Laparoscopic Treatment of Endometriosis
Endometriosis is a condition that causes pelvic pain, painful periods, and infertility. Endometriosis is caused by the cells of the inside of the uterus migrating to a different location. The cells on the inside of the uterus, called endometrial cells, are normally built up and shed as a period each month. In some women these cells are misplaced on the inside lining of the abdomen. Since this is not their usual location, the body sees these as “foreign” cells; a reaction much like an infection then occurs with inflammation and scarring. This reaction is what causes the pain with endometriosis. Pain of endometriosis often worsens gradually because the misplaced endometrial cells bleed each month at the same time as a period. The cyclic bleeding causes more inflammation each month, which gradually leads to more scarring and pain.
There are two broad categories of management of endometriosis: treatment and cure.
Treatment of Endometriosis
The treatment of endometriosis is by either medicine or surgery. Medicine treatment of endometriosis is done by either birth control pills, progesterone, or Lupron. Birth control pills and progesterone treat the endometriosis by decreasing the amount of bleeding each month. This decreases the stimulation of the existing endometriosis and also decreases the amount of new endometriosis that forms.
Lupron is a menopause medicine that temporarily stops the stimulation of endometriosis. Lupron stops endometriosis by stopping the production of estrogen and progesterone from the ovaries. When no estrogen and progesterone is made from the ovaries, the endometriosis is completely inactive and does not cause pain or scarring.
Surgical treatment of endometriosis involves laparoscopic removal of endometriosis. Laparoscopic surgery is done using a camera placed through a one quarter inch incision in the belly button. Two or three other incisions also one quarter inch in diameter are placed in various areas in the abdomen for surgical instruments. Laparoscopic treatment of endometriosis completely removes all visible spots of endometriosis and scar tissue using a laser. Laser laparoscopic treatment of endometriosis is the best way to treat the pain of endometriosis. This is because all spots of endometriosis are removed, therefore the body no longer needs to respond using inflammation and scarring. The scar tissue that is present as a result of the existing endometriosis is also removed at the time of surgery. The removal of scar tissue markedably decreases the pain that is present all throughout the month, at ovulation, and with intercourse.
Cure for Endometriosis
The cure for endometriosis is menopause. Menopause happens in three ways: (1) natural, (2) medical, and (3) surgical.
(1) Natural menopause usually happens around age 50. The definition of natural menopause is no periods for one year. This happens when the ovaries stop making estrogen and progesterone. When there is no estrogen to build up the endometriosis and no progesterone to tell it to bleed, the endometriosis becomes inactive. It then goes dormant and no longer causes inflammation or pain.
(2) Medical menopause is caused by medication called Lupron. Lupron is a shot that is given for temporary menopause. This is done for a specific short term goal as one of the facets of the treatment of endometriosis. An example is to make endometriosis dormant for several months while waiting to get pregnant.
(3) Surgical menopause happens when the uterus and ovaries are removed. This is the cure for endometriosis in women who have finished childbearing and are having too much pain to wait for natural menopause. The uterus and ovaries can be removed laparoscopically, and the endometriosis can be treated at the same time. This is done laparoscopically with 4 small incisions in the abdomen. It requires an overnight stay and a two to four week recovery. Most women who choose a complete hysterectomy for endometriosis have great pain relief and remarkably improved quality of life.
Hysterectomy Without Menopause
For the past several years, Dr. Maikis has been recommending removing the uterus and only one ovary for the treatment of endometriosis. This surgical approach has all the benefits of a “total” hysterectomy without the side effects of immediate menopause. There is a small chance of recurrence of pain if the endometriosis continues to grow, but the vast majority of women have complete pain relief with intact hormones.
Endometriosis is a condition where the cells in the lining of the uterus (endometrium) instead of shedding and bleeding as a period are misplaced on the inside of the abdomen. These cells surround the organs inside the abdomen (ovaries, bowel and bladder) and cause pain. When the lining of the uterus bleeds, the endometriosis cells in the abdomen also bleed. The body’s inflamatory reaction to these misplaced bleeding cells cause pain and scarring in the abdomen. Removing the uterus and ovaries is the best cure for endometriosis. This is true for 2 reasons:
1. The uterus is removed so no new endometriosis can form.
2. The lining of the uterus and the endometriosis cells both grow in response to the cyclic hormones, estrogen and progesterone, that come from the ovaries. When there is no estrogen and progesterone to stimulate the endometriosis, the cells do not bleed. When the cells do not bleed they become inactive and do not stimulate the body’s inflammatory reaction. The pain with endometriosis is more likely to be decreased when the uterus and ovaries are removed because the endometriosis is inactive.
Endometriosis and Infertility
Endometriosis decreases fertility. The probable way that it decreases fertility is by creating an environment inside the pelvis that is toxic to eggs. An egg is released from the ovary at ovulation, and needs to be picked up by the fallopian tube. Before it goes into the fallopian tube, it is exposed to the environment inside the pelvis. The body’s response to endometriosis is to bring its inflammation cell to try to heal the endometriosis from within. This inflammatory environment is toxic to eggs. Laparoscopic treatment of endometriosis removes endometriosis. The body then does not have to create inflammatory cells to heal the endometriosis on its own.
Endometriosis causes infertility by causing scar tissue in the pelvis. This scar tissue can move the ovaries and fallopian tubes away from each other, can block the eggs from releasing from the ovary, and can block the fallopian tube from picking up the egg after ovulation. Removing scar tissue at laparoscopic surgery can improve all of these mechanical blockages caused by endometriosis.
