Decoding the Mystery of Scar Endometriosis

Endometriosis, a perplexing condition where endometrial-like tissue is found outside the uterus, manifests in various forms. Among them is scar endometriosis, a rare yet distressing subtype that warrants heightened awareness and understanding. This is often a consequence of surgical procedures. Scar endometriosis can profoundly impact an individual’s quality of life, necessitating prompt diagnosis and effective management.

Introduction

Scar endometriosis, an extrapelvic manifestation of endometriosis, is characterized by the growth of endometrial-like tissue within or around a surgical scar. While its incidence is relatively low, ranging from 0.03% to 1.08% of endometriosis cases, the symptoms can be just as debilitating and the diagnosis challenging. This article delves into the intricacies of scar endometriosis, shedding light on its causes, symptoms, diagnosis, and treatment options, empowering individuals to navigate this intricate condition with knowledge and confidence.

Etiology: Unveiling the Root Causes

The precise etiology of scar endometriosis remains a subject of ongoing research and debate. However, several theories have been proposed to explain its development:

1. Iatrogenic Transplantation: This widely accepted theory suggests that during surgical procedures, endometriosis cells inadvertently become implanted within the surgical incision or scar tissue. This phenomenon is particularly common in obstetric and gynecological surgeries, such as cesarean sections, hysterectomies, and laparoscopic procedures.
2. Lymphatic or Vascular Dissemination: Similar to other forms of endometriosis found in the body,  these cells may travel through lymphatic or vascular channels, eventually seeding and proliferating within surgical scars or distant sites.
3. Metaplastic Transformation: This theory proposes that specialized cells within the surgical scar undergo metaplastic changes, transforming into endometrial-like cells under the influence of specific hormonal or environmental factors.

While these theories provide plausible explanations, the exact mechanisms underlying scar endometriosis remain elusive, underscoring the need for further research to unravel the complexities of this condition.

Clinical Manifestations: Recognizing the Signs

The clinical manifestations of scar endometriosis can vary, making early recognition a challenge. However, certain symptoms may raise suspicion and prompt further investigation:

• Cyclical Pain: One of the hallmark symptoms is cyclical pain or discomfort at the surgical scar site, often coinciding with menstrual periods. This pain can range from mild to severe and may radiate to adjacent areas.
• Swelling or Lump: Many people with scar endometriosis report the presence of a palpable lump or swelling at the scar site. This lump may fluctuate in size and tenderness throughout the menstrual cycle.
• Cyclical Bleeding: In some cases, patients may experience cyclical bleeding or discharge from the surgical scar, further indicating the presence of endometriosis.
• Dysmenorrhea and Pelvic Pain: Scar endometriosis can coexist with pelvic endometriosis, leading to additional symptoms such as dysmenorrhea (painful periods) and chronic pelvic pain, especially if endometriosis has been left untreated.

It is crucial to note that the absence of cyclical symptoms does not necessarily exclude the possibility of scar endometriosis, as some cases may present with non-cyclical pain or discomfort.

Diagnostic Approach: Piecing Together the Puzzle

Diagnosing scar endometriosis can be challenging due to its non-specific symptoms and the need for a multidisciplinary approach. The diagnostic process typically involves the following steps:

1. Medical History and Physical Examination: A thorough medical history, including details of previous surgeries, menstrual patterns, and associated symptoms, is essential. During the physical examination, healthcare professionals may palpate the surgical scar site for any palpable masses, nodules, or tenderness.
2. Imaging Modalities: Various imaging techniques can aid in the diagnosis and assessment of scar endometriosis:
   • Ultrasonography: Ultrasound is often the initial imaging modality employed, as it can detect hypoechoic or heterogeneous lesions with irregular borders at the scar site.
   • Magnetic Resonance Imaging (MRI): MRI provides detailed information about the extent and depth of the lesion, aiding in surgical planning.
   • Computed Tomography (CT) Scan: While less commonly used, CT scans can help differentiate scar endometriosis from other conditions, such as hernias or malignancies.
3. Biopsy and Histopathological Examination: Ultimately, a definitive diagnosis requires a biopsy or surgical excision of the lesion, followed by histopathological examination. The presence of endometrial glands and stroma within the scar tissue confirms the diagnosis of scar endometriosis.

It is essential to note that a multidisciplinary team including gynecologists, radiologists, and pathologists may be necessary to establish an accurate diagnosis and develop an appropriate treatment plan.

Treatment Strategies: Alleviating the Burden

The management of scar endometriosis aims to alleviate symptoms, prevent recurrence, and preserve fertility when desired. The treatment approach is multifaceted and tailored to each individual’s unique circumstances:

1. Surgical Intervention: Wide surgical excision with clear margins is the ideal treatment for scar endometriosis. This procedure involves the complete removal of the endometriosis lesion(s), including any affected surrounding tissue or muscle layers. In cases of extensive involvement, abdominal wall reconstruction with mesh reinforcement may be recommended.
2. Hormonal Therapy: While not a definitive treatment, hormonal therapies such as oral contraceptives, progestins, or gonadotropin-releasing hormone (GnRH) agonists can provide temporary symptom relief, and some research shows that these therapies may suppress the growth of lesions. However, these medications may have side effects and do not address the underlying lesion.
3. Combined Approach: In some cases, a combined approach involving surgical excision followed by adjuvant hormonal therapy may be recommended and may reduce the risk of recurrence.
4. Pain Management: Effective pain management strategies, including the use of non-steroidal anti-inflammatory drugs (NSAIDs) or other analgesics, may be necessary to alleviate discomfort associated with scar endometriosis.

