At this time endometriosis
cannot be cured, but removing the tissue can do away with, or at least reduce, the pain and improve fertility. Medications have limited success in treating endometriosis. It is a disease that frequently grows more severe as you grow older, but the good news is that there are many ways to ease symptoms and reduce complications. The therapy depends on the severity of the symptoms, the location and degree of endometriosis, your age and plans for childbearing. If the only symptom is mild premenstrual pain, the only treatment necessary may be a medication, such as aspirin or ibuprofen to relieve the pain.
Women near menopausal age, in most cases, but not all, can expect significant improvement or elimination of the pain once their periods stop. Dr. Biggerstaff may prescribe birth control pills, progesterone pills, or other drugs to control your hormones. The purpose of these medicines is to stop heavy menstrual periods from occurring. They may also help with your menstrual cramps to some degree. If you have endometriosis, medication will not eliminate the disease. There is no medication currently available that does anything more than relieve the symptoms of endometriosis.
Some of the drugs (so-called GnRH analogues such as Depo-Lupron) used for treating endometriosis are very expensive and can cause significant side effects. The drugs are usually taken for 6 months. A woman on these medications is frequently pain free, but the pain usually returns within 6 to 12 months after stopping the drug. Additionally it is not possible to get pregnant while taking these drugs.
Danocrine is another drug used for many years to decrease the symptoms of endometriosis but has similar drawbacks as the GnRH analogues. Dr. Biggerstaff prescribes these medications very infrequently because of their cost and the fact that the pain is only suppressed but not eliminated.
If your pain is significant, Dr. Biggerstaff frequently recommends laparoscopy
to determine the extent of endometriosis and to remove the diseased tissue. In most cases, he uses an Ultrapulse
to remove endometriosis and the associated scar tissue. Additionally, if you have severe cramping in the midline of your lower abdomen (as opposed to the sides), Dr. Biggerstaff may discuss the possibility of a procedure called a presacral neurectomy
This procedure is used to interrupt the nerves going to the uterus when endometriosis is located in the muscular wall of the uterus, so-called adenomyosis. Fortunately, presacral neurectomy can now be performed laparoscopically. Of note is the fact that very few physicians have the training and experience to perform this procedure.
Another possible treatment is surgical removal of the organs containing the endometrial growths, such as the fallopian tubes, uterus, or the ovaries (If your uterus is removed, you can never become pregnant.). A hysterectomy should be considered as the last option for endometriosis therapy. Fortunately, Dr. Biggerstaff very infrequently finds it necessary to perform a hysterectomy to treat endometriosis.
Different physicians treat endometriosis in different ways.
There is a significant difference in the way physicians treat endometriosis, and as a result, a significant difference in the chance that all of the endometriosis will be removed. Most physicians vaporize or coagulate endometriosis using a laser or electrical cautery. When endometriosis is superficial, this method is effective. But when endometriosis invades the surrounding tissues (as it frequently does), the superficial ablation technique frequently leaves endometriosis behind, along with its associated pain.
In 1989, a friend and fellow physician in Memphis, Dan Martin, demonstrated that simple destruction of endometriosis would frequently result in incomplete removal of the disease. He demonstrated that 61% of patients had endometriosis penetrating greater than 2mm, 43% had endometriosis penetrating greater than 3 mm, and 25% had endometriosis penetrating greater than 5mm. Coagulation would have missed the full depth of the endometriosis in 61% and vaporization in 25% of the patients. So, what is the best technique to have the best chance of getting rid of endometriosis?
Total removal of extensive endometriosis has been shown to be the best technique for treating disease.
The following drawings show an area of endometriosis, show endometriosis is frequently left when cauterizing the tissue in the first row, and show complete removal when excising the disease in the second row. Click on drawing to enlarge.
Few physicians use this technique because of the extensive training and practice necessary to become proficient. A laser or scissors can be used to remove (excise) the endometriosis.
When using a laser, the instrument is used like a knife to remove the diseased tissue. Endometriosis may attach itself to the bladder, intestine, ureters or major blood vessels. Unfortunately, the amount, location, and depth of penetration of endometriosis can only be determined at the time of laparoscopy. In most cases Dr. Biggerstaff finds the laser to be a more precise tool than scissors, because the laser can cut through tissue completely and very accurately, literally one layer of cells at a time.
He routinely treats patients with extensive endometriosis using the laser excision technique, and other physicians refer patients to him for excision of extensive endometriosis. The following photos demonstrate endometriosis on the left and right uterosacral ligaments (supporting structures for the uterus) and the appearance after removal of endometriosis with the laser. Click to enlarge.
How long will the effects of treatment last?
No treatment has been found yet that is 100 percent effective. Endometriosis will recur or progress after hormone therapy alone. Endometriosis may recur after surgery, but the likelihood is less if the endometriosis is carefully excised. If conservative surgical therapy (at least one ovary is left in place) is chosen, studies show the recurrence rate appears to be up to 30-40%. You should be leery of any physician who suggests that any treatment will result in close to a 100% long-term cure rate. While all of the endometriosis may be removed, the root cause of the endometriosis (such as retrograde menstruation) is still there.
What can I do to help myself?
Keep a careful record of your symptoms. The easiest way to do this is to assign a number to each of the symptoms you have and record them by number on your calendar for three months. Record all symptoms, including any time lost from work and leisure activities. Report the symptoms to your doctor. Take your calendar with you to your appointment. If you have not yet been diagnosed with endometriosis, your doctor may not suspect endometriosis without this information.
Try the following to easy your pain:
- Take warm baths.
- Wear loosely fitting clothing.
- Use a hot water bottle or heating pad on your abdomen.
- Avoid constipation by increasing the fiber in your diet.
- Do relaxation exercises.
- Take pain medication as recommended by your doctor. (The pain medication works much better if you can predict the onset of your next episode of pain and begin the medication 12-24 hours before the onset of pain.)
- See a physician who has the skills and knowledge to safely remove the disease.
What can be done to help prevent endometriosis?
Currently there is no prevention for endometriosis and no guarantee of cure in all cases. Much research is being conducted in an effort to find a solution. Since we think there is a link to your immune system, being as healthy as you can with diet, exercise, adequate sleep, and stress management may all help with endometriosis. Further information on endometriosis can be obtained from the Endometriosis Association at endometriosisassn.org.
The information provided by Advanced Healthcare for Women and E. Daniel Biggerstaff, III, M.D. is for informational purposes only. As each woman is unique, do not rely on this information for diagnosis and treatment. We cannot guarantee the accuracy of the content and advise that you see a qualified Health Care Professional for individual needs and care.
Advanced Healthcare for Women
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Savannah, Georgia 31405