapies that decrease estrogen production. Endometriosis is a known estrogen-dependent disease.”


Dr. McCarus believes surgery should be a last treatment with medical therapies being tried initially. As a national lecturer, he is invited across the United States to speak about new treatments for endometriosis. He currently treats patients who travel across the U.S. and particularly Florida to see him with very positive outcomes.

“For patients that do require surgery, we’ve seen tremendous success. With state-of-the-art surgical suites and technology, we can use minimally invasive techniques while offering better outcomes for the patient in reducing long-term pain,” Dr. McCarus explains.

Trust an Expert Team

For any woman suffering with pelvic pain in silence: You voice (and treatment options) will be heard here.

“As a gynecological care provider, I see patients every day who complain of pelvic pain and have been challenged by this disease. I’ve dedicated my career to becoming an expert in treating endometriosis because I felt a calling to understand the cause and progression of the disease, and improve the medical and surgical treatments available to patients,” shares Dr. McCarus.

If you have endometriosis, if you’ve been struggling to find an expert who can help you — you’ll find answers here.

“I’ve built my reputation as an expert in treating endometriosis. I see patients from all over the U.S., who have struggled with ineffective treatments and are still in pain, which inspired me to create care pathways and train thousands of other doctors on how to aggressively treat this disease with medical and surgical therapies. It’s my belief that we need to constantly challenge ourselves to do our best to help patients find the healing they deserve,” Dr. McCarus concludes.

Start Feeling Your Best Again

You can find all the care you need for endometriosis at AdventHealth for Women. We’re here to help you live your best life with advanced treatments and whole-person care. Learn more about Dr. Steven McCarus and his expert team.

To schedule an appointment, call our Women’s Health Navigator at Call407-720-5191.

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