It is crucial to engage in shared decision-making with healthcare professionals, weighing the risks and benefits of each treatment option to determine the most appropriate course of action.

Preventive Measures: Minimizing the Risk

While the complete prevention of scar endometriosis may not be feasible in all cases, certain measures can be taken to reduce the risk of its development:

1. Meticulous Surgical Technique: During surgical procedures, particularly those involving the uterus or pelvic region, strict adherence to meticulous surgical techniques is paramount. This includes minimizing the risk of cell seeding, proper handling of surgical specimens, and thorough irrigation of the surgical site.
2. Containment of Tissue Biopsies: The use of endo-bags or containment devices during laparoscopic procedures can help prevent the inadvertent dissemination of endometriosis cells into the surgical field.
3. Careful Wound Closure: Ensuring proper closure of the peritoneum and fascial layers during abdominal surgeries can help minimize the risk of endometriosis cell implantation within the surgical site.
4. Postoperative Monitoring: Regular follow-up and vigilance for any signs or symptoms of scar endometriosis in the postoperative period can aid in early detection and prompt management.

While these preventive measures cannot guarantee the complete elimination of scar endometriosis, they can contribute to reducing the risk and promoting better outcomes for patients undergoing surgical procedures.

Psychological Impact and Support

Scar endometriosis can have a profound impact on an individual’s psychological well-being, often leading to feelings of frustration, anxiety, and diminished self-esteem. The chronic pain, discomfort, and potential impact on fertility can take a toll on mental health, underscoring the importance of holistic care and support.

Healthcare professionals should be attuned to the psychological needs of patients with scar endometriosis and provide access to counseling, support groups, or mental health resources as needed. Building a strong support system and fostering open communication can empower an individual to cope with the challenges of this condition more effectively.

Fertility Considerations

For individuals desiring fertility,  the impact of scar endometriosis on fertility is a significant concern. While the condition itself may not directly affect fertility, the presence of pelvic endometriosis or the surgical interventions required for treatment can potentially impact fertility outcomes.

In such cases, a multidisciplinary approach involving reproductive endocrinologists and fertility specialists may be necessary. Fertility preservation techniques, such as egg or embryo freezing, may be considered for people undergoing extensive surgical procedures. Ongoing monitoring and tailored treatment plans can help optimize fertility outcomes for those affected by scar endometriosis.

Emerging Treatments and Research Frontiers

While current treatment modalities for scar endometriosis have shown promising results, ongoing research efforts aim to further enhance our understanding and management of this condition. Some emerging areas of interest include:

1. Targeted Therapies: The development of targeted therapies that selectively inhibit the growth or proliferation of endometriosis could potentially offer more effective and less invasive treatment options.
2. Stem Cell Therapy: Preliminary research explores the potential of stem cell therapy in regenerating or repairing damaged tissue, potentially reducing the need for extensive surgical interventions.
3. Genetic and Molecular Studies: Investigating the genetic and molecular mechanisms underlying scar endometriosis could provide insights into its pathogenesis and pave the way for personalized treatment strategies.
4. Improved Diagnostic Techniques: Ongoing efforts to refine imaging modalities and develop novel biomarkers could enhance the accuracy and timeliness of scar endometriosis diagnosis.

As research continues to advance, the future holds promise for more effective, personalized, and minimally invasive approaches to managing scar endometriosis.

Multidisciplinary Care: A Collaborative Approach

Scar endometriosis often requires a multidisciplinary approach involving various healthcare professionals, each contributing their expertise to ensure comprehensive care. This collaborative team may include:

• Gynecologists: Gynecologists play a pivotal role in diagnosing, treating, and managing scar endometriosis, as well as addressing any associated pelvic endometriosis or fertility concerns.
• Radiologists: Radiologists are essential in interpreting imaging studies and guiding the diagnostic process, particularly in cases where surgical intervention is being considered.
• Pathologists: Pathologists provide crucial insights by examining tissue samples and confirming the diagnosis of scar endometriosis through histopathological analysis.
• Surgeons: Surgical specialists, such as general surgeons or plastic surgeons, may be involved in the surgical management of scar endometriosis, particularly in cases requiring complex reconstructive procedures or mesh reinforcement.
• Pain Management Specialists: Chronic pain associated with scar endometriosis may necessitate the involvement of pain management specialists to develop effective pain control strategies.
• Mental Health Professionals: Psychologists, counselors, or therapists can provide invaluable support in addressing the psychological impact of scar endometriosis and promoting overall well-being.

Effective communication and collaboration among this multidisciplinary team are essential to ensure comprehensive, coordinated care tailored to each patient’s unique needs.

Patient Education and Advocacy

Empowering patients through education and advocacy is crucial in addressing the challenges posed by scar endometriosis. Healthcare professionals should prioritize providing accurate and up-to-date information to patients, fostering a better understanding of the condition, its implications, and available treatment options.

Patient support groups and advocacy organizations play a vital role in raising awareness, promoting research, and advocating for improved access to care and resources. These platforms can also serve as a valuable source of support, allowing individuals with scar endometriosis to connect, share experiences, and gain strength from one another. By fostering a collaborative approach between healthcare professionals, patients, and advocacy groups, we can collectively work towards improving the quality of life for those affected by scar endometriosis and advancing our understanding of this complex condition.

Conclusion

Scar endometriosis, a rare and often overlooked manifestation of endometriosis, presents unique challenges in diagnosis and management. However, by raising awareness, promoting early recognition, and embracing a multidisciplinary approach, we can better support everyone affected by this condition.

