Your periods should not be painful … period.

You dread your monthly periods. The pelvic pain, heavy bleeding and extremely painful cramps just don’t seem normal. Your ob/gyn suspects you have endometriosis and has referred you to a minimally invasive gynecologic surgeon in order to confirm the diagnosis and help determine the best treatment options.

Washington University physician Scott Biest, MD, minimally invasive gynecologic surgeon explains, “Endometriosis is the presence of endometrial-like glands and supportive tissue outside the uterus. 

There is a wide range in the degree of severity of symptoms that patients may have: ranging from none at all to pelvic pain, severe menstrual cramps, discomfort with intercourse, pelvic masses and infertility.

However, some patients are completely asymptomatic (they have no symptoms).  The only way to make the diagnosis is to perform laparoscopy to confirm the presence of the disease process.”

There are no clear common causes of endometriosis.  Risk factors that may increase a woman’s chance of developing endometriosis include early onset of menses, short menstrual cycle length, no pregnancies, as well as a family history of a 1st degree relative having endometriosis. 


Dr. Biest says, “The treatment of endometriosis depends on the severity of the patient’s symptoms.  Ideally the goal is to remove the presence of any endometriosis during the laparoscopy procedure and normalize the woman’s pelvic anatomy as it may be distorted from the disease process. We would then treat the patient postoperatively with medications — unless she is trying to get pregnant.

Medications can include oral contraceptives, high-dose progesterone, as well as GnRH agonists and antagonist (a group of drugs that are modified versions of a naturally occurring hormone that helps control the menstrual cycle).

Unfortunately endometriosis can return after a patient’s initial treatment – depending on the severity of the condition.

A patient who has completed childbearing or has no desire for children in the future and has failed medical management of her endometriosis may be treated with a hysterectomy and removal of her fallopian tubes and ovaries.”


There are many women with early stage endometriosis who are still able to get pregnant. However, the later stages of endometriosis causes distortion of the pelvic anatomy which reduces the rate of spontaneous pregnancies.

The rate of infertility is increased in patients with endometriosis. Treatment for these women who are unable to get pregnant can include in vitro fertilization.

If you have any symptoms of endometriosis (severe menstrual cramps, pelvic pain, discomfort with intercourse, infertility), do not hesitate to see your doctor.  An early diagnosis may result in more successful treatment and recovery.

For more information or to make an appointment with Dr. Biest, please call 314-747-5470.

Barnes-Jewish Center for Outpatient Health
4901 Forest Park Avenue, Suite 710
St. Louis, MO 63108