Every
month when the uterus contracts to squeeze out the
endometrial lining during menstruation, some tissue
and blood is propelled backward through the
fallopian tubes and into the abdominal cavity. Since
we have been doing laparoscopies, we have observed
that this backflow probably occurs among all women.
However, it does not always cause problems. Most
women's bodies are able to resist the implantation
of endometrial tissue in surfaces surrounding the
uterus. In other women, there are varying degrees of
resistance, leading to anything from mild to severe
endometriosis.
Current medical thinking holds that
women with endometriosis have some immunological
defect that renders them incapable of rejecting
implantation of misplaced endometrial tissue. In
other words, their immune systems are unable to
mount a defense against the implants.
Most commonly, endometrial implants
lodge either in a pouch-like area behind the uterus
called the cul de sac and/or around the fallopian
tubes. Endometrial tissue can also attach itself to
the ovaries. If it does, the monthly blood flow
becomes trapped, leading to the formation of a cyst
called an endometrioma. When the endometrial tissue
is forced into the wall of the uterus and takes
root, the condition is called adenomyosis. The blood
and tissue shed each month become trapped in the
wall. Adenomyosis can be extremely painful and may
cause heavy bleeding or infertility. The condition
is often indistinguishable from
fibroids.
The Goal of
Treating
Endometriosis
-
Relieve pain,
-
Shrink
endometriosis or slow its growth,
-
Remove the
endometriosis,
-
Maintain or
restore fertility.
Remarkable new drugs as well as some
very sophisticated surgical techniques have made it
possible to eradicate endometrial implants and
associated adhesions simply and quickly by endoscopy
or laparoscopy. However, even the latest approaches
have their limitations.
Laparoscopy in the treatment of Endometriosis
The aim of surgery is to remove as
much of the endometriosis as possible while
maintaining the woman’s ability to have children.
Surgery is recommended if:
-
The pieces of
endometriosis are larger than 4–5cm (1.5–2
inches),
-
There are many
adhesions or they are interfering with the
normal workings of internal organs such as the
bowel,
-
The endometriosis
is blocking the Fallopian tubes and causing
infertility,
-
There is severe
pain, which cannot be controlled with
painkillers or hormones.
The endometriosis may be cut away, or
destroyed with heat produced by an electric current
or by using a laser. This can often be done by
laparoscopy, using small incisions in the belly and
a telescope to view the inside of the pelvic area
(keyhole surgery) done on an outpatient basis.
Surgical devices in use include
Electrosurgery, Laser,
Cavitational Ultrasonic Surgical Aspirator (CUSA),
Harmonic Scalpel and others.
Endometriosis-The Latest Drugs
Two types of drugs are the mainstays
of endometriosis treatment today. They are Danocrine
and GnRH agonists. These drugs have the same effect:
They induce a transient block in estrogen
production. Since the endometrial tissue requires
estrogen to grow, endometriosis is temporarily
halted.