Through meticulous surgical techniques, targeted therapies, and ongoing research, we can strive to alleviate the physical and emotional burdens associated with scar endometriosis. Additionally, fostering open dialogue, patient education, and advocacy efforts can empower an individual to navigate this journey with knowledge, support, and resilience. By unraveling the enigma of scar endometriosis, we can pave the way for more effective treatments, improved quality of life, and a deeper understanding of this intricate condition, ultimately providing hope and solace to those affected.

REFERENCES:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2851454

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10024799

https://www.shreeivfclinic.com/endometriosis/scar-endometriosis

https://casereports.bmj.com/content/2014/bcr-2014-206693

https://www.mdpi.com/2296-3529/9/2/20

10 months ago Treatment No comment

Does Removing Endometriosis and Fibroid Tumor Increase the Chances of Pregnancy?

Table of contents

• Overview of Endometriosis and Fibroids
• Endometriosis and Infertility
• Fibroids and Fertility
• Endometriosis and Pregnancy Outcomes
• Fibroids and Pregnancy Outcomes
• Treatment Options for Fertility Preservation
  • Endometriosis Surgery 
  • Fibroid Removal
• Fertility Outcomes After Surgery
• Pregnancy Monitoring and Management
• Non-Surgical Treatment Options
  • Endometriosis:
  • Fibroids:
• Emerging Treatments and Future Directions
• Emotional and Psychological Support
• Conclusion

Overview of Endometriosis and Fibroids

Endometriosis and uterine fibroids are prevalent gynecological conditions that can profoundly impact a woman’s reproductive health and fertility. Endometriosis, affecting approximately 10% of individuals assigned female at birth (AFAB),  occurs when endometrial-like tissue is found outside of the uterus, primarily in the abdominopelvic cavity.  Fibroids, on the other hand, are non-cancerous growths made up of fibrous tissue and smooth muscle cells that develop in or around the uterus. They may also be called uterine myomas or leiomyomas and affect an estimated 20–40% of AFABs, often during their childbearing years.

While these conditions are distinct, they share some common characteristics, including the potential to cause infertility and pregnancy complications. This article aims to provide a comprehensive understanding of the effects of endometriosis and fibroids on pregnancy, as well as the various treatment options available to maintain fertility.

Endometriosis and Infertility

Endometriosis is a leading cause of infertility, responsible for approximately 50%  of infertility cases. The condition can impair fertility by obstructing the fallopian tubes, disrupting the hormonal milieu, causing inflammation, and altering endometrial development, thereby reducing the chances of successful embryo implantation.

However, it’s important to note that many individuals with endometriosis can still conceive naturally or with the assistance of fertility treatments. The impact of endometriosis on fertility may depend on the severity and location of the endometrial lesions.

Fibroids and Fertility

While fibroids are generally non-cancerous, their presence can affect fertility in several ways. Submucosal fibroids, which protrude into the uterine cavity, can significantly reduce the chances of successful embryo implantation and pregnancy rates during assisted reproductive technologies (ART) such as in vitro fertilization (IVF).

Intramural fibroids, which grow within the uterine muscle wall, can also impair fertility by distorting the uterine cavity and disrupting the hormonal environment necessary for successful implantation and placentation.

Endometriosis and Pregnancy Outcomes

People with endometriosis may face an increased risk of certain adverse pregnancy outcomes, including:

• Placental abnormalities (placenta previa, placental abruption)
• Preterm birth
• Pregnancy-induced hypertension/preeclampsia
• Cesarean delivery

The risk of these complications may be influenced by factors such as the severity of endometriosis, the presence of infertility, and the use of fertility treatments. However, many individuals with endometriosis can have successful, uncomplicated pregnancies.

Fibroids and Pregnancy Outcomes

Fibroids can also impact pregnancy outcomes in various ways. Individuals with fibroids may be at an increased risk of:

• Placental abnormalities (placental abruption, placenta previa)
• Preterm labor and delivery
• Fetal malpresentation (breech presentation)
• Cesarean delivery
• Postpartum hemorrhage

The risk of these complications may be influenced by factors such as the size, number, and location of the fibroids. Large fibroids, or those located in the uterine cavity, may pose a greater risk to the pregnancy.

Treatment Options for Fertility Preservation

For individuals with endometriosis or fibroids who desire future fertility, surgery or removal of the endometriosis lesions and/or fibroid(s)  may be recommended to improve their chances of conception and reduce the risk of pregnancy complications.

Endometriosis Surgery 

While there is no one-size-fits all approach to addressing endometriosis, surgical excision or removal of the lesions is thought to be the ideal approach to addressing the lesions directly. This minimally invasive surgery aims to remove the lesions while preserving the uterus and ovaries, allowing for future fertility.

Fibroid Removal

For individuals with fibroids who wish to maintain their fertility, a myomectomy may be recommended. This surgical procedure involves the removal of fibroids while preserving the uterus. Depending on the size, number, and location of the fibroids, myomectomies can be performed through various approaches, including:

• Hysteroscopic myomectomy (for submucosal fibroids)
• Laparoscopic myomectomy (for intramural or subserosal fibroids)
• Abdominal myomectomy (for larger or multiple fibroids)

The choice of approach depends on factors such as the size and location of the fibroids, as well as the surgeon’s expertise and the patient’s preferences.

Fertility Outcomes After Surgery

Studies have shown that those who undergo endometriosis excision or myomectomy for fibroid removal can achieve pregnancy rates ranging from 50-60%. However, it’s important to note that these procedures do not guarantee fertility, and the success rates may vary depending on factors such as age, severity of the condition, and the presence of other infertility factors.

