A Guide To Managing Endometriosis

WHAT IS ENDOMETRIOSIS
     Endometriosis- the presence of endometrial tissue outside the uterus- has been recognized for more than 100 years. Although many theories exist as to its cause, none of these is universally accepted. Once diagnosed, endometriosis can be treated in a variety of ways, depending on the individual patient.

     Endometrial tissue normally lines the inside of the uterus. The occurrence of endometrial tissue outside the uterus is known as endometriosis. Some common sites of endometriosis are the ovaries, fallopian tubes, outer surface of the uterus, ligaments supporting the uterus, tissue lining the pelvic cavity, cervix, and vagina.

     Except for its location outside the uterus, this endometrial tissue in itself is usually completely normal. All endometrial tissue, whether inside or outside the uterus, can respond to the female sex hormones controlling the reproductive cycle. Just as the endometrial tissue lining the uterus grows and thickens under the influence of estrogen and progesterone and then breaks down and bleeds at menstruation, so does the endometrial tissue outside the uterus. However there are some differences for example, endometrial tissue and blood inside the uterus are discharged in the normal way~ by menstruation~ if fertilization of the egg has not occurred. But endometrial tissue growing outside the uterus has no normal exit and, when break down and bleeding occur, remains within the body.

     This growing and bleeding endometrial tissue remaining in the body may cause pain, abnormal menstruation, and tissue formation. It can also result in infertility.

     The symptoms of endometriosis can vary considerably from patient to patient. The most common symptoms by far are pain during menstruation, pain in the lower abdomen before or after menstruation, irregular or heavy menstrual bleeding, pain during sexual intercourse, and infertility.

     Today, the outlook for women with endometriosis is far better than it was in the past. Using modern diagnostic techniques and the newer treatment methods, endometriosis can be detected earlier and treated more successfully.

HOW TO DETECT THE PROBLEM
     Begin by talking to your physician and outlining your symptoms. Sometimes, even a simple pelvic examination can outline areas of tenderness. Your physician may then order an ultrasound or sonogram to identify endometrial tissue outside the uterus.

CONSERVATIVE SURGERY
     To confirm the diagnosis, you may need a laparoscopy (a telescopic instrument used to view your pelvic organs). Operative laparoscopy with the use of various types of LASER, can be employed during this procedure to vaporize any lesions found. This is an Out-Patient Procedure (23 hour hospital stay), done under general anesthesia requiring only a few finger-nail sized incisions. Recovery time is only 5-7 days.

HORMONAL DRUGS
     Hormone therapy works by manipulating the hormones that control menstruation and the swelling of your endometrial lesions. This therapy may be used before, instead of, or after surgery. There are Gn-RH Agonists, Danazol, Birth Control Pills, Progestins, and Anti-Prostaglandins.

MAJOR SURGERY
     Laparotomy (a larger, open incision) is often advised for larger implants that cannot be reached with the laparoscope, or if other pelvic organs (such as your bowel) are involved. Like laparoscopy, this surgery preserves your fertility. This can still sometimes be carried out on an Out-Patient basis, or may require several days of hospitalization. Recovery time (time off work) is usually 2-4 weeks.

     Hysterectomy (removal of your uterus, and sometimes your fallopian tubes and ovaries) is often advised if your endometriosis is severe and involves mainly your uterus. If more conservative methods have failed to relieve your symptoms and if you are past child-bearing age, hysterectomy may be indicated.

   Home Page                                        Top of Page