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Diagnosing and Treating Endometriosis- Part Three in our Four Part Series

So you suspect that you might suffer from Endometriosis but don’t know what steps to take next? By consulting with your doctor and learning about the different tests and treatments offered in dealing with this condition.

How is Endometriosis diagnosed and what testing is necessary? Read our 3rd in our 4 part Series on Endometriosis.

How is Endometriosis Diagnosed?

Endometriosis is divergent in its symptoms and still difficult for doctors to diagnose.  Once suspected, however, the definitive diagnosis is made by looking inside and finding lesions of endometriosis.

A laparoscopy and sometimes a biopsy are necessary.  Even with the naked eye you can have a hard time finding microscopic lesions, and much of Endometriosis is microscopic.  However, a trial using hormonal drug therapy may be used to confirm or rule out Endometriosis.  Other investigatory procedures may be performed, such as the following:

  • Pelvic Exam – After collecting your medical history your doctor will perform a physical and pelvic exam.  The doctor will evaluate the size and position of the ovaries and check for nodules behind the cervix.
  • Laparoscopy – Diagnostic laparoscopy is used to confirm a suspected diagnosis of Endometriosis.  It may be used to treat the condition at the same time.  The procedure requires a general anesthetic before small incisions are made in the abdomen and a thin fiber optic tube inserted.
  • Imaging Tests – An ultrasound is performed in cases where other conditions are suspected such as fibroids and ovarian cysts.  This non-invasive procedure can pick up large cysts and detect “chocolate “cysts larger than one centimeter.  For more information on these and other preliminary tests, read my firsthand account at “Next Steps”...

Traditional Treatments Currently being Offered

The treatment of Endometriosis is often multi-faceted and there is no perfect method of managing it.  How a doctor proceeds depend on the severity of symptoms, stage of the disease, your age and desire to conceive.  The options involve three fundamental approaches: 1) watchful waiting, 2) hormonal therapy, and 3) surgery.  Which is best for you?
Watchful waiting: This approach is suitable if you have mild Endometriosis or not interested in your Fertility.  Given the fact that you are interested in enhancing your chances of pregnancy, we will surmise that sitting idly by will not get you any closer to achieving your goal of becoming pregnant.  Now is the time to actively engage in lifestyle modifications and natural therapies.  Sure, each month you can take over the counter pain medicines such as ibuprofen, naproxen and other non-steroidal anti-inflammatory drugs (NSAIDS) or acetaminophen (Tylenol) for pain relief, but this is simply masking a serious issue needing to be addressed.  Consider changing your diet, consulting with an Acupuncturist, or consulting with an RE (Reproductive Endocrinologist) to see what available options there are for those not wanting to further debilitate their already taxed Fertility.  For further information, read our various articles under “Getting Started”…

Hormonal therapy: These include birth control pills, progestins, GnRH agonists and Danazol.  If you are young, not ready to start a family and have minimal to moderate pelvic pain, hormonal therapy is often recommended.  It prevents the growth of Endometriosis and protects against unwanted pregnancy.  However, you can’t expect to be taking hormones for several years, can you? Again, looking into treatment alternatives would be your best bet here because as with any medication or drug, there are consequences:

Negative effects of the drugs

  • Symptoms recur within 5 years of treatment for about half of the patients.
  • They do not enhance fertility and can rather further impede your ability to conceive, especially if prescribed long term birth control pills, for example.
  • Side effects are distressing.  Compliance and dropout rates are high.
  • GnRH agonists and Danazol increase the risk of birth defects.  When taking these drugs doctors recommend using a condom, diaphragm, cervical cap or other non-hormonal birth control method.  Definitely not helpful for those wanting to become pregnant or causing any detrimental harm to your unborn child should an unexpected pregnancy occur.

Invasive Treatments being Offered

Surgery: There are two basic surgical approaches: (1) conservative surgery – laparoscopy/laparotomy and (2) radical surgery –hysterectomy.  Let’s evaluate these in further detail:

Conservative Surgery– Is minimally invasive surgery to remove Endometriosis without removing any normal tissue or reproductive organs.  The risks for recurrence or residual pain increases with the severity of the condition, however so be mindful of this should you opt for this treatment.  Sure, the removal of the Endometriosis in mild cases may increase the chances for spontaneous pregnancies for a short time period, but then the scarring very quickly comes back, often worse than before.  Thereby causing greater Infertility, ironically enough.

Radical Surgery – or Hysterectomy, is the surgical removal of the uterus.  A hysterectomy does not cure Endometriosis. Removal of both ovaries (bilateral oophorectomy) along with the uterus offers the best potential cure for the condition.  For obvious reasons, this option eliminates your fertility entirely.  Please do not consider this option without seriously weighing all of the consequences.

The textbook advice given to women with cysts on the ovaries is to have a laparotomy, and this is technically correct for women who no longer want to have children.  If you are trying to conceive, fertility specialists recommend delaying surgery and staying away from the ovaries, while opting for individualized treatment approaches.  What are these approaches?  Read on to see how you can take charge of your own Fertility and curb your Endometriosis in the final installment of this Series…

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