Pregnancy Monitoring and Management

For those with endometriosis or fibroids who become pregnant, close monitoring and specialized care may be recommended to mitigate potential risks and ensure the best possible outcomes for both the mother and the baby.

This may involve regular ultrasound examinations to monitor fetal growth and placental function, as well as close monitoring for signs of preterm labor or other complications. In some cases, additional interventions or precautions may be necessary, such as bed rest, medication, or early delivery.

Non-Surgical Treatment Options

While surgical tumor removal is often the preferred option for those seeking to preserve fertility, there are also non-surgical treatment options available for managing endometriosis and fibroids. These include:

Endometriosis:

• Hormonal therapies (e.g., birth control pills, GnRH agonists)
• Anti-inflammatory medications
• Complementary therapies (e.g., dietary modifications, exercise)

Fibroids:

• Gonadotropin-releasing hormone (GnRH) agonists
• Selective progesterone receptor modulators (SPRMs)
• Uterine artery embolization (UAE)
• Magnetic resonance-guided focused ultrasound (MRgFUS)

These non-surgical options may be used to manage symptoms, reduce tumor size, or provide temporary relief before pursuing fertility treatments or tumor removal surgery.

Emerging Treatments and Future Directions

Research is ongoing to develop new and improved treatment options for endometriosis and fibroids, with a particular focus on preserving fertility and minimizing the risk of adverse pregnancy outcomes.

Some areas of active research include:

• Novel hormonal therapies and targeted therapies for endometriosis
• Improved surgical techniques for myomectomy and endometriosis excision
• Non-invasive tumor removal methods (e.g., MRgFUS, UAE)
• Preventative strategies to reduce the risk of endometriosis and fibroid development

As our understanding of these conditions continues to evolve, it is hoped that more effective and less invasive treatment options will become available, improving the quality of life and reproductive outcomes for individuals affected by endometriosis and fibroids.

Emotional and Psychological Support

The journey through endometriosis, fibroids, and infertility can be emotionally and psychologically challenging for many. It’s essential to recognize and address the emotional impact of these conditions, as well as the stress and anxiety that can accompany fertility treatments and pregnancy complications.

Support groups, counseling, and mental health resources can be invaluable in helping individuals cope with the emotional and psychological aspects of their condition and treatment. Healthcare providers should be mindful of these needs and provide appropriate referrals and support services as needed.

Conclusion

Endometriosis and fibroids are common gynecological conditions that can have a significant impact on fertility and pregnancy outcomes. While these conditions can pose challenges, there are various surgical and non-surgical options and treatment strategies available to help individuals achieve their desired family size while mitigating potential risks.

By working closely with their healthcare providers, people with endometriosis or fibroids can develop personalized treatment plans that address their individual needs and preferences. With proper management and care, those suffering from these conditions can successfully navigate pregnancy and achieve their dreams of parenthood.

REFERENCES:

https://www.uchicagomedicine.org/en/forefront/womens-health-articles/2022/august/fibroids-fertility-pregnancy

https://www.webmd.com/women/uterine-fibroids/what-if-i-have-uterine-fibroids-while-pregnant

https://www.acfs2000.com/fibroids-and-endometriosis.html

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3608270

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9187594

10 months ago Treatment No comment

Navigating the Road to Recovery: A Comprehensive Guide to Endometriosis Surgery Aftercare

The journey towards relief from endometriosis often involves surgical intervention, but the road to recovery can be a winding one. While endometriosis surgery offers hope for alleviating debilitating symptoms, the post-operative phase demands patience, diligence, and a steadfast commitment to self-care. This comprehensive guide aims to equip you with the knowledge and strategies necessary to navigate the recovery process with confidence and ease.

Table of contents

• Understanding the Endometriosis Surgery Landscape
  • Laparoscopy: A Minimally Invasive Marvel
  • Robotic Surgery: A More Advanced Approach
  • Laparotomy: The Open Approach
• Preparing for the Post-Operative Journey
• The First Few Days: Taking It Slow
• The Weeks Ahead: Gradual Progress and Patience
• Returning to Normal Activities: Listening to Your Body
• Embracing a Holistic Approach to Recovery
• Addressing Potential Complications and Recurrence
• Fertility Considerations After Endometriosis Surgery
• Embracing a Positive Mindset and Self-Care
• Endometriosis Surgery Recovery: A Transformative Journey

Understanding the Endometriosis Surgery Landscape

Endometriosis, a chronic condition characterized by the growth of endometrial-like tissue outside the uterus, can wreak havoc on an individual’s quality of life. When medications and lifestyle modifications fail to provide adequate relief, surgical intervention may become a viable option. Minimally invasive approaches are now the go-to approaches for endometriosis surgery. 

Laparoscopy: A Minimally Invasive Marvel

Laparoscopy, a minimally invasive procedure, is the preferred approach for endometriosis surgery. This technique involves making small incisions in the abdomen and inserting a laparoscope—a slender camera—to visualize and remove endometrial lesions or scar tissue. Laparoscopy offers numerous advantages, including reduced recovery time, minimal scarring, and a lower risk of complications.

Robotic Surgery: A More Advanced Approach

While you may hear mixed opinions on whether robotic surgery is better or worse than a laparoscopic approach, it appears that robotics are the way of the future. Providers using a robotic approach have to undergo more extensive surgical training, but the outcomes may be superior. While the operative time, or time and anesthesia, can be longer than laparoscopic surgeries, the visualization is undoubtedly better. Endometriosis can present with some hard-to-see or hard-to-recognize lesion types, and using this approach may be a better way to visualize those hard-to-see lesions to remove them. 

