Endometriosis

What Is Endometriosis?
Diagram of female anatomy with severe endometriosisDiagram of normal female anatomyEndometriosis occurs when tissue normally located inside the lining of the uterus has grown outside the uterus. It can be found on the ovaries, fallopian tubes, intestines and possibly other places in the pelvic cavity. Sometimes it can even grow outside of the pelvis.

This extra tissue may be referred to as endometrial tissue implants, or simply “implants.” During your period, this extra tissue swells with blood along with the normal tissue in your uterus. This swelling and blood can irritate nearby tissues, which can cause pain or cramps. Constant irritation may cause scar tissue known as “adhesions” to form. These adhesions can bind organs together and cause additional pain or discomfort. Adhesions may also make it difficult to get pregnant or maintain a pregnancy. In other words, adhesions caused by endometriosis can cause infertility.

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Severe Endometriosis
Endometriosis is one of the most common health problems for women.1 Symptoms are usually experienced by women in their 30s and 40s, but can occur in anyone who has menstrual periods. The exact cause of endometriosis is unknown, although there are many theories. Unfortunately, there is no cure for endometriosis, but there are several treatments for the pain and infertility it may cause.

Common Symptoms of Endometriosis
If you have endometriosis, you may have one or more of these symptoms:

  • Cramps and menstrual pain
  • Pelvic pain
  • Pain during sexual intercourse
  • Infertility

Stages of Endometriosis
The stages of endometriosis are ranked as follows: minimal (I), mild (II), moderate (III) or severe (IV). Staging of this condition depends on the number, size and site of the implants. The stage also depends on the extent of the adhesions and whether other pelvic organs are involved. The severity of your disease may not match the pain you feel. Even mild endometriosis can cause severe pain.

Diagram of normal female anatomyDiagram of stage two of endometriosisDiagram of stage three of endometriosisDiagram of stage 4 endometriosis


Endometriosis Treatment Options

Your doctor may recommend treating your endometriosis with over-the counter pain medications, hormone therapy, surgery or a combination of treatments. If your pain is severe and on-going, your doctor may recommend either endometriosis resection or a hysterectomy as a cure, depending on whether you want to preserve your uterus. Talk to your gynecologist or OB/GYN to find out the benefits and risks of each treatment and which one may be best for you.

Hormone Therapy
Hormone therapy regulates or blocks the hormones that control your menstrual cycle. Certain hormones can limit the swelling of your endometrium and implants. This treatment may be used before, instead of or after surgery. The following are different types of hormone therapies:

  • GnRH Agonists and FSH and LH Inhibitors—These medications are used to stop or lower the production of estrogen and progesterone hormones.
  • Birth control pills—These help to regulate the estrogen and progesterone in your body.
  • Progestins—A form of progesterone that helps to keep estrogen levels low.
  • Danazol—This hormone stops or lowers the production of estrogen and progesterone.

Surgery
When the symptoms of endometriosis are severe or affect a woman’s quality of life, surgery is often recommended. Surgery is often performed through open surgery techniques or, in certain cases, laproscopically. There are two surgical options for treating endometriosis:

  • Endometriosis resection—This involves removal of endometrial tissue implants while leaving the uterus in place. Endometriosis resection is usually recommended for women who want to become pregnant in the future.
  • Hysterectomy—This procedure involves removing the uterus and other organs affected by endometriosis, such as the ovaries or fallopian tubes. Hysterectomy is often recommended for patients who do not desire a future pregnancy.

Fortunately, there is a minimally invasive surgery option for treating endometriosis. This surgery is designed to overcome the limits of traditional open and laparoscopic surgery.

Robotic Surgery
Robotic surgery machineIf your gynecologist or OB/GYN recommends surgery to treat endometriosis, you may be a candidate for minimally invasive surgery. Using state-of-the-art technology, robotic surgery requires only a few tiny incisions, so you can get back to your life faster.

Just like open surgery, there are two different types of surgery performed by robotic surgery.

  • Robotic Endometriosis Resection—This procedure offers women with moderate to severe endometriosis a definitive treatment that preserves the uterus. It also offers patients the potential benefits of minimally invasive surgery. Unlike conventional open and laparoscopic surgery, a minimally invasive endometriosis resection offers the added benefit of computer and robot-assisted technology to help your doctor perform a very precise operation. The more precise, the lower the risk of the endometriosis recurring.
  • Robotic Hysterectomy for Endometriosis—If you have decided to have a hysterectomy after discussing treatment options with your doctor, you may be a candidate for robotic hysterectomy—a definitive treatment for endometriosis. Potential benefits of robotic hysterectomy compared to traditional open and laparoscopic surgery include:
    • Less pain2
    • Fewer complications3
    • Less blood loss4,5
    • Shorter hospital stay5
    • Low risk of wound infection6
    • Quicker recovery and return to normal activities7

For a physician referral, call 678-312-5000 or click here to find a doctor and search “robotic surgery.”

Request a FREE educational and testimonial DVD about robotic hysterectomies in the mail from Gwinnett Medical Center–Duluth.

1“Endometriosis”. WomensHealth.gov; The Federal Government Source for Women’s Health Information. Available from: http://womenshealth.gov/faq/endometriosis.cfm#j
2 “Hysterectomy”. Medline Plus; A Service of the U.S. National Library of Medicine – National Institutes of Health. Available from: http://www.nlm.nih.gov/medlineplus/hysterectomy.html
3National Institutes of Health., A Service of the U.S. National Library of Medicine. “Hysterectomy”. Available from: http://www.nlm.nih.gov/medlineplus/ency/article/002915.htm
4Ko EM, Muto MG, Berkowitz RS, Feltmate CM.Robotic versus open radical hysterectomy: a comparative study at a single institution. Gynecol Oncol. 2008 Dec;111(3):425-30. Epub 2008 Oct 16.
5Piquion-Joseph JM, Navar A, Ghazaryan A, Papanna R, Klimek W, Laroia R. Robot-assisted gynecological surgery in a community setting. Journal of Robotic Surgery, 2009:1-4.
6DeNardis SA, Holloway RW, Bigsby GE, Pikaart DP, Ahmad S, and Finkler NJ. Robotically assisted laparoscopic hysterectomy versus total abdominal hysterectomy and lymphadenectomy for endometrial cancer. Gynecologic Oncology 2008;111:412-417.
7Payne, T. N. and F. R. Dauterive. A comparison of total laparoscopic hysterectomy to robotically assisted hysterectomy: surgical outcomes in a community practice. J Minim Invasive Gynecol, 2008;15(3): 286-291.

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