Women who have had hysterectomies for conditions such as uterine fibroids, abnormal uterine bleeding, endometriosis, or pelvic pain might not have needed the procedure.

Many women who have endometriosis are forced to become advocates on their own behalf when primary care physicians and specialists ignore the signs of the condition, Eric G. Heegaard, MD, said in a recent interview with the Huffington Post.

While the cause of endometriosis is unknown, one theory notes the lining of the uterus is shed through retrograde menstruation. When blood flows into the fallopian tubes and enters the pelvic cavity, endometrial cells pepper the cavity, continue to grow and cause pain.

Endometriosis affects more than 200 million women worldwide. A report from the Worldwide Endometriosis Research Foundation states the annual cost of lost productivity in the U.S. due to endometriosis is $140 billion. Endometriosis often goes unrecognized among medical professionals, and it takes women an average of 7 – 10 years to receive a diagnosis.


“The real epidemic for women with endometriosis is that few medical professionals are listening.”

It is heartbreaking to realize these women are not being helped. They are not suffering in silence—they have been telling people about their symptoms. The silent epidemic is really that no one has listened to them. It is unfortunate that gynecologists are listening to the same women we’re seeing at Reproductive Associates of Delaware (RAD) and telling them their symptoms are normal.

Surgery is frequently the most effective option to excise endometrial lesions and keep these women out of pain. Since endometriosis is a progressive disease, surgery may still be required, even if a patient has had surgery in the past. However, it is often unnecessary for these women to undergo more aggressive surgeries such as a laparotomy or hysterectomy to feel relief from their pain. At RAD, we are able to both evaluate and treat these patients with laparoscopy, a minimally invasive procedure.

Treating patients with chronic pain is a two-step procedure: we first anatomically restore their pelvis without removing their reproductive organs. That includes removing endometriosis, and removing adhesions caused by endometriosis that may be affecting the bowel, bladder, fallopian tubes, and ovaries.

Most patients who complete surgery will see their pelvic pain return within three to four regular menstrual cycles if not treated further. Therefore, our second step is to hormonally suppress our patients and prevent their menstrual cycle from resuming and causing symptoms to return.

What is interesting about this article and in others I’ve read is that few physicians suppress their endometriosis patients after surgery. Surgery is very important, but the only way to not have endometriosis recur—because there is no cure—is to continue to keep these cells inactive. At RAD, we have found the most effective way to do this is by using Gonadotropin-releasing hormone (GnRH) agonists to suppress the endometrial cells, and eventually giving add-back hormonal therapy to patients.

Endometriosis is a disease that affects women of all ages and socioeconomical status. Women with pelvic pain should seek treatment from an endometriosis specialist and to understand their treatment options. They should also ask how these specialists follow their patients long-term. The hope is that we will never need to perform additional surgeries on these women.

At RAD, we have taken a pledge to help women with endometriosis to the best of our ability. Maintaining reproductive potential is the highest priority at RAD, and our hope is these women will be able to move forward with their fertility wishes now and in the future.