Endometriosis is usually diagnosed at the time of laparoscopy.
Your Eve Health surgeon will plan and discuss with you the likelihood of the presence, severity and location of endometriosis prior to surgery but these factors may only be clearly identified at the time of surgery. If endometriosis is diagnosed it will usually be treated at the same operation. Your gynaecologist will carefully survey the inside of the pelvis and abdomen with the laparoscope and identify the sites and severity of endometriosis. Using energy sources such as monopolar and bipolar diathermy (electrosurgery) all the endometriosis will be excised (removed) and sent to the laboratory for testing. The aim is to restore normal anatomy by removing endometriosis, treating endometriomas, dividing adhesions (internal scar tissue) and optimising fertility if required. Occasionally the severity of the endometriosis will be more severe and additional more-involved surgery will be required. In these circumstances your Eve gynaecologist will have a detailed discussion with you.
While laparoscopy is the only sure way to diagnose endometriosis and can be an important part of your treatment if you do have endometriosis, it only part of the endometriosis treatment jigsaw puzzle and not the whole solution.
Laparoscopy can diagnose and remove endometriosis, which can help to remove the inflammatory lesions and lessen pain. Around 80% of women experience improved symptoms after a laparoscopy but recurrence rates are as high as 21% by two years and 40-50% by five years. The recurrence in pain may be due to new disease growing, or pain from up-regulated pain pathways even after endometriosis is removed. In a small percentage of cases it may also be due to not having all of the endometriosis properly removed.
It is for this reason that is important to see a gynaecologist who specialises in endometriosis surgery and is highly experienced at removing endometriosis. We now have the view that the first surgery should be the best surgery and that if you have complete surgery the first time as well as a holistic approach to treatment, you should not need repeat surgeries.
Holistic care means using a combination of hormonal methods to help prevent endometriosis from growing back and also lessening underlying inflammation and other factors which can contribute to pain in women who suffer from endometriosis, such as pelvic muscle pain, nerve pain and gut symptoms.
Depending on your other needs such as contraception, options for hormonal treatment are:
- The oral contraceptive pill – a combination of oestrogen and synthetic progesterone which turns off the ovaries and prevents ovulation.
- The Mirena IUCD – an intrauterine device containing levenorgesterol (a synthetic progesterone) which helps to suppress growth of endometrial tissue and endometriosis locally.
- Visanne (Dionogest) – a newer progesterone medication taken as a tablet every day which works to prevent the growth of endometrial tissue as well as working to prevent new blood vessel formation to endometriosis deposits.
- Other progesterone only medications – Medroxyprogesterone acetate, Depo Provera, natural micronised progesterone all help to inhibit endometrial growth.
- GnRH agonists – in severe cases occasionally a hormone blocker is used to prevent the ovaries from making oestrogen and progesterone.
All of these hormonal medications have potential side effects, which your doctor at Eve will discuss with you in detail to determine the right option for you.
Even after surgery or on hormonal therapy you may have the occasional pain flare, which may be related to a period or muscle spasm. We tend to recommend NSAIDS (non-steroidal anti-inflammatory drugs) such as ibuprofen and Ponstan as they are anti-prostaglandins and can reduce these inflammatory compounds released during a period and hence reduce pain.
Ginger root is a natural alternative that some women may like to try. It also inhibits the production of prostaglandin and in several studies looking at a dose 500mg three times a day, has shown to be more effective than placebo for managing period pain and as effective as ibuprofen.
Both of these sorts of pain relievers should be taken with food.
Opiates such as Codeine and Endone are not usually recommended long-term as they can be addictive and lead to constipation and further pain and gastrointestinal issues. Sometimes, a drug called Endep is used to help desensitise pain pathways in women who have developed persistent pain.
Diet and Lifestyle
Ways of managing endometriosis through diet, lifestyle, and natural therapies is discussed on our blog: The effect of diet and lifestyle on your endometriosis