Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Surgical treatment for endometriosis can be useful when
the symptoms of endometriosis are severe or when there has been an inadequate
response to medical treatment. Surgery is the preferred treatment when there is
anatomic distortion of the pelvic organs or obstruction of the bowel or urinary tract.
Surgical therapies for endometriosis may be either classified as conservative,
in which the uterus and ovarian tissue is preserved, or definitive, which
involves hysterectomy (removal of the uterus), with or without removal of the
ovaries.
Conservative surgery is typically carried out by
laparoscopy. Endometrial implants may be excised or obliterated by laser. If the
disease is extensive and anatomy is distorted, laparotomy (opening of the abdominal wall via a larger
incision) may be required.
While surgical treatments can be very effective in the
reduction of pain, the recurrence rate of endometriosis following surgical
treatment has been estimated to be as high as 40%. Many doctors recommend for
women who have had surgery for endometriosis to take oral medications after surgery to
help maintain symptom relief.
Treatment of infertility associated with endometriosis
Endometriosis is more common in infertile, compared to
fertile, women. However, the condition usually does not fully prevent
conception. Most women
with endometriosis will still be able to conceive, especially those with mild to
moderate endometriosis. It is estimated that up to 70% of women with mild and
moderate endometriosis will conceive within three years without any specific
treatment.
The reasons for a decrease in fertility are not completely understood, but
might be due to both anatomic and hormonal factors. The presence of
endometriosis may involve masses of tissue or scarring (adhesions) within the
pelvis that may distort normal anatomical structures, such as Fallopian tubes,
which transport the eggs from the ovaries. Alternatively, endometriosis may
affect fertility through the production of hormones and other substances that
have a negative effect on ovulation, fertilization of the egg, and/or
implantation of the embryo. Infertility associated with endometriosis is more
common in women with severe forms of the disease.
Treatment
options for infertility associated with
endometriosis are varied, but most doctors believe that surgical treatments are
superior to hormonal or medical treatments for endometriosis when the goal is
enhancement of fertility. Assisted reproduction techniques may also be used when appropriate in
combination with surgical therapy.
Endometriosis At A Glance
Endometriosis is the abnormal growth of cells (endometrial cells)
similar to those that form the inside of the uterus, but in a location
outside of the uterus.
Endometriosis is most commonly found on other organs of the pelvis.
The exact cause of endometriosis has not been identified.
Endometriosis is more common in women who are experiencing infertility than
in fertile women, but the condition does not fully prevent conception.
Most women with endometriosis have no symptoms, in which case therapy is
neither appropriate nor necessary.
Pelvic pain during menstruation or ovulation can be a symptom of
endometriosis, but may also occur in normal women.
Endometriosis can be suspected based on the woman's pattern
of symptoms, and sometimes during a physical examination, but the definite
diagnosis is confirmed by surgery, usually laparoscopy.
Treatment of endometriosis includes medication and surgery for both pain
relief and treatment of infertility if pregnancy is desired.
Van Gorp T; Amant F; Neven P; Vergote I; Moerman P. Endometriosis and the development of malignant tumours of the pelvis. A review of literature. Best Pract Res Clin Obstet Gynaecol 2004 Apr;18(2):349-71.
Abdominal pain is pain in the belly and can be acute or chronic. Causes include inflammation, distention of an organ, and loss of the blood supply to an organ. Abdominal pain can reflect a major problem with one of the organs in the abdomen such as the appendix, gallbladder, large and small intestine, pancreas, liver, colon, duodenum, and spleen.
Menstrual cramps (pain in the belly and pelvic area) are experienced by women as a result of menses. Menstrual cramps are not the same as premenstrual syndrome (PMS). Menstrual cramps are common, and may be accompanied by headache, nausea, vomiting, constipation, or diarrhea. Severity of menstrual cramp pain varies from woman to woman. Treatment includes OTC or prescription pain relief medication.
