Stage I (Minimal)
Findings restricted to only superfical lesions and possibly a few filmy adhesions
Stage II (Mild)
In addition, some deep lesions are present in the cul-de-sac
Stage III (Moderate)
As above, plus presence of small endometriomas on the ovary and more adhesions
Stage IV (Severe)
As above, plus larger endometriomas, extensive adhesions
Treatments While there is no cure for endometriosis, in many patients menopause (natural or surgical) will abate the process. In patients in the reproductive years, endometriosis is simply managed: the goal is to provide pain relief, to restrict progression of the process, and to relieve infertility if that should be an issue. In younger women with unfulfilled reproductive potential, surgical treatment tends to be conservative, with the goal of removing endometrial tissue and preserving the ovaries without damaging normal tissue. In women who do not have need to maintain their reproductive potential, hysterectomy and/or removal of the ovaries may be an option; however, this will not guarantee that the endometriosis and/or the symptoms of endometriosis will not come back, and surgery may induce adhesions which can lead to complications. Â In general, patients are diagnosed with endometriosis at time of surgery, at which time ablative steps can be taken. Further steps depend on circumstances: patients without infertility can be managed with hormonal medication that suppress the natural cycle and pain medication, while infertile patients may be treated expectantly after surgery, with fertility medication, or with IVF. Â Sonography is a method to monitor recurrence of endometriomas during treatments. Â It is suggested, but unproven, that pregnancy and childbirth can cease the growth of endometriosis.[citation needed]. Nevertheless, after the pregnancy, there is no guarantee that the endometriosis will not recur. Treatments for endometriosis in women who do not wish to become pregnant include:
[edit] Medication
NSAIDs not only reduce pain but also reduce menstrual flow. They are commonly used in conjunction with other therapy. For more severe cases narcotic prescription drugs may be used. Progesterone or Progestins: Progesterone counteracts estrogen and inhibits the growth of the endometrium. Such therapy can reduce or eliminate menstruation in a controlled and reversible fashion. Progestins are chemical variants of natural progesterone. Avoiding products with xenoestrogens, which have a similar effect to naturally produced estrogen and can increase growth of the endometrium. Hormone contraception therapy: Oral contraceptives reduce the menstrual pain associated with endometriosis.[16] They may function by reducing or eliminating menstrual flow and providing estrogen support. Typically, it is a long-term approach. Recently Seasonale was FDA aproved to reduce periods to 4 per year. Other OCPs have however been used like this off label for years. Continuous hormonal contraception consists of the use of combined oral contraceptive pills without the use of placebo pills, or the use of NuvaRing or the contraceptive patch without the break week. This eliminates monthly bleeding episodes. Danazol (Danocrine) and gestrinone are suppressive steroids with some androgenic activity. Both agents inhibit the growth of endometriosis but their use remains limited as they may cause hirsutism. Gonadotropin Releasing Hormone (GnRH) agonist: These agents work by increasing the levels of GnRH. Consistent stimulation of the GnRH receptors results in downregulation, inducing a profound hypoestrogenism by decreasing FSH and LH levels. While quite effective, they induce unpleasant menopausal symptoms, and over time may lead to osteoporosis. To counteract such side effects some estrogen may have to be given back (add-back therapy).
