After your diagnosis of endometriosis, various treatment options begin to take over the conversation. While there are many options, most endometriosis specialists, like Dr. Iris Orbach, state that “excision is best.”
These are some of the more “common” tests available to determine the severity of endometriosis.
–Magnetic resonance imaging or MRI. An MRI is an exam that uses a magnetic field and radio waves to create detailed images of the organs and tissues within your body. For some women, an MRI helps with surgical planning, giving your surgeon detailed information about the location and size of endometrial implants.
-Laparoscopy. With certain cases, your doctor may refer you to a surgeon for a laparoscopy that allows the surgeon to view inside your abdomen. While you are under general anesthesia, your surgeon makes a tiny incision near your navel and inserts a slender viewing instrument called a laparoscope, to look for signs of endometrial tissue outside the uterus. During this procedure, your doctor may also take a biopsy of tissue for further testing.
-Pelvic exam. During a pelvic exam, your doctor manually palpates or feels areas in your pelvis for abnormalities, such as cysts on your reproductive organs or scars behind your uterus. Normally it is not possible to feel small areas of endometriosis unless they have caused a cyst to form.
-Ultrasound. This test uses high-frequency sound waves to create images of the inside of your body. To capture the images, a device called a transducer is either pressed against your abdomen or inserted into your vagina for a transvaginal ultrasound. Both types of ultrasounds may be done to get the best view of your reproductive organs. Ultrasound imaging will not definitively tell your doctor whether you have endometriosis, but it can identify cysts associated with endometriosis called endometriomas. (NIH, Dr. Orbach, Endometriosis.org)
Treatment of Endometriosis
There are a variety of ways to go about treating endometriosis, and all of those ways involve medication or surgical intervention. The method that your healthcare team suggests will depend on how severe the signs and symptoms are, and if you are planning to try to conceive a child in the future. Most specialists suggest trying the least invasive treatments first, and progress as necessary, if and when the treatment fails.
–Pain medication is the first medication your doctor will recommend, and they will begin with an over-the-counter pain reliever. An NSAID nonsteroidal anti-inflammatory, ibuprofen like Advil, or naproxen sodium like Aleve, to help ease the pain from menstrual cramps. If you find yourself taking the maximum dosage of these medications or more, you need to meet with your doctor to discuss different options to help control your pain levels. Overdosing on any sort of pain medication is never a good idea and can cause your body undue turmoil in other areas, creating entirely different and serious complications.
–Hormone therapy and supplemental hormones are sometimes helpful in reducing or eliminating the pain of endometriosis. The sudden rises and falls in hormone levels during the menstrual cycle causes endometrial implants or cells to thicken, break down and bleed. Hormone medication may help to regulate, and thusly slow the endometrial tissue from growing and prevent any new spreading cells. This therapy is not a fix for endometriosis, just something to help ease the symptoms. Some of the hormone therapies being used to treat endometriosis are:
-Progestin therapy. A variety of progestin therapies, including an intrauterine device like Mirena, contraceptive implants, contraceptive injections like Depo-Provera or progestin pills, can halt menstrual periods and the growth of endometrial cells, which may relieve endometriosis signs and symptoms.
-Aromatase inhibitors. Aromatase inhibitors are a class of medicines that reduce the amount of estrogen in your body. Your doctor may recommend an aromatase inhibitor along with a progestin or combination hormonal contraceptive to treat endometriosis.
-Hormonal contraceptives. Birth control pills, patches, and vaginal rings help control the hormones responsible for the buildup of endometrial tissue each month. Most women have lighter and shorter menstrual flow when they are using a hormonal contraceptive. Using hormonal contraceptives, especially continuous cycle regimens, may reduce or eliminate pain for some women in certain cases.
-Gonadotropin-releasing hormone agonists and antagonists. These drugs block the production of ovarian-stimulating hormones, lowering estrogen levels and preventing menstruation. This causes endometrial tissue to shrink. Because these drugs create an artificial menopause, taking a low dose of estrogen or progestin along with these agonists and antagonists may decrease menopausal side effects, such as hot flashes, vaginal dryness, and bone loss. Your periods and the ability to get pregnant return when you stop taking the medication.
–Conservative surgery for endometriosis can be helpful for those who are trying to or planning to try in the future, to conceive and carry a child to term. This surgery works to remove the endometrial implants or misplaced cells that have taken up residence in the wrong areas of your body, causing these problems to begin with. If you are also experiencing severe pain, this surgery could help to relieve some of that pain. This surgery does not permanently fix endometriosis and only preemptively reduces scarring, cell build-up, and provides possible and temporary pain relief. This surgery does not remove the ovaries, which is how this helps to preserve and save your conceiving chances. (NIH, Dr. Orbach, Endometriosis.org)
This procedure can be done laparoscopically or through a more traditional abdominal surgery for the more invasive cases. With this, a slender viewing camera is inserted through a small incision near your navel and inserts instruments to remove the endometrial tissue through another small incision. After these treatments, you may be prescribed hormonal medications to help improve pain.
Question: “Can women who have endometriosis conceive?”
Endometriosis does cause issues within the female reproductive system, some of which can make conceiving and carrying a child to full-term and birth very complex. The uterine cells that relocate outside of the uterus can build up and cause a scar-tissue thick closing in the fallopian tubes, preventing ovum or eggs from coming down to be fertilized, and stopping the sperm and semen from being able to bypass this blockage to fertilize the egg. If you are having trouble getting pregnant, your healthcare team may recommend fertility treatments given by a fertility doctor. These treatments can range from stimulating your ovaries to produce more eggs, excision surgeries to remove some of the scar tissue when needed to clear out the fallopian tubes, or even in vitro fertilization. Whichever treatment is right for you will be discussed in depth with your healthcare team. (Dr. Orbach)
Question: “I have severe endometriosis and no longer in childbearing years. The pain is intense, and I just want it to be done dealing with it. What will my options be?”
In severe cases, after other treatments have stalled or failed, many specialists will suggest a hysterectomy with removal of the ovaries, called an oophorectomy. Although a hysterectomy does not “cure” endo. This, or excision surgery, are usually the last options, as now the surgeries to remove endometrial tissues are much more precise than that have ever been, which saves many women from having to have their reproductive systems entirely removed. Removing the ovaries results in surgical menopause, which can improve the pain and symptoms of endometriosis in some women- but does trigger all menopause symptoms. Those going into early menopause have increased risks for heart and blood vessel diseases in the future, certain metabolic conditions, and early death. Even if the ovaries are left in place after the hysterectomy, this surgery can still cause life-long medical issues in those under the age of thirty-five. (NIH)
Once your receive your endometriosis diagnosis, you will want to research doctors in your area who specialize in this condition, as they are few and far between. Consider the skill of the surgeon who you select to do your excision surgery, and which doctor you are comfortable enough to work with for some time, as endometriosis is forever.
Citations:
American Cancer Society
Endo What
Endometriosis.org
National Institute of Health
Dr. Iris Orbach
Note: This article is for informational purposes only with information compiled from numerous major health sources listed in the citations. Please consult your medical team for your situation or concerns.