An ectopic pregnancy is a pregnancy located outside the inner lining of the uterus. The majority of ectopic pregnancies occur in the Fallopian tube. Symptoms include abdominal pain, amenorrhea, and vaginal bleeding. Treatment options include observation, medication, or surgery.
Though uterine cancer's cause is unknown, there are many factors that will put a woman at risk, including: over age 50, endometrial hyperplasia, using hormone replacement therapy, obesity, using tamoxifen, being Caucasian, having colorectal cancer. Symptoms of cancer of the uterus (endometrial cancer) include abnormal vaginal bleeding, painful urination, painful intercourse, and pelvic pain. Treatment depends on staging and may include radiation therapy or hormone therapy.
Ovarian cysts are fluid-filled, sac-like structures within an ovary. Causes of ovarian cysts are numerous. Symptoms of an ovarian cysts may be pain in the belly or pelvis. Treatment of an ovarian cysts depends on type of cyst.
Normal vaginal bleeding (menorrhea) occurs through the process of menstruation. Abnormal vaginal bleeding in women who are ovulating regularly most commonly involves excessive, frequent, irregular, or decreased bleeding. Causes of abnormal may arise from a variety of conditions.
Infertility is the diminished ability to conceive a child. The primary cause of infertility in men is a sperm disorder. In women, the primary cause of infertility is an ovulation disorder. Most forms of infertility can be treated. Conventional infertility therapies include drugs or surgery.
Menstruation (menstrual cycle) is also referred to as a "period." When a woman menstruates, the lining of the uterus is shed. This shedding of the uterine linking is the menstrual blood flow. The average menstrual cycle is 28 days. There can be problems with a woman's period, including heavy bleeding, pain, or skipped periods. Causes of these problems may be amenorrhea (lack fo a period), menstrual cramps (dysmenorrhea), or abnormal vaginal or uterine bleeding. There are a variety of situations in which a girl or woman should see a doctor about her menstrual cycle.
Pregnancy planning is important to help prevent exposure of the mother and fetus to potentially harmful medications and substances during the early days, and throughout the pregnancy. Nutritional planning, prevention of birth defects, conditions such as high blood pressure, heart disease, diabetes, and kidney disease need careful monitoring. Gestational diabetes, preeclampsia, and pregnancy induced hypertension are conditions that may arise during pregnancy. Immunizations, inherited disorders, exercise, air travel, intercourse, and birth control are important factors to consider when planning a pregnancy.
Menstrual cramps and premenstrual syndrome (PMS) symptoms include abdominal cramping, bloating, a feeling of fullness, abdominal pain, mood swings, anxiety and more. Treatment for menstrual cramps and premenstrual syndrome (PMS) symptoms include regular sleep, exercise, smoking cessation, diet changes, and OTC or prescription medication depending on the severity of the condition.
Sexual dysfunction refers to a problem that arises during any phase of the sexual response cycle, preventing an individual or couple from experiencing sexual satisfaction. Physical, medical, and psychological conditions may affect sexual functioning, resulting in inhibited sexual desire, inability to become aroused, lack of orgasm, and painful intercourse. Treating the underlying physical and psychological problems usually resolves most female sexual problems.
Trying to get conceive, or become pregnant can be challenging, frustrating, and an emotional rollercoaster for some couples. There are things you can do to chart progress, which may ultimately lead to a successful healthy pregnancy, or, when necessary, lead to discussions with a fertility specialist. Being aware of your menstrual cycle, charting your fertility pattern, knowing the reasons for infertility, and treating infertility are key points to discuss with your partner and physician.
Women's health is an important topic area to guide a woman through the stages of her life, as well as knowing the conditions and diseases that may occur. Educating yourself so that the transitions into different phases of life is key to a healthy, happy, and productive life.
Surgical menopause happens when a premenopausal woman has her ovaries removed in a surgical procedure called a bilateral oophorectomy. An abrupt menopause follows, with women often experiencing more severe menopausal symptoms than if they were to go through natural menopause. Chemotherapy and pelvic radiation therapy may also cause menopause by damaging the ovaries.
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