Laparotomy: The Open Approach

This is an older approach that has been replaced with minimally invasive approaches, but you may still occasionally see someone undergo a laparotomy. In cases of extensive endometriosis or when laparoscopy is not feasible, laparotomy, an open surgical procedure, may be recommended. Laparotomy involves a larger incision in the abdomen, allowing for better visualization and access to deeply infiltrating endometriosis lesions. While more invasive, laparotomy may be necessary in certain circumstances.

Preparing for the Post-Operative Journey

Before embarking on the recovery path, it is crucial to lay the groundwork for a smooth transition. Your healthcare provider will provide specific instructions tailored to your unique situation, but here are some general guidelines:

• Arrange Transportation: Have a trusted friend or family member available to drive you home after the procedure, as you will be unable to operate a vehicle immediately following surgery.
• Stock Up on Essentials: Ensure your pantry and refrigerator are stocked with easily digestible foods, such as soups, broths, yogurt, and fruits, as well as plenty of fluids to stay hydrated.
• Prepare for Medication Management: Discuss any necessary medication adjustments with your healthcare provider, including pain relievers, antibiotics, and laxatives to aid in post-operative recovery.
• Create a Comfortable Environment: Arrange your living space to minimize unnecessary movement and exertion, ensuring easy access to essential items and a comfortable resting area.

The First Few Days: Taking It Slow

The initial days following endometriosis surgery are crucial for initiating the healing process. During this time, it is essential to prioritize rest and follow your healthcare provider’s instructions diligently:

• Manage Pain and Discomfort: Take prescribed pain medications as directed to alleviate discomfort and promote healing. Applying a heating pad or ice pack to the incision site can also provide relief.
• Stay Hydrated and Nourished: Consume plenty of fluids and easily digestible foods to support your body’s recovery efforts. Avoid heavy, greasy, or spicy meals that may cause digestive discomfort.
• Embrace Gentle Movement: While rest is essential, light movement, such as short walks around the house, can aid in circulation and prevent complications like blood clots.
• Monitor Incision Sites: Keep an eye on your incision sites for signs of infection, such as redness, swelling, or pus drainage. Follow your healthcare provider’s instructions for proper wound care.

The Weeks Ahead: Gradual Progress and Patience

As the days turn into weeks, your body will continue its healing journey. During this phase, it is important to strike a balance between rest and gentle activity, while adhering to your healthcare provider’s recommendations:

• Increase Activity Levels Gradually: After the initial recovery period, you can gradually increase your activity levels, starting with light exercises like walking or gentle stretching. Listen to your body and avoid overexertion.
• Manage Expectations: Recovery timelines can vary significantly based on the extent of the surgery, your overall health, and individual healing rates. Be patient and celebrate small victories along the way.
• Attend Follow-up Appointments: Keeping scheduled follow-up appointments with your healthcare provider is crucial for monitoring your progress and addressing any concerns or complications that may arise.
• Seek Support: The recovery process can be emotionally and physically taxing. Reach out to loved ones, support groups, or mental health professionals for encouragement and guidance during this journey.

Returning to Normal Activities: Listening to Your Body

As you continue to heal, the desire to resume your normal routine may become increasingly strong. However, it is essential to listen to your body and follow your healthcare provider’s advice regarding the appropriate timeline for returning to various activities:

• Work and School: Depending on the nature of your job or studies, you may be able to return to work or school within two weeks of the surgery. However, if your responsibilities involve physical labor or strenuous activity, a longer recovery period may be necessary.
• Exercise and Sports: Low-impact exercises like walking or light yoga can typically be resumed within a few weeks, but strenuous activities and high-impact sports should be avoided until your healthcare provider gives the green light.
• Intimate Relationships: It is generally recommended to abstain from sexual activity for at least six weeks after endometriosis surgery to allow for proper healing. Discuss any concerns with your healthcare provider.
• Travel and Vacations: While short trips may be possible within a few weeks, it is advisable to postpone extended travel or vacations until you have fully recovered, typically within 6-8 weeks after the surgery.

Embracing a Holistic Approach to Recovery

Recovery from endometriosis surgery extends beyond physical healing; it encompasses emotional and mental well-being as well. Embracing a holistic approach can enhance your overall recovery experience:

• Prioritize Stress Management: Chronic stress can hinder the healing process. Incorporate relaxation techniques like deep breathing exercises, meditation, or gentle yoga into your routine to promote a calm and peaceful mindset.
• Seek Emotional Support: Endometriosis can take a toll on mental health, and the recovery process can be emotionally taxing. Lean on your support system, join support groups, or consider seeking professional counseling to navigate the emotional challenges.
• Nourish Your Body: A balanced diet rich in whole foods, antioxidants, and anti-inflammatory nutrients can aid in the healing process and promote overall well-being. Consult with a nutritionist or dietitian for personalized dietary recommendations.
• Stay Positive and Patient: Recovery from endometriosis surgery is a journey, and setbacks or slower progress than anticipated can be disheartening. Maintain a positive mindset, celebrate small victories, and trust in the healing process.

Addressing Potential Complications and Recurrence

While endometriosis surgery aims to alleviate symptoms and improve quality of life, it is important to be aware of potential complications and the possibility of recurrence:

• Recognizing Signs of Complications: Be vigilant for signs of infection, excessive bleeding, or worsening pain, and promptly report any concerns to your healthcare provider. Especially around the incision sites, look for abnormal redness, swelling, heat, or pain. 
• Managing Recurrence Risk: Endometriosis can recur after surgery, even with the best surgery. However, the persistence of endometriosis can occur when not all lesions are removed. Discuss long-term management strategies with your healthcare provider.
• Exploring Alternative Treatments: If endometriosis symptoms persist or recur despite surgery, explore alternative treatment options such as hormonal therapy, pain management techniques, or complementary therapies in consultation with your healthcare provider.

