Doctor’s (woman) office – A Latina servicewoman (18-35) is in the office with an OB-GYN. Eliana is in uniform.

Doctor: Hi, Eliana. I’m glad to see you again. Are you still having heavy bleeding and intense pain during your period?

Eliana: Yes, it’s still really bad. Sometimes it hurts so much I can barely walk and it makes me exhausted and anxious.

Doctor: I’m sorry it’s not getting any better. The results from the tests we did last time came back. Your endoscopy ruled out GI issues and your ultrasound ruled out ovarian cysts, which leads me to suspect that you have endometriosis.

Symptoms include
Intense menstrual cramps
Pain during pooping
Pain during sex
Abdominal pain during or in between periods
Back pain during or in between periods
Heavy menstrual bleeding
Bloating
Nausea
Fatigue
Depression
Anxiety
Infertility

Eliana: Oh, I’ve heard of that before but I don’t know exactly what it is.

Doctor: It’s when tissue similar to the tissue that lines your uterus grows on other parts of your body. They’re called lesions. This fits with a lot of your symptoms and it could also explain why you’ve had trouble getting pregnant.

Eliana: If I do have it, can it be treated?

Possible treatments for endometriosis
Birth control pills
Gonadotropin-releasing hormone (GnRH) medicines
Danazol (hormonal medicine)
Laparoscopy
Hysterectomy

Doctor: There are a few options. Birth control pills, hormonal medicines or a hysterectomy to remove the uterus are common treatments — but those aren’t good for someone who wants to get pregnant.

Eilana: So does that mean I have to wait to treat it or give up on getting pregnant?

Getting relief from endometriosis
NSAIDS like Advil, Motrin, Aleve
Acupuncture
Pelvic floor therapy
Cognitive behavioral therapy
Stress management
Exercising
Healthy sleep
Eating healthy

Doctor: No, not at all. There are some things you can do to get some relief from the pain that won’t affect your fertility. 

You can try over-the-counter painkillers, like Advil or Aleve, or a prescription medicine that helps suppress the endometriosis and control pain. Acupuncture, cognitive behavioral therapy, eating healthy, exercising regularly and getting enough sleep may also help, too.

Eliana: I’ll definitely try those things. Is there anything else we can do?

Doctor: Another option is a laparoscopy. That means we’d look inside your uterus with a camera, called a laparoscope. It’s the only way to tell for sure if you do have endometriosis. And, if you do, we can also take out any lesions we find while we’re in there.

Eliana: I would like to know for sure if I have endometriosis, but will the laparoscopy hurt my chances of getting pregnant?

Doc: No — the procedure might actually help you get pregnant naturally.

Eliana: Ok … since I definitely don’t want the birth control pills or a hysterectomy, let’s try the laparoscopy.

Doctor: That sounds like a good idea to me. 

Eliana: Thank you for explaining all my options.

A year later …

Eliana is in the hospital being handed a baby by her OB-GYN.

Doctor: Congratulations! It’s a girl! 

Eliana: Thanks, it’s been a long road — but it feels so good to finally be here.