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Endometriosis: Doctors
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Endometriosis is usually confirmed and treated by a gynecologist. Your primary care doctor... is often the first to recognize endometriosis. A team of specialists, including an endocrinologist and a surgeon, may also become involved in your care.
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Certain findings of a pelvic examination can lead your physician to suspect endometriosis. A sign that strongly suggests endometriosis is nodularity along the uterosacral ligament, which the doctor may feel during a combined vaginal and rectal exam. The nodules are often tender to the touch. An enlarged ovary can indicate the disease, especially if the doctor finds that the ovary is ... fixed in position. Occasionally, endometrial implants may be visible in the vagina or the cervix. A physician may suspect endometriosis based on the history and results of a pelvic exam, but cannot confirm its presence without additional studies.
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The doctors have coined the term "radical excision of endometriosis with reproductive preservation," which was introduced at the American Society of Reproductive Medicine Annual Meeting in 1995 and the AAGL. In the past two years, 30 patients have come for a second opinion, because hysterectomy had been recommended for their endometriosis related pain. The term 'radical surgery' signified that endometriosis was aggressively removed from all parts of the pelvis. In five cases this has necessitated colectomy/anastomosis and 28 cases required ureteric dissection and retroperitoneal excision of periureteric endometriosis, including the one case of ureteric anastomosis. Al1 these women had their uterus spared, as well as their ovaries. In a one-year follow-up period, 90 percent had significant pain improvement and of those attempting pregnancy, 11 percent achieved pregnancy without any further treatment, 12 percent achieved pregnancy with fertility stimulation and 30 percent achieved pregnancy by either GIFT or in Vitro Fertilization.
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A physical examination can sometimes help your doctor locate definite signs of endometriosis. Physical examination findings are normal in about 50% of women with endometriosis. Other times, the doctor may find nodules and tissue masses on the upper part of the vagina, on the back of the uterus and cervix, and between the rectum and vagina. These may be tender when touched. The uterus may ... be tilted upward because of scarring behind the uterus and on the pelvic walls.
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The only way to know for sure if you have endometriosis is to have a surgery called laparoscopy. In this procedure, a tiny cut is made in your abdomen. A thin tube with a light is placed inside to see growths from endometriosis. Sometimes doctors can diagnose endometriosis just by seeing the growths. Other times, they need to take a small sample of tissue, or a biopsy, and study it under a microscope.
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Some doctors use progestins to treat endometriosis. Progestins are synthetic progesterone-like drugs prescribed as pill or injections. Side effects include water retention, mood swings, and irregular vaginal bleeding. They are considerably less expensive than the other medications. One special drawback of the injectable form is that it may inhibit fertility for an unpredictable period of time after treatment is discontinued.
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