As part of your initial diagnostic work-up, your .doctor usually starts with the following:
Review of medical history & symptoms
Ultrasound with Color Doppler
Laparoscopy with biopsy- the most specific for the diagnosis
Can Diagnostic and operative laparoscopy perfomed on the same day?
Please note that, at our Center, we perform both a diagnostic and operative laparoscopy on the same day. This way, you can avoid having to undergo two surgical procedures.
Any alternatives forsurgery?
In mild symptoms -Exercise and relaxation techniques Nonsteroidal anti-inflammatory drugs (NSAIDs), prescription painkillers to relieve cramping and pain.
FOR MORE SERIOUS SYMPTOMS
For women who experience more severe symptoms, treatment options can include:
Prescription medications to control pain
Why do I need to have surgery and medicine for my endometriosis?
Endometriosis can only be diagnosed by laparoscopy. At the time of a laparoscopy,great care is taken to destroy any visible endometrial lesions (also called implants) and any adhesions. Some endometriosis isn't visible, yet it responds well to medication. That's why we combine medical and surgical therapy to treat this unpredictable disease.
Will I ever need another laparoscopy?
Most girls will not require any more laparoscopic procedures in the future, but some may. This depends on many factors, such as when your last procedure was, if you are having a problem with pain control while taking medication, and if your gynecologist feels it is necessary to check to see if your endometriosis has grown. If your endometriosis has grown, the lesions will be removed and/or destroyed. The goal is to lower your pain and preserve your fertility.
Will I need to have my uterus removed?
You will NOT need to have your uterus removed (hysterectomy). All treatment will be aimed at relieving your pain and preserving your ability to have children some day.
Will I be able to get pregnant?
Not being able to get pregnant (infertility) can result if endometriosis causes changes in your pelvic organs, including your fallopian tubes and ovaries. With early treatment, endometriosis should not interfere with your ability to become pregnant
Should I get pregnant soon to cure my endometriosis?
You may have heard that "pregnancy cures endometriosis". This is a myth.
Should my sisters and other family members get checked?
Women are more likely to develop endometriosis if a close female relative from their parents side has it. Likewise, if you have been diagnosed with endometriosis, and someone in your family (such as your sister, or cousin) has painful periods and pelvic pain at other times during her menstrual cycle that interfere with school and social activities, it is a good idea to suggest that they get evaluated.
Will endometriosis affect a girl if she's already had a baby?
A girl who has already had a baby can still have endometriosis. Pregnancy, and the increase in progesterone levels often relieve women of symptoms, but they typically return after birth and/or after stopping breastfeeding.
How endometriosis cause infertility?
Approximately 30-40% of women with the disease are infertile. This makes endometriosis one of the top three causes of female infertility. Many women are unaware of their infertility or endometriosis until they attempt to get pregnant. In some women, endometriosis goes untreated and the disease progression allows the endometrial lesions to block the fallopian tubes and inhibit ovulatory functioning or makes the endometrium unreceptable for embryo implantation.
Do I have bowel symptoms because of endometriosis?
Bowel symptoms are extremely common in patients with endometriosis.
intestinal cramping and painful bowel movements occur in approximately 25% of patients; constipation occurs in 35% of patients and diarrhea occurs in more than 60% of patients. These numbers reflect the patients with severe or crippling symptoms only. When patients with mild or moderate symptoms are included, these symptoms become even more common.
What are the bowel symptoms ?
There is a constellation of bowel symptoms that can occur in endometriosis patients. These include:
Painful bowel movements
Alternating constipation and diarrhea
Nausea and/or vomiting
What is rectovaginal nodule?
Deep implants in adjacent structures such as the uterosacral ligaments or rectovaginal septum can also cause bowel symptoms. Painful bowel movements and occasionally rectal bleeding can result from endometriosis in these locations.
Does adhesions due to endometriosis cause pain?
