Endometriosis: Surgical Options for Treatment While Preserving the Uterus

I have endometriosis!

Hello Doctor: I have a high CA-125 level (approximately 75) from a blood test.
After a thorough examination by a gynecologist, I was diagnosed with endometriosis, which has affected my daily life (such as heavy menstrual bleeding, pain during intercourse, and severe anemia).
The doctor has recommended surgical treatment since medication has not been effective.
However, I would like to preserve my uterus.
Could you please explain what the surgical treatment entails and how the surgery is performed? Thank you! Taichung - Xiao Huang

Xiao Huang, 40~49 year old female. Ask Date: 2011/01/09

Dr. Dong Yuhong reply Obstetrics and Gynecology

Hello; Endometriosis can significantly impact daily life due to symptoms such as heavy menstrual bleeding, dyspareunia, and severe anemia.
If symptoms do not improve with medication, surgical intervention may be indicated.
Your primary physician will likely discuss the surgical options with you.
If you have a desire to preserve your uterus, it is important to communicate this to your physician.
This way, your doctor can discuss the implications of both preserving and not preserving the uterus based on your specific situation, allowing you to consider your options.
When you mention that the medication is not effective, does this mean that you have already undergone treatment with medications that have not worked, or do you believe that treatment has not been attempted yet? Engaging in further discussions with your primary physician is the best way to determine your treatment plan.
You may also consider seeking a second opinion; consulting another physician in person may provide you with additional insights that could be helpful.
Thank you.

Reply Date: 2011/01/09

More Info

Endometriosis is a complex and often painful condition where tissue similar to the lining of the uterus grows outside the uterus. This can lead to various symptoms, including heavy menstrual bleeding, pelvic pain, and even complications such as infertility. Given your situation, where you have elevated CA-125 levels and significant symptoms impacting your quality of life, it’s understandable that you are seeking surgical options that allow for the preservation of your uterus.

Surgical Options for Endometriosis
1. Laparoscopy: This is a minimally invasive surgical procedure that is often the first-line treatment for endometriosis. During laparoscopy, a surgeon makes small incisions in the abdomen and uses a camera (laparoscope) to visualize the pelvic organs. The surgeon can then remove or destroy endometrial tissue while preserving the uterus and ovaries. This procedure can significantly alleviate symptoms and improve quality of life.

2. Laparotomy: In more severe cases of endometriosis, a larger incision may be necessary to access the pelvic cavity. This is less common for endometriosis but may be required if there are large cysts or extensive adhesions. The goal remains the same: to remove as much endometrial tissue as possible while preserving the uterus.

3. Endometrial Ablation: This procedure involves destroying the lining of the uterus to reduce or eliminate menstrual bleeding. However, it is not typically recommended for women who wish to preserve their fertility, as it can make future pregnancies more complicated.

4. Fertility-Sparing Surgery: If you are considering future pregnancies, it’s essential to discuss fertility-sparing options with your surgeon. This may involve removing endometriosis while leaving the uterus and ovaries intact.
5. Hormonal Treatments Post-Surgery: After surgery, your doctor may recommend hormonal therapy to help manage any remaining endometriosis and reduce the risk of recurrence. This can include birth control pills, hormonal IUDs, or other medications that suppress estrogen.

Considerations Before Surgery
- Severity of Symptoms: The decision to proceed with surgery often depends on the severity of your symptoms and how they affect your daily life. Since you mentioned heavy bleeding and pain during intercourse, surgery may be a beneficial option for you.

- Consultation with a Specialist: It’s crucial to consult with a gynecologist who specializes in endometriosis. They can provide a thorough evaluation and discuss the best surgical options tailored to your needs.

- Risks and Benefits: Like any surgical procedure, there are risks involved, including infection, bleeding, and potential complications related to anesthesia. Discuss these risks with your healthcare provider to make an informed decision.

- Post-Operative Care: Recovery from laparoscopic surgery is generally quicker than from open surgery, but you will still need time to heal. Your doctor will provide guidelines on activity restrictions and follow-up appointments.

Conclusion
In summary, surgical treatment for endometriosis can be an effective way to alleviate symptoms while preserving the uterus. Laparoscopy is often the preferred method due to its minimally invasive nature and quicker recovery time. It’s essential to have a detailed discussion with your healthcare provider about your symptoms, treatment goals, and any concerns you may have regarding surgery. This will help ensure that you receive the best possible care tailored to your individual situation. Remember, you are not alone in this journey, and seeking support from healthcare professionals and support groups can be incredibly beneficial.

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