- If you think you might have this disease,
talk with your OB/GYN (obstetrician/gynecologist), since she or he is
the only type of doctor trained to look for this condition. There are a
number of tests a doctor can perform to try to find out if you have
endometriosis. Sometimes, imaging tests are used to make a "picture" of
the inside of the body, which allows a doctor to locate larger
endometriosis areas. The two most common imaging tests are ultrasound, a
machine that uses sound waves to make the picture, and magnetic
resonance imaging (MRI), a machine that uses magnets and radio waves to
make the picture.
The only way to know for sure if you have endometriosis is to have a
laparoscopy. This is a surgery with general anesthesia in which a
tube with a light is placed inside your abdomen. The surgeon can then
check your organs and see any growths or tissue from endometriosis. This
procedure will show the location, extent, and size of the growths and
help you and your doctor make better treatment decisions. Before
surgery, you will need to discuss your medical history with your doctor,
and have a physical (pelvic) exam.
What causes endometriosis?
No one knows for sure what causes this disease. One theory is that
during menstruation some of the menstrual tissue backs up through the
fallopian tubes into the abdomen, where it implants and grows. Another
theory suggests that endometriosis may be genetic, or runs in families.
Researchers also are looking at the role of the immune system and how it
either stimulates or reacts to endometriosis. It may be that a woman's
immune system does not remove the menstrual fluid in the pelvic cavity
properly, or the chemicals made by areas of endometriosis may irritate
or promote growth of more areas.
Other researchers are looking into endometriosis as a disease of the
endocrine system, the body's system of glands, hormones, and other
secretions, since estrogen appears to promote the growth of the disease.
What is the treatment for endometriosis?
There is no cure for endometriosis. But there are many treatments, each
of which has pros and cons. It is important to build a good relationship
with your doctor, so you can decide what option is best for you.
Pain Medication
For some women with mild symptoms, no further treatment other than
medication for pain may be needed. For women with minimal endometriosis
who want to become pregnant, doctors are saying that, depending on the
age of the woman and her amount of pain from the disease, the best thing
to do is to have a trial period of unprotected sex for six months to one
year. If she does not get pregnant in that time, then further treatment
may be needed.
Hormone Treatment
For patients who do not wish to become pregnant, but need treatment for
their disease, their doctors may suggest hormone treatment. Hormone
treatment is most effective when growths are small. Hormones can come in
pill form, by shot or injection, or in a nasal spray. There are several
hormones used for this treatment including a combination of estrogen and
progestin such as birth control pills, a progestin alone, Danocrine (a
weak male hormone), and GnRH agonists (gonadotropin releasing hormone).
Birth control pills control the growth of the tissue that lines
the uterus and often decrease the amount of menstrual flow. They usually
contain two hormones, estrogen and progestin. Once a woman stops taking
them, the ability to become pregnant returns, but the symptoms of
endometriosis also may return. Some women take birth control pills
continuously, without using the sugar pills that signal the body to go
through menstruation. When birth control pills are taken in this way,
the menstrual period may stop altogether, which can reduce pain or get
rid of it entirely. Some birth control pills contain only progestin, a
progesterone-like hormone. Women who can't take estrogen use these pills
to reduce menstrual flow. With these pills, some women may not have pain
for several years after stopping treatment. All birth control pills
might cause some mild side effects like weight gain, bleeding between
periods, and bloating.
Danocrine has become a more common treatment choice than either
progestin or combination hormone pills. Side effects with Danocrine
include oily skin, pimples or acne, weight gain, muscle cramps,
tiredness, smaller breasts, breast tenderness, headaches, dizziness,
weakness, hot flashes, or a deepening of the voice. Women on Danocrine
probably will only get a period now and then, or might not get it at
all. Women who take Danocrine also should take steps to prevent
pregnancy because it can harm a baby growing in the uterus. Because
other hormones, like birth control pills, should be avoided, health care
providers recommend that you use condoms, a diaphragm, or other
"barrier" methods to prevent pregnancy.
GnRH agonists (used daily in a nose spray, or as an injection
given once a month or every three months) prevent the body from making
certain hormones to prevent menstruation. Without menstruation, the
growth of endometriosis is slowed or stopped. These medications can
cause side effects, such as hot flashes, tiredness, problems sleeping,
headaches, depression, bone loss, and vaginal dryness. Most health care
providers recommend that a woman stay on a GnRH agonist for about six
months. After that time, the body will start having a period again and a
woman could get pregnant. But, after that time, about half of women have
some return of their endometriosis symptoms.
Surgery
Surgery is usually the best choice for women with extensive
endometriosis, or those with severe pain. There are both minor and major
surgeries that can help. Your doctor might suggest one of the following
surgical treatments:
-Laparoscopy - also used to diagnose the disease, your doctor can
treat you with this surgery as well. If your doctor is going to treat
the endometriosis during this surgery, he or she must make at least two
more cuts in your lower abdomen, to pass lasers or other small surgical
tools into your abdomen. Then he or she will remove the growths and scar
tissue or destroy them with intense heat and seal the blood vessels
without stitches. The goal is to treat the endometriosis without harming
the healthy tissue around it. Recovery from laparoscopy is much faster
than for major surgery, like laparotomy.
-Laparotomy - this is a last resort for endometriosis treatment
because it is major abdominal surgery in which your doctor either
removes the endometriosis and / or removes the uterus (a process called
hysterectomy). He or she also might remove the ovaries and fallopian
tubes at the time of a hysterectomy, if the ovaries have endometriosis
on them, or if damage is severe. Having the surgery does not ensure that
the disease will not return or that the pain will go away.
How do I cope with a disease that has no cure?
You may feel many emotions - sadness, fright, anger, confusion - and
feel alone. It is important to get the support you need to cope with
endometriosis. It is also important to learn as much as you can about
the disease. Talking with friends, family, and your health care provider
can help. You might want to join a support group to talk with other
women who are going through the same thing.
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