Fertility Considerations After Endometriosis Surgery

For many individuals with endometriosis, preserving fertility is a significant concern. Endometriosis surgery can potentially improve fertility outcomes, but it is crucial to have an open dialogue with your healthcare provider about your goals and options:

• Timing for Conception: Depending on the extent of the surgery and your overall health, your healthcare provider may recommend waiting a specific period before attempting conception to allow for complete healing.
• Assisted Reproductive Technologies: In cases of moderate to severe endometriosis, assisted reproductive technologies (ART), such as in vitro fertilization (IVF), may be recommended to improve pregnancy chances.
• Fertility Preservation Options: If you are considering future fertility but are not ready for conception immediately after surgery, discuss fertility preservation options like egg freezing with your healthcare provider.

Embracing a Positive Mindset and Self-Care

The recovery journey after endometriosis surgery can be physically and emotionally challenging, but embracing a positive mindset and prioritizing self-care can make a significant difference:

• Celebrate Small Victories: Recovery is a process, and every milestone, no matter how small, deserves celebration. Acknowledge and appreciate your progress, even on days when it may seem insignificant.
• Practice Self-Compassion: Be kind and patient with yourself throughout the recovery process. Healing takes time, and setbacks are a natural part of the journey. Treat yourself with the same compassion you would extend to a loved one.
• Engage in Enjoyable Activities: While rest is essential, engaging in low-impact activities that bring you joy and relaxation can boost your mood and overall well-being. Read a book, listen to music, or indulge in a favorite hobby that doesn’t strain your recovery.
• Seek Professional Support: If you find yourself struggling with anxiety, depression, or other mental health concerns during the recovery process, don’t hesitate to seek professional support from a therapist or counselor.

Endometriosis Surgery Recovery: A Transformative Journey

Recovering from endometriosis surgery is a transformative journey that requires patience, perseverance, and a commitment to self-care. While the road may be winding, embracing a positive mindset, following your healthcare provider’s guidance, and listening to your body’s needs can pave the way for a successful recovery and improved quality of life. Remember, every person’s journey is unique, and with the right support and strategies, you can navigate this path with resilience and emerge stronger on the other side.

REFERENCES:

https://my.clevelandclinic.org/health/treatments/4620-endometriosis-surgery

https://www.healthline.com/health/endotough/surgery-for-endometriosis

Postop Care – The next 6-12 weeks

After Your Laparoscopy

1 year ago Treatment No comment

Understanding Bladder Endometriosis and Its Treatment

Bladder endometriosis is a medical condition that affects a significant number of women worldwide. It involves the growth of endometrial-like tissue on or in the bladder. This article aims to provide an understanding of bladder endometriosis, how it is diagnosed, and the surgical procedures involved in its treatment.

Table of contents

• What is Bladder Endometriosis?
• Epidemiology and Etiology
• Symptoms of Bladder Endometriosis
• Diagnosis of Bladder Endometriosis
• Treatment of Bladder Endometriosis

What is Bladder Endometriosis?

Bladder endometriosis is a subtype of endometriosis, a condition in which cells similar to those that make up the lining of the uterus (endometrium) grow outside of it. In bladder endometriosis, these cells grow in or on the bladder. This can lead to various symptoms, including urinary frequency, pain during urination, and even blood in the urine.

Read More: https://icarebetter.com/can-endometriosis-be-treated-without-surgery/

Epidemiology and Etiology

Bladder endometriosis is relatively uncommon, occurring in approximately 1-2% of all women with endometriosis. It is most frequently diagnosed in women of reproductive age, with an average age of diagnosis around 35 years. Studies have suggested that heritability may play a role in the development of bladder endometriosis, with some women having a family history of the condition.

The exact cause of bladder endometriosis is still being researched. However, four main theories have been proposed:

• The embryonal theory suggests that bladder endometriosis originates from Müllerian remnants in the vesicouterine/vesicovaginal septum.
• The migratory or metastatic theory suggests it is an extension of an adenomyotic nodule of the anterior uterine wall.
• The transplantation theory posits that it results from the implantation of regurgitated endometrium.
• The iatrogenic theory suggests it occurs after pelvic surgery, such as cesarean delivery or hysterectomy.

Symptoms of Bladder Endometriosis

The symptoms of bladder endometriosis can vary from person to person, but often include one or more of the following:

• Frequent urination: The need to urinate often is a common symptom.
• Dysuria: This is a term for pain or discomfort during urination.
• Hematuria: This refers to blood in the urine, which may be visible or detected on a urine test.
• Lower abdominal pain: Some patients may experience pain in the lower abdomen, often worsening during menstruation.
• Recurrent urinary tract infections: Some women may have frequent UTIs.

Read More: https://icarebetter.com/can-endometriosis-grow-inside-the-bladder/

Diagnosis of Bladder Endometriosis

Diagnosing bladder endometriosis can be a complex process, as the symptoms can mimic other conditions such as recurrent cystitis or bladder infections. Various diagnostic modalities are used in the preoperative assessment of bladder endometriosis. These include:

• Transabdominal and transvaginal ultrasound: These are the initial investigations of choice for suspected bladder endometriosis due to their immediate availability and easy access.
• Magnetic resonance imaging (MRI): This imaging technique can not only delineate the morphologic abnormalities of bladder endometriosis but can also potentially identify other common sites.
• Cystoscopy: This procedure allows doctors to view the inside of the bladder and urethra using a thin, lighted instrument.
• CT urogram or MRI urogram: These tests involve injecting intravenous contrast material (a type of dye) into the urinary bladder to obtain images of the urinary tract.

