Endometriosis: Diagnosis and Treatments

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How is endometriosis diagnosed?

Endometriosis is a puzzling disease. There are many roadblocks to diagnosing endometriosis. These range from professional ignorance of endometriosis, how the disease presents itself and the myths associated with the disease.

There is no simple, accurate, noninvasive way to diagnose endometriosis. Certain symptoms may suggest to a doctor that a diagnosis is needed. A physical and internal examination may suggest the possibility of endometriosis, but a definitive diagnosis requires looking through a laparoscope at the internal organs as well as doing an endometrial tissue analysis. This is also referred to as an endometrial biopsy and involves removing tissue from the uterus for microscopic examination. An endometrial tissue analysis is done for one of three purposes: to determine why a woman may be experiencing heavy or irregular menstrual periods, to determine if a woman's endometrium is able to sustain and nourish a fertilized egg or to test for uterine cancer. This procedure can be done in hospital or on an outpatient basis and can be performed by a general practitioner or a gynaecologist.

What is a laparoscope?

A laparoscope is a thin, inflexible fiber-optic tube about a foot long with a lens at one end that your doctor uses to look inside your abdominal cavity. Laparoscopy is a surgical procedure done using the laparoscope. A small cut is made in your abdomen and the laparoscope is inserted. Your doctor is able to move the laparoscope around your abdomen and check the state of your abdominal walls for any endometrial implants.

After the procedure you may experience some abdominal pain that can last for a couple of days. You may experience gas and cramping from the carbon dioxide gas used to expand your abdomen during the procedure. Within five days you should be able to resume normal activities. Strenuous activities such as jogging, swimming, brisk walking or heavy lifting are not recommended for at least two weeks.

When you receive a diagnosis your doctor should tell you the stage of your endometriosis.

What is staging?

You may have been told that your endometriosis is a stage 1, 2, 3, or 4. Doctors use these stages to describe how severe your endometriosis is and each stage is based on a weighted point system. This system is set up to clarify the extent of endometriosis based on location, size, and number of endometrial implants involving the ovaries, uterus, fallopian tubes, cul-de-sac, and peritoneum. Each implant is assigned a point depending on its size.

Stage 1 is minimal (1-5 points)

Stage 2 is mild (6-15 points)

Stage 3 is moderate (16-40 points)

Stage 4 is severe (over 40 points)

Stages 1 and 2 endometrial implants are small and not widespread. Stages 3 and 4 implants are usually large with extensive scar tissue.

How is endometriosis treated?

There are a number of treatment options available and success rates vary. In all cases, endometriosis can reoccur.

1. Drug therapy: These are usually your doctor's first course of action. They may be medications prescribed to reduce inflammation, control pain or regulate your hormonal levels.

2. Surgical treatments: Doctors can operate to reduce pain and the number of implants and adhesions. These are bands of scar tissue that d normally separate organs, usually as a result of surgery.

Types of surgery include:

Laparotomy is a conservative surgery done to remove only the diseased tissue such as lesions, implants, cysts and adhesions. The uterus and at least one ovary and fallopian tube are left.

Hysterectomy refers to the surgical removal of the uterus. With a total or complete hysterectomy, the surgeon removes only the uterus and cervix, leaving the fallopian tubes and ovaries. Ovulation still occurs but you will no longer have your period. When the fallopian tubes and both ovaries are removed along with the uterus and cervix, the procedure is called a total hysterectomy with bilateral salpingo-oopherectomy.

Oopherectomy is the surgical removal of one (unilateral) or both ovaries (bilateral). When only one ovary is removed and not your uterus, you will continue to be fertile and have periods. If both ovaries are removed, you will experience surgical menopause as your hormonal balance will be affected. Removal of the ovaries if often recommended for endometriosis as the reduction in estrogen in your body causes implants to shrink.

Some doctors may tell you that a complete hysterectomy is the only certain cure for endometriosis. Be aware that if any endometrial tissue is missed during surgery, your endometriosis can come back.

3. Laparoscopy as a treatment: Laparoscopy can sometimes be used to remove or destroy endometrial implants. If your desire is to become pregnant, this treatment may make it possible providing there are no other causes for your infertility. Not all doctors are trained to use the laparoscope as a treatment for endometriosis. You will need to discuss this with your doctor.

4. Complementary therapies and lifestyle changes: Complementary therapies are based on the belief that all illness impact upon your emotional and physical well-being. Most complementary therapies are holistic - they treat the whole person rather than a specific ailment or body part. This can be a welcome approach for women with endometriosis.

Complementary therapies are those not normally offered by the general medical system. They include a wide range of therapies such as:

  • nutrition and herbal medicine;
  • homeopathy;
  • acupuncture;
  • chiropractic;
  • osteopathy; and
  • naturopathy.

Where can I go for more information?