Endometriosis is the most common cause of pelvic pain in women. It can be quite debilitating, decreasing the quality of a woman’s life as well as contributing to decreased productivity and problems with sexual relations. It is also a common cause of infertility in women. If medical therapy is no longer effective then surgical options exist to address this problem.

Surgery can be diagnostic and therapeutic. A laparoscopy can be done to diagnose endometriosis. This is typically the next step in the process if pelvic pain has not responded to nonsteriodal analgesic medication or hormonal manipulation such as birth control pills. This procedure is done under general anesthesia. A small incision is made in the umbilicus and a long scope with an attached camera and light is inserted. The abdomen is distended with carbon dioxide gas allowing visualization. Other small incisions can be made in the lower abdomen to insert other ports through which instruments can be placed to aide with visualization and to perform other maneuvers.

Visualization of the uterus, ovaries, tubes and pelvic peritoneum is easily achieved. Implants of endometriosis can be identified. Common locations include behind the uterus, on the pelvic sidewall and along the tubes and ovaries. These sites can be incised or burned. Endometriosis can also cause scarring or adhesions causing the pelvic structures to be matted together. These adhesions can be taken down via laparoscopy. This is called lysis of adhesions. A large ovarian cyst containing thick chocolate colored fluid can also be found in endometriosis. This is called an endometrioma. It can be surgically removed via laparoscopy as well. Ablating endometriotic implants, taking down adhesions and removing an endometriotic cyst can provide significant relief of the pain caused by endometriosis.

Once surgery is complete and a diagnosis of endometriosis is made, a strategy for long-term treatment should be considered. Use of a GnRH agonist such as Lupron or Zoladex is effective in treating any remaining endometriosis and contributes to keeping the disease in remission. This is usually for 6 months. Once this course of therapy is complete continued treatment with hormones such as birth control pills or progestin only therapy is ideal to prevent recurrence. Another option is to use progestins or birth control pills immediately after the surgery.

Endometriosis can recur once treatment is stopped. The recurrence rate has been reported at 45% at 5 years after treatment. For some this can be frustrating and debilitating. Definitive treatment involves a complete hysterectomy with the removal of both ovaries. This is the ultimate treatment of endometriosis however the consequence is premature menopause, which lead to other medical issues and concerns. Leaving the ovaries is another option with immediate suppressive treatment to minimize the chance of recurrence. This decision should be made in conjunction with your health care provider once all other options have been tried or at least considered.

I hope this article has provided you with information that will help you make wise choices, so you may:

Live healthy, live well and live long!