To determine whether you have endometriosis, your physician will typically commence with a physical examination. During this examination, you’ll be required to articulate your symptoms, detailing the location and timing of any discomfort you experience.
Various tests are employed to identify indicators of endometriosis:
- Pelvic examination: Your healthcare provider will palpate areas in your pelvic region using one or two gloved fingers to detect any unusual changes. These changes may encompass cysts on the reproductive organs, tender areas, irregular growths known as nodules, and scarring behind the uterus. Often, small areas of endometriosis may not be palpable unless a cyst has developed.
- Ultrasound: This diagnostic procedure employs sound waves to generate images of the body’s interior. A transducer device may be pressed against the abdominal region or inserted into the vagina in a method known as transvaginal ultrasound to capture these images. Both forms of ultrasound may be utilized to obtain optimal views of the reproductive organs. While a standard ultrasound cannot definitively confirm the presence of endometriosis, it can identify cysts associated with the condition, known as endometriomas.
- Magnetic resonance imaging (MRI): MRI utilizes a magnetic field and radio waves to produce images of the body’s organs and tissues. In certain cases, an MRI aids in surgical planning by providing detailed information to the surgeon regarding the location and dimensions of endometriosis growths.
- Laparoscopy: If necessary, your healthcare provider may refer you to a surgeon for this procedure. Laparoscopy allows the surgeon to visually inspect the inside of your abdomen for signs of endometriosis tissue. Before the procedure, you will receive medication to induce a sleep-like state and alleviate pain. Subsequently, the surgeon makes a small incision near your navel and inserts a slender viewing instrument called a laparoscope.
Laparoscopy offers insights into the location, extent, and size of endometriosis growths. Your surgeon may also extract a tissue sample, known as a biopsy, for further evaluation. With careful planning, a surgeon can often address endometriosis during the laparoscopy, minimizing the need for additional surgical interventions.
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Treatment for endometriosis frequently entails either medication or surgery. The decision regarding the preferred approach, made in collaboration with your healthcare team, hinges on the severity of your symptoms and whether you desire pregnancy.
In most cases, medication is initially recommended. If its effectiveness is insufficient, surgery may be considered as an alternative option.
Your healthcare team might suggest over-the-counter pain relievers as an initial step. These medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve), can alleviate painful menstrual cramps.
Additionally, if pregnancy is not a current goal, your healthcare providers may advise hormone therapy in conjunction with pain relievers.
Hormone medications can sometimes alleviate or eliminate endometriosis-related pain. The natural hormonal fluctuations throughout the menstrual cycle cause endometriosis tissue to thicken, break down, and bleed. Synthetic versions of hormones can slow the growth of this tissue and prevent the formation of new tissue.
However, it’s important to note that hormone therapy is not a permanent solution for endometriosis. Symptoms may return once treatment is discontinued.
Various therapies used to address endometriosis include:
- Hormonal contraceptives: Birth control pills, patches, shots, and vaginal rings regulate the hormones that trigger endometriosis. Many individuals experience lighter and shorter menstrual periods when using hormonal birth control, which may also alleviate or eliminate pain in some cases. The likelihood of relief tends to increase with the prolonged use of birth control pills without breaks, typically for a year or more.
- Gonadotropin-releasing hormone (Gn-RH) agonists and antagonists: These medications suppress the menstrual cycle and reduce estrogen levels, causing endometriosis tissue to shrink. They induce an artificial menopause. Combining a low dose of estrogen or progestin with Gn-RH agonists and antagonists can alleviate menopausal symptoms such as hot flashes, vaginal dryness, and bone loss. Menstrual periods and fertility usually return upon discontinuation of the medication.
- Progestin therapy: Progestin, a synthetic hormone involved in the menstrual cycle and pregnancy, can halt menstrual periods and the growth of endometriosis tissue, thereby relieving symptoms. Progestin treatments include intrauterine devices releasing levonorgestrel (Mirena, Skyla, others), contraceptive rods implanted under the skin (Nexplanon), birth control injections (Depo-Provera), or progestin-only birth control pills (Camila, Slynd).
- Aromatase inhibitors: These medications decrease estrogen levels in the body. Your healthcare team may recommend combining an aromatase inhibitor with progestin or combination birth control pills to manage endometriosis.
Conservative surgery involves the removal of endometriosis tissue while aiming to preserve the uterus and ovaries. For individuals with endometriosis who are attempting to conceive, this type of surgery may enhance the likelihood of successful pregnancy. It can also provide relief if the condition causes severe pain, although endometriosis and associated pain may recur over time post-surgery.
Typically performed through small incisions, known as laparoscopic surgery, this procedure is the preferred approach. In rare cases, surgery requiring a larger abdominal incision may be necessary to address thick bands of scar tissue. However, even in severe instances of endometriosis, the laparoscopic method is often effective.
During laparoscopic surgery, a slender viewing instrument called a laparoscope is inserted through a small incision near the navel. Surgical instruments are then utilized to excise endometriosis tissue through another small incision. Some surgeons employ robotic devices controlled by them to assist with laparoscopy. Following the surgery, your healthcare team may recommend hormone therapy to help alleviate pain.
Endometriosis can pose challenges to conception. If you experience difficulty getting pregnant, your healthcare team may suggest fertility treatment options. You may be directed to a specialist in infertility, known as a reproductive endocrinologist. Fertility treatments may involve medications to stimulate ovary function, encouraging the production of more eggs. Additionally, procedures such as in vitro fertilization, which involve the mixing of eggs and sperm outside the body, could be recommended. The choice of treatment is tailored to your individual circumstances and needs.
Hysterectomy with removal of the ovaries
Hysterectomy, the surgical removal of the uterus, was previously considered the most effective treatment for endometriosis. However, contemporary perspectives view it as a last resort for pain relief when other treatments have proven ineffective. Many experts now advocate for surgical approaches that meticulously target the complete removal of all endometriosis tissue.
The removal of ovaries alongside the uterus, known as oophorectomy, induces early menopause. While the absence of ovarian hormones may alleviate endometriosis pain for some individuals, others may continue experiencing symptoms if endometriosis persists post-surgery. Early menopause also carries risks of heart and vascular diseases, specific metabolic conditions, and premature mortality.
In individuals not seeking pregnancy, hysterectomy may be utilized to manage symptoms associated with endometriosis, such as heavy menstrual bleeding and painful menstruation due to uterine cramps. Even when the ovaries are retained, a hysterectomy can have lasting health implications, particularly if performed before the age of 35.
Finding a healthcare professional with whom you feel comfortable is essential for managing and treating endometriosis. Seeking a second opinion before initiating any treatment allows you to fully understand your options and weigh the advantages and disadvantages of each approach.
Treating endometriosis in women involves a multifaceted approach that considers the severity of symptoms, fertility goals, and individual health considerations. While medication, hormonal therapy, and conservative surgery remain primary avenues of treatment, newer perspectives prioritize the meticulous removal of endometriosis tissue to alleviate pain and preserve fertility whenever possible.
It’s crucial for individuals facing endometriosis to collaborate closely with their healthcare providers to explore all available treatment options. Seeking a second opinion can provide clarity and ensure informed decision-making. Ultimately, finding a treatment plan tailored to each individual’s needs and preferences is essential for effectively managing endometriosis and improving overall quality of life.
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