Detailed history and careful physical examination will often give clues to the presence of endometriosis. Non-invasive imaging, such as ultrasound scan can pick up endometriosis ovarian cysts (endometriomas). However, the gold standard to diagnose this condition is still through laparoscopy (key hole) surgery, by means of direct visualisation and biopsy of typical endometriosis lesions. Once the diagnosis is established, it is important to look at the goal of the treatment. Where fertility is desired, medical treatment will not be suitable, as treatment using hormonal medications such as progesterone-like substances and birth control pills, all inhibit ovulation. There is a good body of evidence showing increased pregnancy rate and successful pregnancy after surgical treatment of mild to moderate endometriosis. For women with severe endometriosis, the evidence in terms of effectiveness of surgical treatment is not as clear. However, with restoration of a normal anatomy, it may assist women who require IVF treatment. There is also good evidence that favours removal or excision of endometriosis lesions rather than just “burning” (diathermy) them. Depending on the severity of the endometriosis, sometimes surgical treatment can be performed together with diagnostic procedure. When it is too severe, the gynaecologic surgeon may decide to do this in a separate procedure, after appropriate counselling and pre-operative preparation. Abnormal peritoneal lining of the abdomen is excised to achieve complete removal of endometriosis at the end of the procedure. To treat endometrioma, a cystectomy is performed, while preserving as much healthy ovarian tissue as possible. All scar tissue is divided, and to prevent formation of new scar tissue, special anti-adhesion barrier is applied. In the majority of these types of surgeries, they can be completed with laparoscopy (key hole). There are a lot of online resources and support available readily to assist women in understanding this condition, including: Detailed history and careful physical examination will often give clues to the presence of endometriosis. 44 Pindara Magazine 2016
Pindara Private Hospital Magazine - Issue Nine
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