Diagnosis of Endometriosis

Diagnosis is usually based on:
• a woman’s symptoms
• a physical examination of the pelvic cavity
• an internal examination of the abdomen and pelvic cavity with an instrument called a laparoscope. The procedure is called a “laparoscopy”.

Laparoscopy
A laparoscope is similar to a small telescope, the doctor inserts it through the wall of the abdomen, via a small cut near the naval. It makes it easy for the doctor to examine the inside of the pelvic cavity. Special lenses on the laparoscope enable the doctor to see patches, these may be few and small or larger and numerous. The doctor may carry out some treatment through the laparoscope.

Degrees of endometriosis
• Mild appears as small patches of endometrium scattered around the pelvic cavity with no scarring
• Moderate appears as larger more widely spread patches of endometrium. They may be attached to the ovaries, fallopian tubes, uterosacral ligaments and the pouch of Douglas. Small fluid-filled bubble shaped swellings (called cysts) may be present
• Severe – most of the organs in the pelvic cavity are affected by the patches of endometrium. The uterus and ovaries are held down by scar tissue. The fallopian tubes are blocked. The bowel, bladder, uterosacral ligaments and the pouch of Douglas may have patches.

Treatment for Endometriosis

Treatment may stop the progress of the disease, several treatments are available. The choice of treatment is an individual decision.

Choice of treatments will depend on:
• severity of the symptoms
• how much endometriosis was found during the laparoscopy
• age of the woman
• the woman's plans to become pregnant
If the woman has no or few symptoms and she has no problem falling pregnant, a “wait and see” approach can be taken. However, if this approach is taken, your condition should be closely monitored by your gynaecologist. Many women with mild endometriosis are not greatly troubled by symptoms.

For women who have mild pain during their period painkillers such as aspirin or paracetamol may be enough. If the pain (or symptoms) is chronic or severe, additional treatments may be tried. These include:
1. Hormonal and natural therapies
2. Surgical treatment
3. A combination of the above treatments.

1. Hormonal and natural therapies
Hormonal therapies have been effective in treating endometriosis for some women and may be effective as a combination with surgical treatment. They have the advantage of treating very small lesions that surgery may miss. As with all prescription medication, hormonal therapies have side effects, which may differ from medicine to medicine and woman to woman. Hormonal therapies can be effective but a gradual return of symptoms may occur after treatment stops.

Treatment using the contraceptive pill
The contraceptive pill can help to relieve the pain of endometriosis in some women, especially if the tablets are taken for several months so that a period does not occur. By using the pill this way the lining of the uterus and patches in the pelvic cavity and abdomen become thin and do not bleed each month. All treatment should be according to your Doctor’s instruction.

Treatment using progesterone
Taken every day, progesterone pills usually help to relieve symptoms and, although they have few side effects, progesterone does not work as well for more serious endometriosis. Progesterone can be given as an injection once every few weeks. However, as with the pill, this is not ideal for women wishing to become pregnant. After a woman stops having injections, effects may take several months to wear off.

Other hormonal therapies
Other registered, prescription medicines also have been used to assist the treatment of endometriosis. Some are known as ‘GnRH agonists which means they prevent the release of oestrogen from the ovaries. This usually reduces the pain associated with endometriosis as well as the number and size of patches.

2. Surgical treatment
Surgery can be effective for women who have mild, moderate or severe endometriosis. The aim of surgery is to remove patches, cysts and adhesions or to repair damage caused by endometriosis. Surgery combined with hormone treatment may improve a woman's chances of falling pregnant.

Laparoscopy
The surgeon may remove patches of endometriosis as they are formed. Patches of endometrium, cysts and adhesions can be removed by cutting, diathermy and laser treatment.

Laparotomy
The surgeon opens the abdomen to find and remove large patches, cysts and adhesions or to repair damage caused by the endometriosis and restore the functions of ovaries and fallopian tubes. This is considered major surgery.

Hysterectomy
During this procedure a woman’s uterus is removed, it is for severe cases of long-term and painful endometriosis, and is only performed in women who are not planning any further pregnancies. One or both ovaries and fallopian tubes may also have to be removed. A hysterectomy is recommended if all other treatments have failed.

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