ENDOMETRIOSIS / ADENOMYOSIS /

ENDOMETRIOSIS / ADENOMYOSIS / PELVIC PAIN

Pelvic Pain

Many women and individuals assigned female at birth (transgender men, gender-diverse individuals) will experience pelvic pain at some point in their life. When this occurs, it can be a frightening experience. The first action when this pain is experienced is to attempt to understand what is causing the pain. Pelvic ultrasound to evaluate the gynecological organs is usually the first test chosen to help determine the cause. However, it is important to remember that not all pain in the pelvis is related to the gynecological organs. Other body systems including the gastrointestinal, urinary, or musculoskeletal systems could be the source of the pain and they may need to be evaluated as well. SUGO is here to ensure comprehensive evaluation of the gynecological system at the highest standards to help you get your answer or eliminate common causes of pelvic pain.

What is the difference between acute pelvic pain and chronic pelvic pain?

Acute pelvic pain is generally a sudden event, where a person goes from having no pain or low-level pain to having moderate to severe pain. Ultrasound is essential to help determine the cause, which may include:

ovarian torsion (when the ovary twists on its blood supply, usually due to a large ovarian cyst),

ruptured or hemorrhagic ovarian cyst (when the ovary bleeds either within or outside of itself following a physiological ovulation event)

ectopic pregnancy (when an embryo implants outside of the uterine cavity, usually within the Fallopian tube)

pelvic inflammatory disease (when there is an active infection within the uterus, Fallopian tubes, or pelvic cavity)

Chronic pelvic pain is defined as daily pelvic pain for a duration of time longer than 6 months. Chronic pelvic pain can be extremely debilitating for the person, leading to an inability to go to school, work, or attend to typical activities of daily living. There are some overlaps with the causes of acute pelvic pain if there is inadequate or timely treatment, for example, in the case of pelvic inflammatory disease. Or, if ovarian cyst events occur repetitively, this can lead to chronic pelvic pain. The most common causes of gynecological chronic pelvic pain include endometriosis and adenomyosis.

Endometriosis

Endometriosis is a chronic full-body inflammatory condition characterized by endometriosis deposits within the pelvis (and sometimes outside of the pelvis). Endometriosis deposits look and behave in some ways like the endometrium (the lining of the uterus), but it is important to note the tissue is not exactly the same. Though not everyone with endometriosis experiences pain, many people will experience pain from the inflammation of the deposits or from the scarring endometriosis can cause.

There are three types of endometriosis:

Ovarian endometriosis – ovarian cysts filled with endometriosis tissue and blood

Deep endometriosis – nodules of endometriosis and fibrosis infiltrating certain tissues like the bowel, vagina, bladder, ureters. In rare circumstances, endometriosis can block the ureters leading to kidney damage

Superficial endometriosis – very small deposits of endometriosis that sit atop the peritoneum or other surfaces in the pelvis but do not penetrate beneath the surface

Endometriosis is a known and common cause of pelvic adhesions, particularly between the ovaries and the pelvic walls and between the uterus and the rectum. In some cases, these severe adhesions can lead to issues with fertility and with bowel movement function.

Historically, people believed you could not diagnose endometriosis on ultrasound and only surgery could diagnose it. This is a myth. If the individuals performing and interpreting the ultrasound are qualified, a diagnosis of endometriosis can be achieved through ultrasound. At SUGO, we apply the modern-day approach detailed by the International Deep Endometriosis Analysis (IDEA) group. On the other hand, when ultrasound does not detect endometriosis, we do not rule out the diagnosis of endometriosis. This is especially true of the smallest type of endometriosis called superficial endometriosis.

Moreover, the severity of endometriosis has become possible to determine using ultrasound as well. This is incredibly valuable information to patients and their gynecological surgeons who may be planning surgery. Understanding the state of endometriosis pre-operatively will optimize the informed consent process and surgical planning, ultimately leading to better patient and surgical outcomes.

Adenomyosis

Adenomyosis is a chronic uterine inflammatory condition caused by the infiltration of endometrial tissue into the muscle of the uterus. People with adenomyosis can experience period pain, heavy menstrual bleeding, and chronic pelvic pain. Though still not fully understood, adenomyosis also contributes to infertility and adverse pregnancy outcomes. Adenomyosis and endometriosis often exist together.

Assessment of the uterus on ultrasound has lagged for adenomyosis, At SUGO, we use advanced protocols to assess for adenomyosis presence or absence, and when present, the severity of the disease. We follow the Morphologic Uterine Sonographic Assessment (MUSA) group methodology.