Endometriosis is as common as asthma and diabetes. Around 200 million or more people around the world have endometriosis. That’s a big number.
Despite being a medical condition of such big magnitude, Endometriosis is shrouded with misinformation, misdiagnosis, and mistreatment. Many women come to accept pain as normal because of these reasons. What’s a woman to do when years of pain and countless doctor visits don’t seem to yield any results?
This is where I’d like to bring your attention to the quality of help that you’re getting from your Physician. You can get relief from the pain of Endometriosis, provided you get your physician right.
Recently, I’ve had a phone call with a woman who was looking for a consultation for a second opinion. She had been diagnosed with stage IV endometriosis, and her physician recommended a Laparotomy to remove the Uterus. She was told that a cesarean incision will be done to remove any deep infiltrating adhesions after removing the Uterus.
First, it would be unfair of me to comment on the surgeon’s methods without knowing their experiences and expertise. But I must point out that removing the Uterus is not a cure for endometriosis, as the disease is outside the uterus how does removing the uterus and leaving the disease help? Substantial issues related to endometriosis persist even if the Uterus is removed.
Second, laparoscopic surgery is one of the best ways to operate on the pelvis area. I can hardly imagine a reason for performing an open surgery for endometriosis. In fact, I’d rather perform a laparoscopy for difficult surgeries. There’s more flexibility with laparoscopy; we can precisely manipulate tissues with it, and everything’s on a big screen for you to see! This is as opposed to an open surgery where your focus is taken up by the bleeding and controlling it.
The myths and misinformation regarding endometriosis are spread not just outside but within the medical community as well. An expert physician would know that we would do hysterectomy (removing the uterus) only when it is absolutely necessary, especially there is associated adenomyosis and not for endometriosis alone. The advanced technology of robotic surgery can also be used for tackling advanced endometriosis cases. Its surgeon’s preference which tool to use for optimum outcomes.
I told the woman on the other end of the phone call exactly that. And perhaps if she chooses to pick an experienced physician/surgeon, surgery would be different from what was recommended to her.
And then perhaps there’s a better chance of expecting a better outcome.
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3 classifications of endometriosis based on location
Treatment of endometriosis depends on understanding the symptoms and the area of endometriosis. Depending on the area where the endometriosis lesions are formed, there are three main classifications of endometriosis.
- Superficial Peritoneal Endometriosis
Superficial endometriosis is, as the name suggests, a less advanced form of endometriosis in the peritoneum membrane. It usually has 1mm – 2mm endometriosis lesions without much mass.
The peritoneum is a thin membrane that lines your abdomen and pelvis.
- Deep Infiltrating Endometriosis
When endometriosis is formed in the uterosacral ligaments, rectovaginal space, the bowel, posterior vaginal wall, and the urinary tract, it is deep infiltrating endometriosis.
The Enzian classification was proposed to identify deep endometriosis outside the pelvic cavity; in the vagina, rectovaginal space, uterosacral ligaments, cardinal ligaments/pelvic sidewall, rectum, and other locations.
Deep Infiltrating Endometriosis is rare, but sometimes a lot of scar tissue can bond organs so they become stuck in place.
- Ovarian Endometriosis
Endometriosis can be found on the surface of one or both ovaries, but it can also be found deep within them too. Deep ovarian endometriosis forms dark fluid-filled cysts that can vary in size known as endometriomas or “chocolate cysts”. The chocolate cysts are often associated with infertility and they are usually coming with a disease in other parts of the pelvis/body.
Laparoscopy / robotic surgery remains the only way to precisely diagnose and excise endometriosis.