Adhesions can also cause or contribute to bowel symptoms (as well as other symptoms associated with endometriosis). Often the bowel is stuck to other structures such as the ovaries, uterus or pelvic sidewall. This scarring can lead to pain during bowel movements or constipation or diarrhea. Abdominal bloating is also associated with adhesive disease, and carefully treating the adhesions may help reduce many of these symptoms.
What about appendix?
endometriosis may/may not be present, other conditions such as scarring or fibrosis may be found, as well as acute or chronic a
Will My Symptoms Improve?
The incidence of bowel symptoms does improve significantly after excision surgery for endometriosis. Based on the post-operative follow-up questionnaires ., there is an 80% reduction in most bowel symptoms.
What if the conditions does not subside?
While most patients have improvement in their bowel symptoms following excision surgery for their endometriosis, some will have a persistence of these symptoms. This may be due to another underlying medical condition (IBD or IBS).
How best is laparoscopy for endometriosis?
Laparoscopy is the most common procedure used to diagnose and remove mild to moderate endometriosis. Instead of using a large abdominal incision, the surgeon inserts a lighted viewing instrument called a laparoscope through a small incision. If the surgeon needs better access, she makes one or two more small incisions for inserting other surgical instruments.
Laparoscopy is usually done under general anesthesia, Directly viewing the pelvic organs is the only way to confirm whether you have endometriosis.
When will be the patient discharged?
Sometimes a surgery requires a hospital stay of 1-2 days depending on your recovery.You will likely be able to return to your normal activities in 2-3 days.
Is it both diagnostic and operative?
Laparoscopy is used to examine the pelvic organs and to remove implants and scar tissue. This procedure is typically used for checking and treating:
Severe endometriosis and scar tissue that is thought to be interfering with internal organs, such as the bowel or bladder.
Endometriosis pain that has continued or returned after hormone therapy.
Severe endometriosis pain (some women and their doctors choose to skip medicine treatment).
An endometriotic cyst on an ovary (endometrioma).
Endometriosis is a major possible cause of infertility. The surgeon usually removes any visible implants and scar tissue. This may improve fertility
For moderate to severe endometriosis, surgery will improve your chances of pregnancy.4
What are the benefits of laparoscopic surgery ?
Compared with open abdominal surgery ,laparoscopy includes less tissue trauma and scarring and smaller incisions along with being able to have an outpatient procedure or a shorter hospital stay and a shorter recovery time.
The skill of the surgeon is critical when surgery is used to treat endometriosis that is causing infertility.
Follow up medicines needed?
At the time of a laparoscopy, great care is taken to destroy any visible endometriotic lesions (also called implants) and any adhesions. Some endometriosis isn't visible, yet it responds well to medication. That's why combinination of medical and surgical therapy to treat this unpredictable disease.
Regular follow-up is necessary.
Combined surgical and medical management stops endometriosis from getting worse. This helps to preserve the fertility.
When to have a follow up visit?
Endometriosis is a chronic condition that requires long-term treatment and follow-up, especially during your childbearing years. Many factors affect how often you will need to be seen by your doctor such as whether or not you are responding to the treatment. Since there is no permanent cure for endometriosis, you will need to be on medication depending on your doctors decision, to keep your symptoms away and preserve fertility.
Is it possible to have recurrence?
Recurrent endometriomas (endometriosis of ovary or chocolate cyst)- as detected by TVS, can remain asymptomatic and do not necessarily progress in size with or without medical treatment. The decision to reoperate depends less on the endometrioma's size than on symptoms, in particular severe pain, and failure of medical treatment. However such patients are also more likely to have signs of deep nodules and adnexal/bowel adhesions and larger endometriomas on TVS scan, thus predisposing them to require a second procedure.
There is no permanent cure for endometriosis, and if it is untreated it will grow, causing pain and lowering your chances of being able to become pregnant in the future. This is why you need to take medication. Treatment is aimed at controlling pain and preventing the endometriosis from getting worse and to reduce the chances of infertility.
With surgical intervention women tend to get relieved of symptoms achieving pregnancy in 80-90% cases.