Your doctor will first of all ask you to describe the pain, it’s intensity and location. Then he will go ahead to do other physical examinations. These include:
Pelvic exam – Your doctor will feel areas around your pelvis for abnormalities as cysts on your reproductive organs or scars behind the uterus. A pelvic exam is however not enough because small areas of endometriosis are hard to find unless they form a cyst.
Transvaginal ultrasound – This is not a definite test for endometriosis but it helps locate cysts associated with the disease. Sound waves are used to produce video images of the reproductive organs by doing an ultrasound of the vaginaThe female genital canal that leads from the opening of the vulva to the cervixThe narrow outer end of the uterus that extends into the vagina. of the uterus. or pelvis.
Pelvic laproscopy – This is a definite test for endometriosis. This is a minor surgical procedure where your doctors directly visualizes the inside of your abdomen for signs of endometrial implants. This test will also provide information about the location, size and stage of the endometrial implants.
A system has been developed for staging endometriosis. The stage of the disease is not directly related to the severity of the disease but it is helpful in predicting a woman’s chances of fertility. Endometriosis is classified from minimal to severe depending on the laproscopy results.
Mild – superficial implants less that 5 cm in aggregate without significant adhesion
Severe – multiple implants including large ovarian endometriomas, thick adhesions
Endometriosis is usually treated with surgery or medication. Treatment options depend on age, severity of disease and symptoms and whether you want to have children in the future. Doctors usually recommend having surgery to be the last resort.
Medications – Your doctor will recommend taking over-the-counter pain medications like motrin, advil etc to ease menstrual cramping. However if this does not work then other treatment options may be considered to manage the signs and symptoms.
Hormone therapy – Inconsistencies in a women’s hormone during menstruation causes endometrial implants to thicken, break down and bleed causing pain. Supplemental hormones may be given to reduce or completely remove this pain. Hormonal therapies used include:
Hormonal contraceptives - Most women experience lighter and shorter periods when on hormonal contraceptives. A continuous cycle regimen of hormonal contraceptives can reduce or eliminate the pain of mild to moderate endometriosis.
Gonadotropin – releasing hormone (Gn-RH) agonists and antagonist – These drugs prevent menstruation by blocking the release of ovarian stimulating hormones. This dramtic decrease in estrogen shrinks endometrial implants. These are administered either as nasal sprays or intramascular injections. This artificial menopause causes serious side effects like irregular vaginal bleeding, hot flashes, fatigue, mood changes and osteoporosis. These side effects can be minimized by administering small doses of estrogen and progesterone in a pill form.
Progestins – These are potent birth control pills used to halt menstruation and growth of implants thereby relieving symptoms. Examples include medroxyprogesterone acetate (Provera) and norethindrone acetate (Camila, Errin)
Androgens – Danazol stimulates high levels of androgens and low levels of estrogen and blocks the production of ovarian stimulating hormones. This as a result prevents menstruation and eliminate endometriosis signs and symptoms by shrinking implants. Note however that it has high incidence of side effects like edemaAn accumulation of an excessive amount of watery fluid in cells, tissues, or body cavities., weight gain, decreased breast size, deepening of voice, hot flashes, oily skin, acne, changes in libido and mood changes. All of these side effects except changes in voice are reversible although it could take several months. Women with certain liverIt is the largest gland of the body. It is active in the formation of certain blood proteins and in the metabolism of carbohydrates, fats, and proteins, kidney and heart conditions should not take Danazol.
Aromatase inhibitors - These block the conversion of hormones such as androstenedione and testosterone into estrogen. They also block the production of estrogen from endometrial implants themselves. Examples include anastrozole (Arimidex) and letrozole (Femara). If used for a long time they may cause bone loss.
Hormonal therapies are not a permanent fix for endometriosis. Symptoms may come back if discontinued.
Surgery – If medication does not work surgery is the next step. Your doctor may perform conservative surgery to remove the implants if you are trying to get pregnant or have severe pain from the disease. The doctor removes implants, scar tissues and adhesions without removing the reproductive organ. It can be done laproscopically or throw traditional abdominal surgery in severe cases.
Hysterectomysurgical removal of the uterus and the cervix. – Surgery may also be done to remove the uterus and cervix (total hysterectomy) as well as both ovaries in very severe cases. Hysterectomy alone is ineffective as the hormones produced by the ovaries can still stimulate any remaining endometriosis to cause pain. It should be the last resort for women in their reproductive age. You cannot become pregnant after a hysterectomy.
LIFE STYLE AND HOME REMEDIES
If pain persist you can relieve symptoms at home with warm baths and heating pad to reduce cramping and relax the pelvic muscle. Increase in physical activities may also reduce the pain.
The main complication of endometriosis is infertility. Doctors usually advice women with endometriosis not to delay in having children because the condition may worsen.