Endometriosis is a relatively common disorder of the female reproductive system. It occurs when endometrial tissue, which is supposed to grow only inside the uterus, develops not only in the uterus but also in other parts of a woman's body. (Usually in the lower abdomen and pelvic area, for example, or in the fallopian tubes and ovaries. However, in some cases, endometrial tissue has been found inside a patient's digestive tract.) The "intended" function of this endometrial tissue is to form a protective layer inside the uterus in which a fertilised embryo can implant and be nurtured should a woman become pregnant. The tissue grows over the course of a woman's menstrual cycle and is normally flushed out when she has her period. Endometrial tissue which grows outside the uterus, however, has no way to escape the body and therefore builds up over several menstrual cycles, causing painful symptoms. It also causes infertility in some patients, which may be reversed by surgery. Before we discover how surgery can help, we need to understand how endometriosis can make a woman infertile in the first place.
Endometriosis And Infertility
Approximately 40% of endometriosis sufferers struggle to conceive. The build up of endometrial tissue outside the uterus can cause cysts, scarring and adhesions (when organs get stuck together), as well as blockages, inside the pelvis and abdomen. This can cause reproductive organs such as the fallopian tubes and ovaries to adhere to the lining of the pelvis or to one another. It may force reproductive organs out of position, which can prevent the successful transfer of a woman's eggs from her ovaries to her fallopian tubes, leaving no egg available for her partner's sperm to fertilise. The same effect can be created by clumps of endometriosis blocking the fallopian tubes. It's also possible that the build up of endometrial tissue causes the over-production of prostaglandins, hormones which may interfere with the processes of fertilisation and embryo implantation.
Who Is A Candidate For Surgery?
Surgery may be the best option for women who want to get pregnant, but you should discuss all your options with your gynaecologist. Pain-killers such as ibuprofen can successfully treat painful symptoms in women who are lucky enough not to have any fertility problems or are not interested in having children at that time. Hormone treatments may also be used but these may interfere with your ability to get pregnant.
How Does Surgery Help?
Surgery for endometriosis will initially aim to remove endometrial implants (clumps of endometrial tissue) from places where they shouldn't be (the fallopian tubes, the ovaries, etc.), as well as to drain any large cysts and separate any organs which have become stuck together. The idea is to allow the reproductive system to start functioning normally again. The removal of the endometrial tissue should also reduce the painful symptoms of endometriosis and improve quality of life. In extreme cases, more radical surgery, such as the removal of parts of the reproductive system, may be recommended. This course of action is usually taken only if the patient is sure that she doesn't want to have any more children.
Types Of Surgery
The type of surgery performed will depend on the location of the endometrial tissue within the patient's body and the severity of her symptoms.
Laparoscopy - this surgical procedure (also known as keyhole surgery) is commonly used in the diagnosis and treatment of endometriosis because it is considered less taxing on the body than other types of surgery. It is often but not exclusively performed under general anaesthetic. One or more small incisions are made in the patient's lower abdomen, through which a laparoscope (like a miniature telescope) and surgical equipment are inserted into the affected area and used to remove endometrial tissue.
Laser surgery - laser surgery may be used as part of a laparoscopy procedure. Here, a laser is used instead of a scalpel to burn away cysts and cut away adhesions and implants. The advantages of the laser are that it is more precise and, when used correctly, causes less tissue damage than conventional surgical tools.
Hysterectomy - hysterectomy (the removal of the uterus and possibly other reproductive organs) is a major surgical procedure which seeks to eliminate the problems caused by endometriosis rather than alleviate them. This is an irreversible procedure which leaves the patient unable to have children. There are three types of hysterectomy:
Total hysterectomy - the removal of the uterus and cervix
Sub-total hysterectomy - removal of the uterus
Total hysterectomy plus bilateral salphingo-oophorectony - removal of the uterus, cervix, ovaries and fallopian tubes.
Making A Decision
Surgery has helped many women with endometriosis to achieve their dreams of becoming mothers. However, while it provides relief from symptoms and can return the reproductive system to normal function, it is not a cure. There is no cure for endometriosis - the condition can only be managed. Therefore symptoms may recur even after surgery. You should discuss surgical options and their side effects with your gynaecologist before making a well-informed decision regarding the best course of action for you.