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Diagnosing and Treating Endometriosis

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Updated November 12, 2009

How is diagnosis of endometriosis made?

Currently, the only way to definitively diagnose endometriosis is through laparoscopy (surgery in which a lighted scope is inserted into small incisions in the abdomen). Because visual diagnosis can be tricky, suspected endometriosis is often removed and sent to pathology for histological confirmation.

Physicians who treat endometriosis frequently may be able to feel endometriosis nodules during a pelvic exam and make a preliminary diagnosis based on their findings and a woman's history of symptoms. However, laparoscopy plus biopsy will show conclusive evidence of the disease as well as its extent; and often, treatment can be done at the same time.

What are the stages of endometriosis?

Although there have been attempts at revising the current staging of endometriosis, many physicians use The American Society for Reproductive Medicine's Revised Classification of Endometriosis . The staging form assigns points, based on the location and depth of the endometriosis. The stages are as follows: Stage I (Minimal) 1-5 points Stage II (Mild) 6-15 points Stage III (Moderate) 16-40 points Stage IV (Severe) 40 points ++

Stage often does not correlate to the level of pain a woman may experience.

What are the treatments for endometriosis, at each stage?

Treatment doesn't really depend on the stage of endometriosis as much as on the patient's symptoms and goals. For example, some of our support group members are mainly concerned about pain management while others are interested in preserving their fertility. The treatments for women who want to retain their reproductive organs may be different from those whose chief complaint is pain.

A number of treatment options exist, but with each option, the patient has to weigh the risks versus the benefits. Drugs used to treat endometriosis include those that put a woman into chemical menopause (GnRH agonists and danazol) and those that attempt to shrink endometriosis lesions by stopping ovulation (birth control pills and progesterone- only pills or shots). Side effects may be significant with many of these drugs, and recurrence after stopping treatment is a problem.

Conservative surgery is another treatment option. The aim of surgery is to remove or destroy endometriosis and to restore distorted anatomy. When the endometriosis is removed, pain may be relieved. If endometriosis is interfering with fertility, surgery may be able to correct these problems. Today, endometriosis surgery in the United States most often involves the use of the laparoscope. Many qualified physicians can diagnose and treat the disease during laparoscopy. However in cases where endometriosis is extensive (such as when a bowel resection is required), a more extensive surgery called laparotomy may be required. A laparotomy requires a large abdominal incision and recovery time is much longer.

Sometimes it becomes necessary for a woman to opt for radical surgery, including removal of the uterus and ovaries, as well as removal of all endometriosis lesions. This is perhaps the hardest decision women with endometriosis face.

Other treatment options include simply treating the pain with painkillers, whether an over- the- counter variety or prescription painkillers. Alternative pain control techniques have been used by our members, including nerve blocks and acupuncture. Because endometriosis symptoms often continue even after treatment, some women have found non- traditional means of alleviating symptoms, including herbal remedies, aromatherapy, dietary modifications, vitamin supplements, relaxation techniques, allergy management, and immunotherapy.

What is the cost of treatment for endometriosis?

It depends on the type of treatment selected. The more expensive treatments are those that involve the newer drugs (GnRH agonists for example) and those that involve surgery. Injections of GnRH agonists cost several hundred dollars per injection (usual treatment is six months). The cost of surgery depends on your locale and the extent of your surgery. Typical outpatient laparoscopy is usually in the range of $12,000 to $15,000 in the U.S. If the surgery is extensive and the woman is admitted for a few days, it could be twice as high.

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