Treatment of Bladder Endometriosis

The treatment of bladder endometriosis typically involves surgery, as medical management is often not effective for this condition. There are several surgical options, including:

• Transurethral resection: This procedure involves the removal of the endometriotic tissue through the urethra using a special instrument.
• Partial cystectomy: This procedure involves the removal of a part of the bladder that is affected by endometriosis.
• Laparoscopic surgery: This is a minimally invasive procedure where small incisions are made in the abdomen to remove the endometriotic tissue.

It’s important to note that the choice of treatment depends on various factors, including the size and location of the endometriotic lesions, the woman’s age, and the presence of other associated conditions.

Long-term Outcomes and Recurrence

Studies have shown that surgical treatment of bladder endometriosis can lead to good results in terms of pain relief and improvement in urinary symptoms. However, endometriosis is a chronic condition, and there is a risk of recurrence. The overall recurrence rate of symptoms is about 30% for combined therapies and about 35% for hormonal treatment alone. Regular follow-up visits are essential to monitor for any signs of recurrence and to manage any ongoing symptoms.

Read More: https://icarebetter.com/can-endometriosis-on-ureter-cause-kidney-shooting-back-pain/

Conclusion

Bladder endometriosis is a challenging condition that requires a comprehensive approach to diagnosis and treatment. It is crucial for women to be aware of the symptoms and to seek medical advice if they are experiencing any urinary problems or pelvic pain. With appropriate treatment, most women with bladder endometriosis can achieve significant relief from their symptoms and improve their quality of life.

References:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3016174/

https://karger.com/uin/article/89/3/249/322520/Diagnosis-and-Treatment-of-Bladder-Endometriosis

https://www.brighamandwomens.org/obgyn/infertility-reproductive-surgery/endometriosis/deeply-infiltrative-endometriosis

https://academic.oup.com/humrep/article/25/4/884/701431

1 year ago Treatment No comment

How to Prevent Endometrioma Cysts

Endometrioma cysts, often dubbed as ‘chocolate cysts’ or “endometrioma”, pose a significant health issue for many women worldwide. Understanding how to prevent endometrioma cysts is crucial for maintaining optimal reproductive health. This comprehensive, empathetic guide will walk you through the essentials of endometrioma prevention, demystifying complex medical terms and offering practical advice.

Table of contents

• Understanding Endometrioma
• Symptoms of Endometrioma
• Causes of Endometrioma
• Who is at Risk?
• How is Endometrioma Diagnosed?
• Why Endometrioma Causes Health Problems
• Preventing Endometrioma: An Overview
• Hormonal Control
• Lifestyle Factors
• Medical Management
• Surgical Treatment
• Complementary and Alternative Medicine (CAM) Therapies

Understanding Endometrioma

Endometrioma, a form of endometriosis, is a condition where tissue similar to the lining of the uterus grows outside the uterus, primarily on the ovaries. This growth often results in cysts filled with blood and tissue products, referred to as ‘chocolate cysts’ due to their dark, chocolate-like appearance. Understanding this condition is the first step in learning how to prevent endometrioma cysts.

Symptoms of Endometrioma

Endometrioma can manifest in a variety of symptoms, some of which are debilitating. Common symptoms include severe menstrual cramps, chronic pelvic pain, discomfort during intercourse, painful bowel movements or urination during menstruation, and fertility issues. In some cases, endometrioma may be asymptomatic, discovered only during a routine check-up or fertility assessment.

Causes of Endometrioma

The exact cause of endometrioma remains a subject of ongoing research. Some theories suggest retrograde menstruation, genetic factors, hormonal imbalances, and immune system dysfunctions. Surgical procedures in the abdominal area may also inadvertently transport endometrial tissue to other parts of the body, leading to endometrioma.

Who is at Risk?

While any woman who menstruates can develop endometrioma, certain factors increase the risk. These include a family history of endometriosis.

How is Endometrioma Diagnosed?

Doctors diagnose endometrioma through several methods, including pelvic examinations, imaging tests like ultrasounds or MRIs, and laparoscopy – a surgical procedure that allows for the visual inspection of pelvic organs. A definitive diagnosis often requires a biopsy, where a small sample of tissue is examined under a microscope.

Why Endometrioma Causes Health Problems

Endometrioma can lead to several health problems, including persistent pain, inflammation, and fertility issues. These cysts can grow, bleed, and cause scarring, leading to complications such as blocked fallopian tubes, adhesions (tissues that bind organs together), and issues with the intestines and bladder.

Preventing Endometrioma: An Overview

While endometrioma cannot be primarily prevented, certain interventions can reduce the risk of progression and recurrence after surgery. These interventions mainly focus on removing the endometriomas through surgery, lowering estrogen levels in the body, and increasing the impact of progesterone-like hormones.

Hormonal Control

Hormonal birth control methods, such as pills, patches, or rings with lower doses of estrogen, can help regulate the menstrual cycle and slow the progression of endometrioma. Intrauterine devices (IUDs) that release hormones may also be beneficial in reducing pain and bleeding.

Lifestyle Factors

Maintaining a healthy lifestyle can influence natural estrogen levels and potentially reduce the risk of endometrioma regrowth and progression. Regular exercise helps decrease body fat, which in turn lowers estrogen levels. Limiting alcohol and caffeine intake can also help, as excessive consumption of either can raise estrogen levels.

