Saturday, July 28, 2007

Introduction- What is Endometriosis and Laparoscopy?

In just over one month's time, I am going to be having an operation called a Laparoscopy to treat a long-standing condition I have called 'Endometriosis'. Below are some notes that I wrote about a year ago from a small research paper I wrote on 'Endometriosis and Work'. If anybody wants to see this full document, they can contact me, or look on my other website, www.bowenworks.org

What is endometriosis?

Endometriosis is a condition in which the endometrium (the lining of the uterus) escapes into the surrounding pelvis and elsewhere.”[i] It is a condition that is so far poorly understood. The shed endometrium cause pain and inflammation as the cells attach themselves to other parts of the pelvis and grow in response to the women’s menstrual cycle. One of the likeliest reasons for endometriosis occurring was discovered by Dr Sampson in the 1920s, who developed the theory of ‘retrograde menstruation’.[ii] More recent arguments to explain the causes of endometriosis include immune factors, blood and lymph transportation theories, genetic and pollutant factors.[iii]

Diagnosis

The ‘Gold Standard’ (evidence level III) diagnosis for endometriosis is with a laparoscopy[i] The amount of endometriosis (if any) and its location can be found during a laparoscopy. If appropriate a surgeon may also remove any cysts or lesions that are found by laser or diathermy.

Images of Endometriosis

from www.emedicine.com

Management of Endometriosis

Endometriosis is often a complicated condition to manage so I am separating pain management from medical management.

Medical Management

Some women might find that they experience less pain after a laparoscopy particularly when they have had some treatment.[i] Some women might even find they can finally conceive. Both these are positive outcomes of surgery. For other women the symptoms of endometriosis can reappear again even quite a short time after surgery. This is because whilst normal menstruation continues, any remaining endometriosis, or new endometriosis continue to be fed by the woman’s hormones during the natural menstrual cycle.

There are a few well-known methods and established drug therapies that can be used to medically manage endometriosis. One is through using the oral contraceptive pill sometimes tricycling packets (combining three months medication at a time) so that a woman has fewer episodes of menstruation[i]. Another method is through use of Danazol a synthetic form of testosterone[ii]. This method results in some unpleasant side effects.[iii] Some women are treated using Depo-Provera, a form of progesterone, but again this also causes side effects and is less commonly used these days[iv]. Lastly, a group of drugs known as GnRH analogues are often used in the treatment of endometriosis. These work by reducing the FS (follicle stimulating) and LH (luteinizing) hormones and lead to lower levels of oestrogen[v]. Since it is the oestrogen that ‘feeds’ the endometriosis, this means that its growth is inhibited. HRT is given in the form of ‘add-back’ therapy to minimise the pseudo menopausal symptoms incurred by this drug regime and to ensure that bone density is retained, as far as possible.

One of the problems with any of these drug regimes is that they cannot be used for indefinite periods. In particular the use of GnRH analogues is not usually recommended for longer than 6-12 months because of concerns about osteoporosis and lack of bone density. The long-term usage (continuous usage over many years) of GnRH analogues is something that is yet to be researched, as far as I am aware.

This all means that medical treatments for endometriosis are fairly short-term, so that even if a woman is experiencing good pain relief and improvement in her symptoms that just as she starts to possibly feel well again the drugs are often stopped. This can be very frustrating, especially if the treatment has been successful.

Pain Management for endometriosis

Pain management for endometriosis is difficult because of the wide range of symptoms that it encompasses. A range of analgesia may be used including paracetamol, aspirin, NSAIDs and codeine-related products.[i] Some women who are in severe pain are occasionally hospitalised and offered morphine related drugs.

The use of TENS machine has been helpful to some women with chronic pelvic pain and endometriosis[ii] Electrical stimulation on the skin via a TENS machine distracts the pain signals and can give relief.

A nutritious diet is also important. One high in fish oils and vitamins B and E, zinc and magnesium can help with the inflammation of endometriosis.[iii] Some women also find complementary medicine can be helpful in their management of endometriosis. The most commonly used therapies are herbal medicine, homeopathy and acupuncture.[iv]

When pain becomes chronic, as it is estimated by Latthe to be a prevalence of 38 per 1000 women aged 15-73, some women might need to be referred to a Pain Management team for further support[v].

Some women with endometriosis find support groups helpful such as those run by the National Endometriosis Society, whilst others will find talking to helplines or website forums useful. These support factors are vital in managing what can often be a very lonely and isolating condition as many women find it hard to talk about gynaecological conditions.

The impact of endometriosis on a woman’s life

Endometriosis can have a profound effect on a woman’s life. In its’ worst form it can cause infertility[i]. It can also have a very negative impact on relationships since many women suffer from painful intercourse, and for some the stress and pain can be too much for a relationship to survive. The incident of relationship break-ups amongst women with endometriosis has not yet been documented.



[i] Jones G et al Measuring quality of life in women with endometriosis Journal of Human Reproduction July 06.


[i] Proctor M and Farquhar C Diagnosis and Management of Dysmenorrhoea BMJ 13.05.06

[ii]Mears Jo Coping with Endometriosis Sheldon Press 1996

[iii] Mills and Vernon Endometriosis – A key to healing through nutrition Element, 1999

[iv] Morris K Living well with Endometriosis Collins 2006

[v] Latthe P et al Factors predisposing women to chronic pelvic pain BMJ 01.04.06




[i] Proctor M and Farquhar C Diagnosis and Management of Dysmenorrhoea BMJ 13.05.06

[ii] Morris K Living well with Endometriosis Collins 2006

[iii] Morris K Living well with Endometriosis Collins 2006

[iv] Henderson and Wood Explaining Endometriosis Allen and Unwin 2000

[v] Hamilton-Fairley D Obstetrics and Gynaecology Lecture Notes Blackwell 2004



[i] Ballweg M Endometriosis – Taking Charge of your Life Endometriosis Society of the USA, 2003



[i] Kennedy and Gazvani The Investigation and Management of Endometrioisis RCOG 2000

4 comments:

Anonymous said...

just read your blog - thanks it was helpful. Im due to have my first laparoscopy on Wednesday - two days time, and am very nervous about it. This is just for diagnosis purposes only, as they are unsure if I have endometriosis or not. I only have painful periods, but they are excruiatingly painful!!

Good luck to you for everything you are going through. take care of yourself.

MizzK said...

I hope that your first laparoscopy goes well. Do feel free to post any comments back to this blog.

Don't worry too much if you get any shoulder pain afterwards as it is just trapped gas, as they pump your abdomen full of gas so that the organs are more easily visible and separated.

Wear baggy clothes afterwards as you will feel quite large for a few days.

Rest up as much as you need to, and take all the recommended painkillers.

After my first lap done in day surgery on a Monday, I was actually back in work by the Thursday, same week.

After lap number two, it took me just over a week to recover.

Lap number three took about 2 weeks to fully recovery.

As you can see there is a bit of a pattern to this. I wonder what anybody else thinks?

Do post again if you need any support!

Jimmy said...

GnRH-a , also known as the booster of the Gonadotrophin releasing hormone. It aids in decreasing the scar tissue formation caused due to surgery. This system helps in halting of menses or periods and impedes the proliferation and decreases the amount of endometrial engrafts. One should not opt for this treatment when pregnant.

hospital in mumbai said...

i read your blog, i recently had Laparoscopy

Which treatment is best for endometriosis cyst Aurvedic or Homeopathic?