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Michael East
M.B.B.S, FRANZCOG, FRCOG, MAOG

T +64 9 522 3797
F +64 9 520 9526

Level 2, Suite 3
Ascot Hospital
90 Greenlane Rd East
Remuera
Auckland 1051
New Zealand
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Endometriosis

Will pregnancy help my endometriosis?

Pregnancy will temporarily relieve the symptoms of endometriosis.  However, Laparoscopic removal of endometriosis is the treatment of choice in managing those women with symptoms of endometriosis.

 

Is endometriosis a chronic condition and can it be cured?

Endometriosis can be a chronic condition if it is not identified and treated appropriately.  There is on average a 7-11 year delay in diagnosis following the onset of symptoms.

Following laparoscopic excision of endometriosis the great majority of women do not experience a recurrence of their disease.

 

Will Hysterectomy cure endometriosis?

A Hysterectomy will not cure endometriosis but it does cure adenomyosis.

Hysterectomy (removal of the uterus with conservation of the ovaries) is a treatment option for those women who have finished their families and have ongoing heavy periods.

If endometriosis is present it needs to be removed at the time of the Hysterectomy or else the symptoms related to endometriosis will continue.

Endometriosis can occur following Hysterectomy and there are few indications for removing the ovaries at the time of Hysterectomy in those women with endometriosis.

 

Is endometriosis a disease of the 21st century?

Endometriosis has been recognised for much of the 20th century.  Previously, symptoms had to be serious before surgery was contemplated. This involved a midline incision in the abdominal wall called a laparotomy.

However, following the development of laparoscopy endometriosis was diagnosed more readily. Medications were developed to treat the symptoms of endometriosis; these mimic either pregnancy or menopause as these are two areas in a woman’s life when symptoms of endometriosis settle down.

However, these medications suppress rather than cure the symptoms whilst they are being taken and they have significant side effects.  If the symptoms of endometriosis continued then a Hysterectomy (removal of the uterus) was recommended often with removal of the ovaries.  The endometriosis was usually not removed.

Over the past 15 years Laparoscopic excision or removal of endometriosis has become the mainstay of treatment.


 

I am having problems trying to get pregnant what should I do?

Women who have normal periods and no pain syndrome will need to have a number of basic investigations performed.

These are usually performed if pregnancy does not occur within 6-12 months of attempting to become pregnant.

Many of these investigations can be performed by your General Practitioner and include:
 

  • Hormone profile check which involves a blood test on the 2nd day of your period.
  • Ultrasound scan just before ovulation on Day 12 of your cycle (Day 1 is the first day of your period i.e. 12 days after your period starts) to see whether you are producing an egg.
  • Further blood test 7 days before your period is due (i.e. on Day 21 for those women who have a 28 day menstrual cycle) to confirm that ovulation has occurred.
  • Assessment of your partner’s sperm

If any abnormality is detected or if you are still not able to conceive, then referral to a Fertility Unit would be sensible.

Women with fertility problems associated with heavy, painful periods would benefit from referral to a Gynaecological surgeon to exclude endometriosis.

  • Endometriosis is associated with difficulty conceiving.
  • If endometriosis is identified as the only reason why you are unable to conceive, and excised your pregnancy rate will improve.

 

If I have an ovarian cyst on ultrasound scan which is suggestive of endometriosis, how is this managed?

A cyst which contains endometriosis is called an endometrioma. This can be associated with more severe endometriosis.  CA125 detected by a blood test can be a marker of endometriosis and is often increased if an ovarian cyst contains endometriosis.

We manage an endometrioma by removing the cyst from the ovary Laparoscopically. Ovaries are rarely removed. Any endometriosis in the pelvis is usually removed at the same time.

 

I understand that endometriosis can be severe involving the bowel wall. How do you manage this form of endometriosis?

Severe endometriosis is usually diagnosed at the time of Laparoscopy. Treatment sometimes requires a second Laparoscopy and bowel prep is sometimes required pre-operatively.

Surgery takes 2-4 hours and normally Hospital stay is 2-4 days and you can return to work after 2 weeks.