MANAGING ENDOMETRIOSIS

Early Diagnosis: Laparoscopy
Laparoscopy is a brief, common, and relatively simple procedure that has been used to diagnose endometriosis for over 20 years. With the laparoscope, a thin, lighted tube inserted in your abdomen, your doctor can look directly into your pelvic cavity to see whether you have endometriosis, and, if you do, how severe it is. The severity of your disease, though, may not match the pain you feel; mild endometriosis can cause extreme pain. Because it's a safe technique, laparoscopy may be used more than once during your lifetime (called repeat laparoscopy). In some cases, your doctor may remove small implants during your laparoscopy (this is called surgical laparoscopy).




YOUR EXPERIENCE
Laparoscopy can be done either in a hospital or out-patient clinic. You may be given a mild sedative to help you relax before the procedure. Once in the operating room, you'll be given a general anesthesia (unless you and your doctor choose a different anesthetic). After laparoscopy, which usually lasts less than an hour, you'll be monitored in a recovery area for several hours. Once home, it takes two to three days to recover fully (or longer if you've had surgical laparoscopy).
RISKS AND COMPLICATIONS
For all the benefits of laparoscopy, it has relatively few risks. Your doctor will discuss the risks (such as bleeding, infection, and anesthetic side effects) with you before the procedure.
THE PROCEDURE
Once you're anesthetized, your surgeon inflates your abdomen with a harmless gas so your pelvic organs are easier to see. Your surgeon places the laparoscope through a tiny incision in or near your naval. Other instruments, such as a probe to move organs, may be inserted through another tiny incision. Some surgeons attach a video camera to the laparoscope to enlarge the view. After the procedure, the gas is released, and your incisions are closed with sutures.
BIOPSY
While the laparoscope is still in place, your doctor may take a tiny bit of tissue from one or more of your implants, to send to a lab to further diagnose and document your endometriosis.




WHAT ENDOMETRIOSIS LOOKS LIKE
Through the laparoscope, your doctor may see a wide variety of endometrial implants, with different colors, shapes, and sizes, from tiny pinpoints to the size of a grapefruit.




THE STAGES OF ENDOMETRIOSIS
Your doctor diagnoses the severity of your endometriosis by the number, size, and location of your implants, and how deeply they press into nearby healthy tissue. Some examples of the stages are:




TREATMENT OPTIONS: HORMONE THERAPY
If you're diagnosed with endometriosis, you have three basic treatment options: hormone therapy, surgery, or a combination of both. Hormone therapy works by manipulating the hormones that control menstruation and the swelling of your endometrium and endometrial lesions. This therapy may be used before, instead of, or after surgery. If hormone therapy is recommended, your doctor will discuss side effects and dosage with you.


Gn-RH Agonists
Gn-RH agonists are synthetic forms of the gonadotropin-releasing hormone.
How they work: Over time, Gn-RH agonists stop the hypothalamus from stimulating FSH and LH production in the pituitary gland. This stops hormone production in the ovaries, and your body enters a temporary pseudomenopause: your estrogen and progesterone levels stay low, you stop ovulating and menstruating, and your endometrium may shrink. Gn-RH agonists are usually prescribed for 6 months. Treatment results may last an additional 6 months or longer after therapy.
Side effects: hot flashes, mood swings, headaches, and vaginal dryness. Bone density may decrease slightly during treatment, but is usually regained after therapy is stopped.

Danazol
Danazol is a synthetic hormone.
How it works: Danazol blocks FSH and LH at the pituitary gland. This creates a temporary pseudomenopause: you don't ovulate or menstruate, your estrogen and progesterone levels remain low, and your endometrium may shrink. Danazol is often used for 3-9 months, and repeated later, if needed.
Side effects: weight gain, hair growth, acne, hot flashes, vaginal dryness, sleep and emotional changes. Liver abnormalities may require you to stop treatment.

Birth Control Pills
Birth control pills are a combination of estrogen and progesterone. They may be taken continously for several months or prescibed in cycles, three weeks on and one week off.
How they work: Birth control pills regulate the levels of estrogen and progesterone in your body. This creates a temporary pseudopregnancy: ovulation, menstruation, and endometrial growth are controlled. Treatment may continue for 6-9 months. If you are taking the pills continously, you may be prescribed increasingly higher doses as your body adapts and spotting or menstrual bleeding occurs.
Side effects: weight gain, nausea, blood clots, and phlebitis (inflammation of veins).

Progestins
Progestins are the synthetic form of progesterone.
How they work: Progestins keep estrogen and progesterone levels low, to prevent ovulation and suppress endometrial growth.
Side effects: midcycle bleeding, weight gain, headaches, stomach irritation, acne.

Other Medications
Your doctor may prescribe an anti-prostaglandin, which blocks your body's own prostaglandins so you have smoother uterine contractions and less pain at menstruation. Many women also find relief in over-the-counter medications such as aspirin and ibuprofen. These mild anti-prostaglandins help reduce inflammation as well as ease pain. Anti-prostaglandins work best if taken early in the pain cycle.




TREATMENT OPTIONS: SURGICAL RELIEF
Nearly every woman with endometriosis considers treatment with surgery at some time in her life. Surgery can range from the most minor procedure (laparoscopy) to complete removal of all reproductive organs. Each surgery has the same goal: to preserve as much of your natural anatomy as possible and still relieve your symptoms. Your doctor will discuss your surgery options with you, as well as their effects on your fertility, and will recommend the best option based on your age, the severity of your endometriosis, and whether you want to have children.


Surgical Laparoscopy
Looking through the laparoscope, your doctor uses tiny surgical instruments to remove implants. Your doctor may trim implants with excision, burn them with cautery, or vaporize them with a laser. Because your doctor operates through tiny incisions, laparoscopy usually causes less bleeding and pelvic organ scarring than other surgeries. Often recommended for mild or moderate endometriosis, laparoscopy preserves your fertility and needs only a 3-10 day recovery.

Laparotomy
With laparotomy, your doctor may also remove implants with excision, cautery or laser. But laparotomy is open pelvic surgery: you'll have a 5-6 inch incision, be in the hospital a few days, and need 3-5 weeks to recover fully. Laparotomy is often advised for large implants that can't be reached with the laparoscope, or if other pelvic organs (such as your bowel) are involved. Like laparoscopy, this surgery preserves your fertility.

Graphics and Text from Krames Communications brochures

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