UK HealthCast: Dr. Peter Movilla explains and shares tips for managing endometriosis

UK HealthCast is a podcast series featuring interviews with UK HealthCare experts on a variety of health-related topics, from how to recognize stroke symptoms to what patients need to know about clinical trials and more.  

This week’s HealthCast features Peter Movilla, MD, FACOG. Dr. Movilla is an OB-GYN who specializes in obstetrics and gynecology pelvic floor disorders. 

We spoke with Dr. Movilla about endometriosis, a common disease among women that often goes undiagnosed or misdiagnosed. Dr. Movilla discussed risk factors and treatment options, among other things.  

Listen to the full podcast at the bottom of the page.  

What is endometriosis and what are some common symptoms?  

Endometriosis is a complex gynecologic disease where the cells that normally reside solely within the lining of the uterus migrate into areas of a patient's body where they're not supposed to be. These cells can end up in a patient's abdomen or around the colon and rectum. They can end up in a patient's pelvis near their cervix, bladder, vagina, and they can even migrate deep within the wall of the uterus.  

Since these cells still behave similarly to the cells that are inside the lining of the uterus, they still respond to estrogen that a patient makes during their monthly menstrual cycle and thus, they can grow, bleed and cause a lot of inflammation and scarring that leads to pain in the abdomen and pelvis. 

Classic symptoms of endometriosis are dysmenorrhea — which means painful periods — and dyspareunia — which means pain during sexual intercourse. A patient can even have painful urination and pain with bowel movements during their periods. The trickiest part of endometriosis is that some patients have no symptoms at all, and endometriosis is only found during a workup for infertility or during surgery for another reason. 

What are some treatment options for endometriosis? 

We have effective many options. I always tell my patients that although surgery is the only definitive means to diagnose endometriosis, if they have the classic symptoms and do not seem to have any other likely cause of their symptoms, then we can treat them medically without surgery and if they feel better, that's great. We can presume that they have endometriosis and continue treating them as such.  

Medical treatment options for endometriosis utilize hormones or hormone modulators that work to counter the effect of estrogen within the body and decrease the amount of estrogen the endometriosis lesions receive. This works to shrink them so that they are not as active and don't cause so much inflammation and pain. And, we have many different types; pills, patches, implants, intrauterine devices and injections that can all be tried and have some pretty good effect on improving a patient's pain symptoms and thus their quality of life.  

For patients who don't respond well to medical management, they can be consulted on the surgical options.   

We also often work with physical therapists who focus on healing the muscle pain that the pelvic floor may have because of endometriosis. 

How can surgery improve quality of life and what does recovery look like? 

Everyone's a little different, but if you need surgery the recovery varies depending on how much endometriosis has to be removed. Most patients, however, go home the same day or the day after. Many patients take off about two weeks from work following surgery and have about a six-week period of time where I tell them they may feel a little more tired than usual as they heal internally, and they should be getting more and more energy back each day. 

For many patients, surgery can significantly improve quality of life by decreasing pain. However, due to the complexity of pain, especially pelvic pain, I tell patients that surgery often is helpful in about 50 to 60 percent of patients, with the remainder of patients either having minimal relief or no improvement at all, which is tough to tell somebody, but this is why careful counseling and about the outcomes from surgery needs to be honest and open because patients still suffering for pain after surgeries still need our help.