Endometriosis is truly a debilitating disease for many and it may present in several different ways. The article brings up many good points and through my experience as an endometriosis surgeon and in reading the individual comments, it is truly something that can have a significant impact on the quality of life, whether one is attempting to build a family or not. As a physician, it is truly frustrating that women are dealing with pain for years upon years without a diagnosis. It impacts everything – school/work/relationships… the list, unfortunately, goes on.
Although this article mentions an “endometrioma,” most women with endometriosis have completely normal findings on ultrasounds, CT scans, and MRI. That being said, their lives have been negatively impacted by something that is underdiagnosed. As a matter of fact, women are passed from doctor to doctor, usually initiated on birth control pills, and instructed to take some NSAIDs. The disease unfortunately progresses.
Our patients are diagnosed by a combination of “listening” to the symptoms and utilizing very basic testing. Our diagnostic accuracy is extremely high. As physicians, we learn that many times we can make the diagnosis simply by listening to a patient tell their story and I can’t tell you how true that really is!
I would agree also that endometriosis should be treated like cancer in that it should be excised. Our philosophy is that wide, peritoneal excision is the only way endometriosis should be treated. In the same way that a cancer surgeon attempts to excise all evidence of disease, both visible and microscopic, so should the endometriosis surgeon excise endometriosis. We feel that women that have multiple surgeries for endometriosis when it is cauterized is due to the persistence of lesions that are missed or not fully treated.
One of the comments highlighted the fact that hysterectomy is not the treatment for endometriosis and I couldn’t agree more. Although it is an effective treatment for adenomyosis, it does not manage the endometriosis. Women that have both conditions may have persistent pain after a hysterectomy. It is essential to excise endometriosis at the time of hysterectomy. Other more conservative ways to manage adenomyosis are available including presacral neurectomy which is a great option for many that desire to have a family in the future.
The last thing I would like to mention is the impact of endometriosis on fertility. Many believe it is due to scarring and problems with the fallopian tubes. In actuality, most women with endometriosis have open tubes. The condition causes a significant inflammatory reaction that can influence egg quality, endometrial (uterine) receptivity, and more importantly, egg reserve. We have performed several studies highlighting the fact that endometriosis is associated with diminished ovarian reserve. Since women are born with all of the eggs they will ever have, losing them at a more accelerated rate can significantly hinder one’s ability to build a family. We perform ovarian reserve testing on women that have endometriosis to provide them with information for the future. When should I start to try for a family? How long should we wait between children? If I don’t want to have a child now, is there something I can do to preserve fertility? These are questions that I help women find the answers to every day. Endometriosis may pose many struggles – debilitating pain, hormonal implications, fertility issues, or a combination thereof. As a physician, we need to be able to provide an effective plan for each.
Christopher W. Lipari, M.D.
Reproductive Endocrinology and Infertility
Jacksonville Center Reproductive Medicine
Advanced Reproductive Specialists