Lupron depo shot is a GnRH agonist and is used to lower the hormone levels in the woman's body to prevent or reduce growth of endometriosis. The injection is given in 2 different doses a once a month for 3 month shot with the dosage of (11.25Â mg) or a once a month for 6 month shot with the dosage of (3.75Â mg).[17] Aromatase inhibitors are medications that block the formation of estrogen and have become of interest for researchers who are treating endometriosis.[18]
[edit] Surgery Although medicine is extensively used for this condition, the most effective treatment is surgical [19]
Conservative therapy is usually applied in women where the reproductive potential needs to be maintained and consists of removal or ablation of endometriosis, adhesions, resection of endometriomas, and restoration of normal pelvic anatomy as much as is possible. It is important to preserve healthy ovarian tissue as much as possible.[2] The approach can be either by laparoscopy or laparotomy, however as laparoscopy is already used to diagnose endometriosis the surgical correction can often be performed at the same session. Further, laparoscopy has a faster recovery time and involves less hospitalization. Laparoscopic removal or ablation of endometriosis in minimal or mild endometriosis has been shown to be equal or better then expectant management, medical therapy, or surgery via laparotomy.[20] Radical therapy in endometriosis removes the uterus (Hysterectomy) and tubes and ovaries (bilateral salpingo-oophorectomy) and thus the chance for reproduction. Modifications of this approach involve preserving a healthy appearing ovary, however, this will increase the risk of recurrence.[21] Radical surgery is generally reserved for women with chronic pelvic pain that is disabling and treatment-resistant. Not all patients with radical sugery will become pain-free. The history of endometriosis is not a contraindication to the use of hormone replacement therapy as the estrogen dose in HRT is low. For patients with extreme pain, a presacral neurectomy may be indicated where the nerves to the uterus are cut. However, strong clinical evidence showed that presacral neurectomy is more effective in pain relief if the pelvic pain is midline concentrated, and not as effective if the pain extends to the left and right lower quadrants of the abdomen.[2] This is due to the fact that the nerves to be transected in the procedure are innervating the central or the midline region in the female pelvis. Â Kelly
--- On Thu, 3/19/09, Linda <lindahalford@comcast.net> wrote:
From: Linda <lindahalford@comcast.net> Subject: Re: feeling hopeless...... To: "Multiple recipients of list ADHESIONS" <adhesions@mail.obgyn.net> Date: Thursday, March 19, 2009, 10:21 AM
Endometriosis cannot be detected by a Pap Smear. I learned this the hard way! My body told me I was going through the change (all the signs were there). The male GYN I was going to said my pap was fine and I wasn't going through the change. I found a good, Christian female doctor who IMMEDIATELY said she believed from all the symptoms that I may have Endometriosis which is the first signs of cancer. She said she wanted to do a test for it because Pap Smears don't detect Endo. She did the test on my first visit to her and said it showed I had Endo. The male GYN had me on hormones which she told me to stop taking immediately as it would make the Endo grow faster. She said I needed a hysterectomy ASAP. After the surgery, I felt so much better. I never went back to that male GYN...he didn't even bother to check me further nor did he tell me Pap Smears don't show Endo. If you must have a hysterectomy and you don't plan to have anymore children, you may want to have a total one so you won't have to worry that cancer cells spilled over to the ovaries. Do men have as many problems as we women? If so, I don't hear about them that much.
>----- Original Message -----
From: Jess To: Multiple recipients of list ADHESIONS
Sent: Wednesday, March 18, 2009 8:01 AM
Subject: feeling hopeless......
I was hoping that maybe some of you may have some more suggestions... I am beginning to feel like a helpless and hopeless cause. Last March was my last laporoscopy to search for adhesions. Been having chronic pain in my right lower pelvic for about 23 months now. The lap in March showed no adhesions, yet it still feels like adhesion pain. I have had 14 operations in the past 10 years, including a full hysterectomy due to adhesions. It was a blessing to think that maybe I beat the adhesion problem, but now the doctors can't find a source for the pain. I have been dealing with my OB doctor, a neurologist, and a pain management specialist. All of whom are at a dead end road. We have done an MRI of the brain because my dad has MS, and having a 1st degree relative increased my chances of brain lesions...well the MRI was normal. Tried an illiolingual block, didn't cure anything. I am on a daily medication regimen for pain, and find that the only thing I am getting from that is probably an addiction. its been 23 months of pain med treatment as well. My team of doctors are clueless as to where to go next...just they all seem to agree to keep me on the pain meds. I was just hoping that maybe some of you may have other suggestions of things you have done or tried in the past, that maybe I could research, and just bring up to the docs. This feeling of fighting a losing battle is wearing me down. I will be 31 on the 28th, and I feel that the fighting of this for the past 10 years has really kicked my butt, in my mind, I say don't give up, but my body can't handle this anymore. My kids are living a nightmare with me cuz of this, and I don't think its fair, right, gosh, I could go on forever. So please help me if you can!!!  thanks for taking the time to listen.                       Blessings,                         Jess
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