Endometriosis : Part 4

by National Institute of Health

(Page 4 of 4)

Laparoscopy involves a small cut in the abdomen, inflating the abdomen with a harmless gas, and then passing a viewing instrument with a light (called a laparoscope) into the abdomen. The surgeon uses the laparoscope to see the growths. To treat the endometriosis, the doctor can then remove the areas, a process called excising (pronounced eks-size-ing), or destroy them with intense heat and seal the blood vessels without stitches, a process called cauterizing (pronounced kaw-terr-eyes-ing), or vaporizing. The goal is to treat the endometriosis without harming the healthy tissue around it. If your surgeon is going to treat the endometriosis during your laparoscopy, he or she must make at least two more cuts in your lower abdomen, to pass lasers or other small surgical instruments into your abdomen to remove or vaporize the tissue. Doctors don't know the exact role of scar tissue in causing endometriosis pain, but some will remove the scar tissue in case it is causing the pain.

Usually, laparoscopy does not require an overnight stay in the hospital. Recovery from laparoscopy is much faster than for major surgery, like laparotomy, a procedure described below.

Major abdominal surgery, or laparotomy - is a more involved surgical procedure, which requires longer recovery time (often one-to-two months).

During laparotomy, doctors either remove the endometriosis and/or remove the uterus (a process called hysterectomy). Doctors may also remove the ovaries and fallopian tubes at the time of a hysterectomy, if the ovaries have endometriosis on them, or if damage is severe. This process is called total hysterectomy and bilateral salpingo-oophorectomy (pronounced bye-latt-ur-el sal-ping-go ooh-for-ek-toe-mee). Health care providers recommend major surgery as a last resort for endometriosis treatment. Having the surgery does not guarantee that the endometriosis will not return or that the pain will go away.

If a woman's pain is extreme, doctors may recommend more drastic procedures that cut the nerves in the pelvis to lessen the pain. One such procedure can be done during either laparoscopy or laparotomy. Another procedure, called a laparoscopic uterine nerve ablation (LUNA) is done during a laparoscopy. Because these procedures cannot be reversed, you and your health care provider will need to talk about these options in great detail before making the final decision about treatment.

What are the treatments for infertility related to endometriosis?

In vitro fertilization (IVF) procedures are effective in improving fertility in many women with endometriosis. IVF makes it possible to combine sperm and eggs in a laboratory and then place the resulting embryos into the woman's uterus. IVF is one type of assisted reproductive technology that may be an option for women and families affected by infertility related to endometriosis.

In the early stages of IVF, a woman takes hormones to cause "superovulation," which triggers her body to produce many eggs at one time. Once mature, the eggs are collected from the woman, using a probe inserted into the vagina and guided by ultrasound. The collected eggs are placed in a dish for fertilization with a man's sperm. The fertilized cells are then placed in an incubator, a machine that keeps them warm and allows them to develop into embryos. After three-to-five days, the embryos are transferred to the woman's uterus. It takes about two weeks to know if the process is successful.

Even though the use of hormones in IVF is successful in treating infertility related to endometriosis, other forms of hormone therapy are not as successful. For instance, hormone therapy that prevents a woman from getting her period, or from ovulating each month, does not seem to improve infertility related to endometriosis. But, researchers are still looking into hormone treatments for infertility due to endometriosis.

Laparoscopy to remove or vaporize the growths in women who have mild or minimal endometriosis is also effective in improving fertility. Some studies show that surgery can double the pregnancy rate. You can review the What are the surgical treatments for endometriosis pain? section of this publication for more information on laparoscopy.

Is endometriosis the same as endometrial cancer?

Endometriosis is not the same as endometrial cancer. Remember that the word endometrium describes the tissue that lines the inside of the uterus. Endometrial cancer is a type of cancer that affects the lining of the inside of the uterus. Endometriosis itself is not a form of cancer.

Does endometriosis lead to cancer?

Current research does not prove an association between endometriosis and endometrial, cervical, uterine, or ovarian cancers. In very rare cases (less than 1 percent) endometriosis is seen with a certain type of cancer, called endometrioid cancer; but, endometriosis is not known to cause this cancer.

But, scientists still don't know what causes endometriosis or what its mechanisms are in the body. In addition, many women are never diagnosed as having endometriosis, which makes linking the condition to other diseases more difficult.

For this reason, women who are diagnosed with endometriosis need to be especially watchful of changes to or in their bodies; they need to communicate these changes to their health care providers as soon as possible, to ensure their own health.

Does endometriosis ever go away?

In most cases, the symptoms of endometriosis lessen after menopause because the growths gradually get smaller. For some women, however, this is not the case.

About the Author

NIH is the nation's medical research agency - making important medical discoveries that improve health and save lives. The National Institutes of Health (NIH), a part of the U.S. Department of Health and Human Services, is the primary Federal agency for conducting and supporting medical research.