From a presentation by Brad Campbell, MD, McLeod OB/GYN Associates Paul Chandler, MD, McLeod Women’s Care

Endometriosis – a condition when tissue from inside the uterus starts to grow outside – can trouble a woman as young as 16 years old. Three McLeod Gynecologists discussed the range of treatments to a group of 100 women:

Here are the key points from their presentation:

DR. CAMPBELL

Most physicians would start you on birth control to see if hormone treatment alone will help. If that doesn’t improve your symptoms, the next step would be to do Lupron. If that has failed in the past or you don’t want to be encumbered by the side effects of that, then we might try a laparoscopy, where we insert a camera through your belly button. We would find the endometriosis from inside the pelvis. If we see endometriosis on the ovaries, uterus, bladder, and sometimes on the intestines, we can remove it.

Most women will have a good result from that procedure. Combined with oral contraceptive pills thereafter, it will prolong your pain-free time. However, endometriosis is a problem that will re-occur until you go through a hysterectomy or menopause.

DR. CHANDLER

To simplify things: You have medical therapies and you have surgical therapies. Then, you have conservative surgical therapies, such as laparoscopy. You go in and cut out or cauterize (burn) to destroy whatever you see.

The medical therapies cover a wide range of treatments. One can do high-dose progestin therapies, such as Aygestin or Norethindrone. One can do birth control pills or an IUD. The Mirena IUD is very good for women with endometriosis. The goal is to stop a woman’s periods. If we can stop the periods, we’ve stopped the process, where the blood comes from the uterus and goes out of the fallopian tubes into the pelvis. If we can stop that process, many times we can reduce pelvic pain.

Let me mention the DaVinci robotically-assisted procedure. It offers a high-tech way to perform a laparoscopy. The robotic unit sits at the bedside. The physician sits at a console, controlling the robot. The advantages in endometriosis surgery include better visualization. You can see better where that endometriosis is.

The robot uses two cameras to create a 3-dimensional view in the pelvis. The instruments are more flexible in manipulation, allowing the surgeon to remove the endometriosis without damaging the other organs.

Many times we’ll alternate between medical and surgical therapies. One of my patients first had endometriosis when she was 16 years old. We tried all kinds of medical therapies, but nothing works. So we went back and did a second laparoscopy. Never count that out; it’s always a good option.

If you want to have a baby, pregnancy works great in treating endometriosis.

You may also find these articles helpful:

Don’t Delay in Seeking Help for Your Endometriosis

Endometriosis – What Women Need to Know

Myomectomy – Removing Fibroids, Yet Retaining Fertility

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