I've had two surgeries already and my Endometriosis has come back both times. What is different about the way you surgically remove endometriosis so that it doesn't return?
Many surgeons who perform laparoscopy to treat endometriosis, although well intentioned, only remove the surface of the disease. With Deep Laparoscopic Excision, the root that lies below the surface is also removed, leaving clean margins. This virtually eliminates the possibility of endometriosis returning. In contrast, vaporization, fulguration and other superficial methods of removal have a 40-60% recurrence rate in the very first year following those types of surgery. This is because only the shallow top layer of disease is removed, leaving behind the deeper root, as opposed to excision, which removes all the endometriosis. You can learn more about excision by exploring our website or calling our offices today.
How does Endometriosis affect fertility?
Endometriosis is a leading cause of female infertility and is known to cause primary or secondary infertility in nearly half of women with the disease. There are several associations between the two. First, adhesions that result from the disease can distort pelvic anatomy, impair oocyte release from the ovary, or inhibit ovum pickup or transport. Secondly, altered peritoneal function has been demonstrated in women with the disease. As such, there is an increased volume of peritoneal fluid, including inflammatory enzymes like macrophages, prostaglandins, interleukin-1, tumor necrosis factor (TNF) and proteases. In addition, altered hormonal and immunoglobulin factors, including IgG and IgA antibodies and lymphocytes, are also increased in the endometrium. These abnormalities alter endometrial receptivity and embryo implantation, and the resultant altered - and decidedly hostile – pelvic environment is not conducive to fertility.
There is also recent evidence to suggest that disorders of the endometrial function may contribute to infertility in women with Endometriosis, and in fact, predispose them to the disease. Reduced endometrial expression of certain cell adhesion molecules during the time of implantation have been detailed in some patients with the disease, lending credence to this hypothesis.
Still other women with Endometriosis also suffer from comorbid endocrine and ovulatory disorders, including luteinized unruptured follicle syndrome, luteal phase dysfunction, abnormal follicular growth, and premature as well as multiple luteinizing hormone surges. These may have a detrimental effect on fertility as well.
With proper surgical treatment, however, a normal pelvic environment can be restored and infertility may be resolved, even in stage III and IV patients. Contact us to learn more.
I was told to have a total hysterectomy, as it would “cure” my endometriosis. Is this true?
In a word, no. While hysterectomy (removal of the uterus) can be helpful for patients with conditions such as adenomyosis, “frozen pelvis” and other related disorders, it should never be considered a first-line treatment for endometriosis. By its very nature, endometriosis is the presence of ectopic endometrial glands and stroma, aberrantly implanted elsewhere in the body. Removal of the uterus does simply that…removes the uterus. It does not address disease implants on the bowel, urogenital tract, in the cul-de-sac, or anyplace else in the abdominopelvic region. This is also true of oophorectomy (removal of the ovaries) and salpingectomy (removal of the tubes). The notion behind this outdated myth is that if a patient ceases to have a period, she will cease to have pain as a result of her endometriosis. Indeed, it is upon this erroneous reasoning that a host of treatments arose over time, i.e. medical suppression. In fact, endometriosis implants produce their own estrogen-synthesizing enzyme known as Aromatase. This enzyme essentially allows the endometriosis to continue thriving in absence of a normal period. The key to treating endometriosis effectively is to remove all disease from all areas through the careful application on surgical excision. In many cases, otherwise healthy organs can and should be preserved.
My doctor told me endometriosis could be treated and even resolved if I got pregnant. Though I’m not really ready for a child, should I follow this advice?
As above, the outdated notion that if a woman “does not have menses, she cannot have pain from endometriosis” is the basis behind this flawed reasoning. While it is true that many patients do feel markedly improved throughout their pregnancy, there is no guarantee that she will not experience recurrence in the months immediately following delivery. Pregnancy suppresses symptoms (in some cases); it does not treat the disease in any way. Additionally, there is recent research indicating that endometriosis in pregnant women is a major risk factor for premature birth, as well as a higher risk of other complications such as pre-eclampsia, and being more likely to give birth through Caesarean section [Hum Reprod. 2009 Sep;24(9):2341-7. Epub 2009 May 12]. Indeed, pregnancy is not something that can be “prescribed” nor is it a “treatment” for endometriosis.
I’m only 17. Am I too young to have Endometriosis?
No. Endometriosis has been found in patients of all ages (including an infant autopsy). The disease can and does exist in the adolescent population, and in fact, studies have shown that as many as 70% of teenagers with chronic pelvic pain went on to have endometriosis proven by laparoscopy. Other reports have indicated that as many as 41% of patients experienced endometriosis pain as an adolescent. Moreover, data indicates that the disease may have an even bigger impact on younger patients versus older women in terms of disease recurrence (double that of older women) and hormonal activity. Dull aching and cramping can occur during menstruation in many women and teens, due to uterine contractions and the release of various hormones, including those known as prostaglandins. However, period pain that becomes so debilitating it renders you unable to go about your normal routine is not ordinary or typical; pain is your body's way of signaling that something is WRONG. If you are suffering from pelvic pain at any point in your cycle, an endometriosis diagnosis should be considered.