After your initial diagnosis of endometriosis, your medical care team can begin your treatment plan. If you have not yet been diagnosed, but suspect you do have endometriosis, you can expect one or more of these tests and procedures to confirm your diagnosis:
–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 ultrasound 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.
How is endometriosis treated?
There are many different ways to go about treating endometriosis, and all of those ways involve medication or surgical intervention. The method that your medical care team suggests will depend on how severe our 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 home 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.
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.
I have heard that women with endometriosis cannot conceive a child. Is this true?
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, or stopping the sperm and semen from being able to bypass this blockage to fertilize the egg. If you are having trouble getting pregnant, your doctor may recommend fertility treatments given by a fertility doctor. These treatments can range from stimulating your ovaries to make more eggs, 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 medical care team.
I have severe endometriosis and am out of my childbearing years. The pain is intense, and I just want it to be over. What will my options be?
In these severe cases, after other treatments have stalled or failed, many specialists will suggest a hysterectomy with removal of the ovaries, called an oophorectomy. This is usually the last option, 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 menopause, which can improve the pain and symptoms of endometriosis in some women. 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.
If you have been diagnosed or will soon be diagnosed with endometriosis, be sure you have found a doctor you are comfortable working closely with and one that gives you treatment options you are comfortable with. Be sure to follow all care tips and treatments prescribed to see the best results for living with endometriosis, being treated, and prepared for the possible return.
Resources Used:
ACS
WebMD
NIH
Reclaiming Intimacy