Currently, the only way a diagnosis of Endometriosis can be had is via laparoscopic surgery. It is VERY important to speak to a gynaecologist who is well-versed in Endometriosis and gynaecological laparoscopy. If your doctor has never had a patient with Endometriosis before, or your doctor has never performed a pelvic/uterine laparoscopy, FIND A NEW DOCTOR.
Too often, women are given laparoscopies by surgeons who had never studied Endometriosis, or had very little training on the subject. As a result, the surgeon doesn’t know what to look for, and after all that time in the operating room, some women are told they don’t have Endometriosis, when in fact, they do. Even worse, women have reported that while Endometriosis was found at time of surgery, the doctor didn’t remove the disease – and instead closed the patient back up and handed her a diagnosis! It is VERY important to interview your surgeon ahead of time to find out how many endometriosis patients he or she has had, how many surgeries have been performed for endometriosis, and what type of surgery.
A benefit of getting a laparoscopy to diagnose Endometriosis is that the surgeon should also remove any Endometriosis found at the time of diagnosis. Many women report feeling great for weeks, months or even years after just one laparoscopy. Keep in mind that it depends upon where the disease is found and whether most or all of it was removed. Any disease left behind can still cause you just as much pain as you were in before the laparoscopy. Remember that laparoscopy is firstly for diagnostic purposes and that any relief gained from the surgery is secondary.
Types of Laparoscopic Surgery
There are two types of pelvic laparoscopy surgery:
- Cauterisation – a laser beam or electrical current is used through the laparoscope to burn off (cauterise) and break up any endometriosis lesions and adhesions that are found.
- Pro: The healing time is supposed to be much faster than excision surgery, because with the focused laser beam, there is less risk of damage to surrounding tissue.
- Con: The laser only penetrates superficial endometriosis lesions – it cannot reach down deep into the tissue to fully remove any deep endo implants.
- Excision – a tiny pair of surgical scissors, as well as surgical scalpel, is used in the laparoscope to cut out (excise) whatever endometriosis lesions are found.
- Pro: Endometriosis lesions, implants and adhesions can actually be carved out, with the diseased tissue being cleared all the way back down to healthy tissue.
- Con: The heated scalpel or scissors can catch on surrounding tissue and accidentally pull/tear it, creating more damage. Cutting out the implants means digging deeper into tissue, and means longer healing time is needed.
- WebMD article entitled, “Laparoscopic Surgery For Endometriosis”
- eMedTV article also titled, “Laparoscopic Surgery For Endometriosis”
- Medical Articles page, titled, “Surgical treatments of endometriosis: laser laparoscopy”
If you are not willing to have a laparoscopy, or your insurance will not cover it:
“There are other tests, which the gynaecologist may perform. These include ultrasound, MRI scans, and gynaecological examinations. None of these can definitively confirm endometriosis (though they can be suggestive of the disease), nor can they definitively dismiss the presence of endometriotic lesions/cysts.” – Endometriosis.org
If you have a diagnosis of Endometriosis, you will be given several treatment options, such as pain medication, hormonal treatment, and alternative medicine. It is STRONGLY ADVISED to consider all other options before requesting a hysterectomy (see also Fact or Myth? Hysterectomy cures endometriosis).
Many women opt for a hysterectomy to solve the pain of Endometriosis. However, it is important to know that if you have Endometriosis on organs outside of the uterus, cervix, fallopian tubes or ovaries, there is always the possibility that hysterectomy will NOT solve your pain problems, unless the disease is also removed from the surrounding organs. Any Endometriosis still in the body after a hysterectomy is still active Endometriosis and can flare up at any time, causing continued debilitating pain.
There are two surgical methods of performing a hysterectomy:
- Abdominal hysterectomy – an incision is made into the lower abdomen and the uterus is removed. It is important to note that your surgeon will choose the type of incision into your abdomen; either a vertical incision, which starts right below your belly button and goes to right above your pubic bone, or a horizontal (bikini line) incision, which is an incision made just above your pubic bone and following the bikini or panty line.
- Vaginal hysterectomy – an incision is made internally – the surgeon goes in through the vagina and makes an incision around the cervix, and takes the uterus out through the vagina. This works best for women who do not have a large uterus.
There are two types of hysterectomy:
- Total hysterectomy – The uterus and cervix are removed.
- Partial hysterectomy – The uterus is removed but the cervix remains intact.
In addition to hysterectomy, you may also opt to have other reproductive organs removed:
- Salpingo-oophorectomy – your ovaries and fallopian tubes are removed.
- Oophorectomy – removal of one ovary.
- Bilateral oophorectomy – removal of both ovaries
A radical hysterectomy is when the uterus, cervix, ovaries, fallopian tubes, associated lymph nodes and the top part of the vagina closest to the cervix are all removed. A radical hysterectomy is only likely to be performed if you have cancer in this region.
For more info:
- Fact or Myth? Hysterectomy cures endometriosis.
- “Hysterectomy is not a guarantee for removing endometriosis!” – EndoResolved.com
- “Hysterectomy does not necessarily cure endometriosis.” – University of Maryland Medical Center
- “If the endometrial implants are responsible for symptoms (pain with intercourse, diarrhea, painful bowel movements, painful or frequent urination) and they are not removed along with the uterus, the symptoms will not change”. – Women’s Surgery Group
- “…when a woman has her uterus removed but not her ovaries, and if endometrial deposits are present on other pelvic organs, the endometriosis is likely to continue to be a problem”. – Better Health Channel
- Definitions of hysterectomy – endometriosis.org
- All kinds of info on hysterectomy – U.S. National Library of Medicine and the National Institutes of Health
- Surgery to remove your uterus – information from MayoClinic.com