Ending Pelvic Pain

Treatment for endometriosis, a common condition among women in their 30’s and 40’s, depends on the individual

Chronic pelvic pain can affect a woman’s quality of life. When that pain has no clear cause and no cure, this can add to the stress. Factor in the risk of infertility for some patients, and you face a potential triple-whammy in a condition known as endometriosis.

“About a third of patients with endometriosis struggle with infertility, which further complicates its management and adds an emotional component,” says OB/GYN Jessica Mullinix, MD. “It is a challenging condition, both to diagnose and to treat.”

The good news is that different treatment options are available depending on each patient’s needs, and these treatments have successfully managed pain and improved the chances of getting pregnant for certain patients.

Dr. Jessica Mullinix

What Is Endometriosis?

“When endometrial glands—the inside lining of the uterus—grow outside of the uterine cavity, this is called endometriosis,” Dr. Mullinix explains. “The tissue that should be growing on the inside of the uterus grows outside of the uterus on other organs or surfaces such as the ovaries, the bowel, the bladder, the abdominal wall, or other sites. These endometrial tissue implants, or lesions as they are called, can cause inflammation and pain.”

Because endometrial tissue is estrogen-dependent, females of reproductive age are most affected. It is more common in women in their 30’s and 40’s; however, Dr. Mullinix says that patients that are pre-menarche or postmenopausal can be affected as well.  The growths from endometriosis are benign, meaning non-cancerous, but they can still cause symptoms. The most common symptom is pelvic pain:

  • Cramping, abdominal pain around the menstrual cycle
  • Chronic pain or pressure that is present throughout the month
  • Can be continuous or associated with bowel movements, intercourse, or daily activities

Talking To Your OB/GYN

The pain symptoms of endometriosis overlap with symptoms of other conditions, which sometimes delays the diagnosis. If a woman is concerned she may have endometriosis, she should talk about her symptoms with her OB/GYN.

“I can make a presumptive diagnosis based on symptoms, a physical exam and possibly imaging, such as an ultrasound,” Dr. Mullinix says. “But the only way to definitively diagnose endometriosis is to biopsy a lesion. I perform laparoscopic surgery to get a sample of the tissue, which is sent to pathology to confirm the tissue type.”

The exact cause of endometriosis in unclear, and there is also not a cure for this condition. So what can be done?

Your Pain vs. Your Goals

“Treatment options range from medication to surgery, and the best option for each patient depends on the severity of symptoms and the goal of therapy,” Dr. Mullinix says. “Typically, treatment starts with pain medications and hormonal therapy, which can be as simple as starting an oral contraceptive.”

For women who want to get pregnant or who are facing severe discomfort, a more tailored approach to hormone therapy and pain medication may be appropriate. Another option is surgery.

“Surgery is typically reserved for patients that fail initial medication therapy,” Dr. Mullinix says.  “Surgery can remove endometrial implants, cysts, and adhesions caused by endometriosis. However, lesions can return even after surgery. So while there are many effective treatments, the lack of a cure does make endometriosis frustrating for patients.”

Though the condition can cause infertility, management of the disease can improve a woman’s chances of becoming pregnant. But even if your goal is simply relief from the pain caused by endometriosis, a talk with your OB/GYN is the place to start.

“Have a detailed discussion with your physician about all of the available options,” Dr. Mullinix says. “Your needs and your therapy goals will help determine our plan.”

Jessica Mullinix, MD, is part of the My Telfair Doc team and is now accepting new patients. Her office is in Professional Office Building on the Candler Hospital campus, Suite 518. This summer she will begin offering some office hours in St. Joseph’s/Candler’s new campus in Pooler. Call 912-819-9650 or visit the My Telfair Doc website.



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