Endometriosis (cont.)
Surgical treatment of endometriosis
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 growth of endometrial tissue
(cells that normally grow inside the uterus (womb), 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 by the practitioner by 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.
Previous medical author contributors:
Leon J. Baginski, MD, FACOG, and Carolyn J. Crandall, MD, FACP
Last Editorial Review: 6/25/2008
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