The medical world believes endometriosis is not curable. This is not true. We have data published as a poster at the American Society for Reproductive Medicine and an ongoing study with clear evidence supporting a cure with resection of endometriosis. For many reasons too numerous to discuss here, only a handful of physicians worldwide perform complete excision of endometriosis. Traditionally, the lesions are simply cauterized or lasered which clearly does not cure the disease. Therefore, all studies that have looked at surgical treatment show short lived relief and minimal results.
This is the only disease that I know of where treatments, both surgical and medical, are promoted that don’t cure the disease. If you have a bowel or skin tumor, for example, you don’t take medicines or do an incomplete surgery, you remove them. The same should be true for endometriosis.
Sadly, this was standard of care from 1900-1975 or so when open surgery was used to evaluate and treat endometriosis. Only with the advent of the “newer, minimally invasive surgery” called laparoscopy did the inferior treatment method emerge. One of the few examples of technological advances actually setting back medical care.
With that said, excision does treat the disease of endometriosis. Our belief is that anyone with endometriosis should be treated at the first suspicion of the disease. The inflammation that is caused by endometriosis likely slowly damages the ovaries removing eggs at a faster than normal rate – hence infertility and earlier menopause. So instead of birth control pills for the adolescent, surgery with complete excision by a very experienced operator is the best course of action. The trick is that the visual appearance of endometriosis is very subtle in youngsters and wider areas should be resected from the typical distribution pattern.
It is possible to miss some microscopic disease utilizing this method, often a lesion or two on the tube or uterine surface. Even then though, the disease is dramatically reduced to a negligible amount that likely would cause no symptoms. Proof that this early intervention will prevent fertility problems or lengthen normal hormone production will be difficult and would take a 40 year longitudinal study that would be very difficult to accomplish. Based on our observations this positive outcome would be very likely.
There is support, however, both in the literature (studies) and in our experience that endometriosis excision improves the pregnancy rate immediately. This is most likely due to the removal of the intense inflammatory response in the pelvis that is consistently present throughout a woman’s life unless treated.
Michael D. Fox, MD
Christopher Lipari, MD
Jacksonville Center Reproductive Medicine
Advanced Reproductive Specialists