Diagnosis and Treatment of Endometriosis

One theory for endometriosis is that they are caused by retrograde menstruation, where menstrual blood flows back through the fallopian tubes and deposits the tissue in various locations, such as the ovaries, fallopian tubes, bladder, intestines, or other tissues attached to the uterus. At first, there may be no indication or noticeable pain, but over time, the surrounding tissue can become inflamed or swollen, which may then develop into lesions or growths. If the displaced endometrial tissue becomes lodged on the ovaries, blood during the menstrual cycle becomes trapped and has nowhere to go, thus accumulating more and more until it forms cysts.

This is a condition that has the potential to greatly affect the daily life and activities of women. Main symptoms of endometriosis include severe menstrual pain and heavy bleeding during menstruation.  If left untreated for too long, it can progress to the point of unbearable pain, at which point surgical removal of the uterus may be required. Allowing this to happen would mean an inability to have children in the future; it is, therefore, an issue that requires early treatment.

Every woman of reproductive age should consider getting tested for endometriosis. For women suffering from unusual symptoms such as pelvic pain, be sure to share as much information as you can with your doctor, especially since symptoms of endometriosis can be similar to other common conditions. Other symptoms which might be indicative of endometriosis are low back pain which worsens during period of menstruation, dysmenorrhea (abdominal cramps or painful menstruation), dyspareunia (painful intercourse) and infertility.

Diagnosis of endometriosis can be done by:  

• Ultrasound – the type of ultrasound the patient has to undergo is the transvaginal ultrasound, where a transducer is inserted into the patient’s vagina or pressed against the abdomen. Ultrasound is not one of the most definite ways of diagnosing endometriosis, but it can detect cysts associated with the condition.
• Pelvic exam – a pelvic exam checks a woman’s reproductive organs for abnormalities. However, most women with endometriosis display normal findings after a pelvic exam. Therefore, a laparoscopy is usually necessary and provides the most definite diagnosis for endometriosis.
• Laparoscopic excision of endometriosis – a form of minimally invasive surgery (MIS), laparoscopic surgery uses a small camera (a laparoscope) to look inside the patient’s abdominal or pelvic organs. With this new medical technique, the surgery can be done with smaller incisions, less pain and faster recovery. The doctor might perform a biopsy if necessary, and the laparoscopic procedure can serve as both a method of diagnosis and treatment.  

Methods such as ultrasound are occasionally used to identify individual lesions, but these methods are not helpful in assessing the extent of endometriosis. Diagnosis of endometriosis is difficult, even with direct visualization, especially since lesions are, at times, difficult to interpret. Having mild symptoms of endometriosis or being an infertile patient does not mean that you are not suffering from a severe case of endometriosis. Therefore, laparoscopic excision of endometriosis is the advisable and most accurate method of diagnosis available.

Medical Treatment

In terms of the treatment of endometriosis, if the symptoms are mild, the doctor may choose to follow up with periodic examinations, and in cases that are further developed, the doctor may prescribe medication. This type of treatment is usually reserved for patients with dyspareunia or milder pelvic pain.There are a variety of medications a doctor can prescribe to relieve the symptoms of endometriosis.

Some patients turn to pain medications when they experience menstrual cramps. While these medications can lessen the pain for a short while, it can never entirely go away. Many women might start taking injections instead. This can lead to patients becoming reliant upon pain medications. For women who experience such painful menstrual cramps, it is important not to self-medicate in such a way. Seeking help from specialists and getting tested for endometriosis remains the better option.

Surgical Treatment

If the medication prescribed appears to be ineffective, surgery might be necessary. Laparoscopic excision of endometriosis is a modern surgical procedure which offers smaller incisions, less pain and faster recovery. The patient can receive even more benefits through the evolvement of this new medical technology. Here are three types of laparoscopic surgeries which have been developed throughout the years:

• Conventional laparoscopy – requires two to four incisions on the abdomen
• Single-port laparoscopy – requires special tools and surgeons with expertise. Unlike conventional laparoscopy, the surgery leaves only one scar on the navel. Once the wound from the incision heals, the scar will be rolled and concealed by the belly button, making it no longer visible.  
• Laparoscopy using the NOTES technique – requires surgeons with particular expertise and is a procedure which proves less painful than other kinds of laparoscopy. NOTES, or natural orifice transluminal endoscopic surgery, is performed through the birth canal and leaves no scars on the skin. This technique is also used for cyst removal. Learn more about the Natural Orifice Transluminal Endoscopic Surgery (NOTES) technique by clicking here. 

Surgical treatment is also commonly used by infertile patients with advanced cases of endometriosis. Women who have intractable pain and possess no desire of pregnancy might be in need of definitive surgery, such as hysterectomy or oophorectomy. The doctor will be the one to recommend which treatment is best suited to the patient’s condition.

Medical Treatment vs. Surgical Treatment

Treatment	Advantages	Disadvantages
Surgical	Beneficial for infertility Possibly better long-term results Definitive diagnosis Option for definitive treatment	Expensive Invasive
Medical	Decreased initial cost Empiric treatment Effective for pain relief	Adverse effects common Unlikely to improve infertility

*Caroline Wellbery, M.D. of Georgetown University School of Medicine

 

References

1. Diagnosis and Treatment of Endometriosis. Available from http://www.aafp.org/afp/1999/1015/p1753.html#afp19991015p1753-b27. Accessed on July 15, 2016.
2. Endometriosis. Available from http://www.mayolniorg/diseases-conditions/endometriosis/basics/treatment/con-20013968. Accessed on July 15, 2016.
3. Getting Diagnosed with Endometriosis. Available from https://www.endometriosis-uk.org/getting-diagnosed-endometriosis. Accessed on July 15, 2016.
4. Endometriosis. Available from http://www.webmd.com/women/endometriosis/endometriosis-exams-and-tests. Accessed on July 15, 2016.