At American University of the Caribbean School of Medicine (AUC), our students learn the medical sciences from expert faculty and staff. But you don’t have to be a practicing or future physician to make use of valuable medical information, especially when it’s delivered pro bono publico — free and for the public good.
Today, AUC graduate Wesley Nilsson, MD ’17, addresses two important women’s health concerns: endometriosis and polycystic ovary syndrome (PCOS). Dr. Nilsson, a board certified Fellow of The American College of Obstetricians and Gynecologists (FACOG), tells us that both endometriosis and PCOS — explained below — can cause fertility and menstruation issues or worse, so it is crucially important for women of reproductive age to know the facts about each condition. Dr. Nilsson is in the midst of the Minimally Invasive Gynecologic Surgery (MIGS) Fellowship at the University of Connecticut School of Medicine, while also working as a locum tenens physician (a temporary doctor who fills in as needed) about an hour away at Bridgeport Hospital.
Dr. Nilsson was kind enough to spare some time to answer our women’s health questions. You can read about Dr. Nilsson’s fascinating educational path — as well as his experiences and thoughts on AUC — in this related spotlight article.
Q: First, what is endometriosis?
Dr. Nilsson: Endometriosis is a medical condition where the normal lining or cells from inside the uterus are found outside the uterus, typically in the pelvis. It has a quoted incidence of one in ten women, and can range from asymptomatic to debilitating.
Q: What causes endometriosis? Is it preventable? Can it be cured?
Dr. Nilsson: There is no definitive cause for endometriosis, but the leading theory is that it involves retrograde menstruation, a common physiologic event when menstrual blood flows back through the fallopian tubes and into the pelvic cavity instead of leaving the body. Retrograde menstruation can deposit endometrial-like cells outside the uterus where they may implant and grow. We have good theories for why endometriosis happens, but it is not preventable. It is also, at this point in time, not curable.
Q: What are the symptoms of endometriosis?
Dr. Nilsson: Endometriosis commonly presents with painful periods, painful intercourse, pelvic or abdominal pain (typically cyclical), and sometimes fertility issues. An important highlight here is that the time from the first symptoms to actually being diagnosed can be several years. Dealing with such painful symptoms for that long can lead to anxiety, depression, and other chronic pain issues.
Q: How is endometriosis diagnosed and treated?
Dr. Nilsson: The reason an endometriosis diagnosis may have such a lengthy delay is because it can present in ways similar to other medical conditions. Seeing a provider who takes a careful history and physical exam will help raise the suspicion of endometriosis. This suspicion is often enough to start a treatment plan. However, to accurately diagnose endometriosis and understand the severity of it, surgery and pathological specimens are often required. The treatment is broad and should be individualized to the patient’s symptoms, fertility goals, and other medical conditions. Treatment options commonly include pain medicine, hormone therapy, or surgery.
Q: What are the challenges and priorities of endometriosis?
Dr. Nilsson: Women’s health in general is in severe need of research and resources. Endometriosis in particular is often overlooked and understudied. Much like mental health conditions, there is a stigma with “painful periods.” Many people think such pain is normal and “just the way it is.” There needs to be a lot of education around women’s health, for both the public and the healthcare system. Even though endometriosis cannot be cured, the progression can be stopped. But this only happens when women's health is prioritized and patients have access to the right healthcare providers.
Q: What is polycystic ovary syndrome (PCOS)?
Dr. Nilsson: PCOS is a hormonal imbalance that creates problems in the ovaries. With PCOS, the egg may not develop properly or it may not be released during ovulation. This can result in infertility in women of reproductive age. Similar to endometriosis, the incidence of PCOS is around 10%, but the condition is often underdiagnosed.
Q: What are the causes and symptoms of PCOS?
Dr. Nilsson: PCOS presents with a broad range of symptoms. The most common ones include irregular menstrual cycles, testosterone-related issues (acne, weight gain, abnormal hair growth), and fertility problems.
Q: How is PCOS diagnosed and treated?
Dr. Nilsson: Seeing a provider who is trained in treating PCOS is important. The medical condition is complex and because it is a lifelong condition with no cure, multiple issues must be addressed over a patient's lifetime. The diagnosis can be made with a careful history, a physical exam, sometimes lab work, and often ultrasound imaging. Treatments, much like those for endometriosis, are very individualized and based on each patient’s goals and current symptoms. Lifestyle changes are often recommended, and a variety of medications may be prescribed. It is important to note that PCOS places patients at higher risk of developing chronic conditions such as diabetes, obesity, hypertension, and endometrial cancer.
Q: How does PCOS affect other women’s health issues?
Dr. Nilsson: PCOS causes imbalances of many different hormones, which can lead to such women’s health issues as infertility, abnormal bleeding (too much or none at all), and endometrial hyperplasia, as well as mental health concerns.
Q: Are endometriosis and PCOS related? How are they similar — and different? Can a woman have both?
Dr. Nilsson: These two diseases have a lot of overlap, but they are separate medical conditions. They can both cause fertility problems and issues with menstruation, and they impact women of reproductive age. It is possible — but uncommon — to have both conditions.
To learn more about these women’s health issues, visit the World Health Organization pages on endometriosis and PCOS. A recent article in the Journal of Reproduction and Infertility gives a good comparison of both, as does this page from the Fertility Centers of Illinois.
At AUC School of Medicine, we’re training future obstetrician gynecologists (OB/GYNs) and other specialist physicians. Our 2023–2024 MD graduates achieved a 98% first-time residency attainment rate* and are now beginning their post-graduate training across 22 specialties. Learn more about AUC and our Doctor of Medicine (MD) program, as well as the requirements for admission. Thank you, Dr. Nilsson, for taking time away from your busy schedule!
*First-time residency attainment rate is the percentage of students attaining a 2024–25 residency position out of all graduates or expected graduates in 2023–24 who were active applicants in the 2024 NRMP match or who attained a residency position outside the NRMP match.