Medical Management

For those not trying to conceive, hormonal birth control is often the first line of treatment to manage symptoms.

Surgical Treatment

Excision surgery is usually considered the gold standard and the only treatment that truly removes the endometrioma lesions. The procedure involves removing the endometrioma while preserving as much healthy ovarian tissue as possible. Following surgery, hormonal treatment is typically resumed unless pregnancy is desired.

Complementary and Alternative Medicine (CAM) Therapies

In addition to conventional treatments, some individuals find relief from endometrioma symptoms through complementary and alternative medicine (CAM) therapies. These can include acupuncture, chiropractic, dietary changes, herbs, or supplements. It’s essential to discuss these approaches with your healthcare provider to ensure they’re safe and suitable for your specific needs.

In conclusion, while endometrioma cannot be prevented, understanding the condition, its risk factors, and potential treatments allows women to better manage their reproductive health. Regular check-ups, open communication with healthcare providers, and proactive lifestyle changes are all crucial in dealing with endometrioma and mitigating its effects on one’s life.

References:

https://my.clevelandclinic.org/health/diseases/22004-ovarian-endometrioma

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7754428/

Chocolate Cysts: Everything You Need To Know

Management of ovarian endometrioma

https://www.womenshealth.gov/a-z-topics/endometriosis

1 year ago Treatment No comment

Endometriosis Supportive Therapy: Can Endometriosis Be Treated Without Surgery?

Endometriosis is an extremely painful chronic condition, which often also leads to infertility or subfertility, that affects about ten percent of women worldwide. It is characterized by growth of endometrial-like tissue, which normally lines the inside of the uterus, outside of the uterus on pelvic organs, the abdomen, bowel, and beyond. This tissue is not the same as the endometrium, characterized by very different behavior and unique molecular profiles.  

Eventually, personalized “theranostic” (therapy and diagnostic) tools will exploit these unique molecular profiles and lead to far better diagnosis, therapy and monitoring approaches.  Research is accelerating in this area, which is already very pervasive in other diseases such as cancer and various immuno-inflammatory conditions.   Meanwhile, the only therapies that are available to actually treat endometriosis, not just masking of symptoms, are hormonal options and excisional surgery.  However, there are major limitations to the argument that hormonal therapies work very well to treat endo rather than simply reduce symptoms.  That leaves surgery.

So, in a word, “can endometriosis be treated without surgery?”, the answer is a resounding NO!  That is not to say that hormonal and other treatments, including anti-inflammatory and perhaps anti-histamine agents (e.g. Zyrtec), both mainstream and integrative-holistic, don’t help. They might.  Let’s unpack this a little bit to give you a roadmap of the options.  

Table of contents

• Understanding Endometriosis
• Diagnosis of Endometriosis
• Conventional Treatment of Endometriosis
  • Hormonal Treatment
  • Surgical Treatment 
• Integrative Holistic View of Endometriosis
• Nutrigenomics and Epigenetics
• Conclusion

Understanding Endometriosis

The exact cause of endometriosis is technically unknown, but we know it is influenced by genetic, genomic, hormonal, immunologic and environmental epigenetic factors.  In other words, it is “multi-factorial”. This means the reason you may have endo could be different from why your friend or even your sister does.  Endo can also behave very differently because different factors are probably in play in different people. This makes a “standard treatment” hard, if not impossible, to recommend to any given patient.  This is changing with the advent of endometriosis bio-molecular pathway research, which will lead to highly individualized targeted treatments. But this is not part of what is available today. 

Diagnosis of Endometriosis

Diagnosing endometriosis is very challenging, because the symptoms can mimic other conditions. This is part of the reason that diagnosis is often delayed by 5-10 years and intentional or inadvertent gaslighting is rampant, depending on which specialist was consulted.  The doctor may be looking at you through a general practice medical lens, or intestinal, urologic, neurologic or other lenses in forming their opinions.   

Rule # 1 is to listen to the patient.  This is almost never done to an appropriate extent.  Why? Because today’s medical system limitations often lead to five-to-ten-minute visits with a semi-interested and overworked provider who is likely under-informed regarding endometriosis.  

When rule #1 is broken, an appropriate evaluation and testing is not likely to be done. Ideally, a clinical suspicion leads to testing that may include ultrasound or MRI, various blood tests, testing for associated conditions and so on.  None of these will reliably lead to a diagnosis of endo but can lead to appropriate specialist referrals to get to the root cause of pain, such as endo. 

Rule #2 in medicine, in general, is to get a diagnosis before recommending treatment.  This is because treatments can be ineffective when treating the wrong condition or, worse, can lead to complications and side effects.  Unfortunately, in the author’s strong opinion, this is often violated specifically in endometriosis treatment.  A common standard is to offer hormonal therapy to patients to see if it might work because the diagnosis might be endometriosis and endo is, in part, fueled by hormones. This may or may not be reasonable depending upon individual circumstances and choices. 

This brings us to rule #3, that we’ll cover next, which proposes that patients should be offered treatment options to select from after informed consent about the potential risks vs the potential benefits based on the best possible scientific evidence.  This is not always done very well and certainly depends on the “trust factor” with your selected specialist(s), since scientific evidence is subject to interpretation.  Most patients do not realize this.    

Conventional Treatment of Endometriosis

Traditional treatment for endometriosis often involves medication or surgery. Medications can include anti-inflammatory pain relievers and hormonal therapies.  In the near future medications will include targeted biomolecular non-hormonal therapies, but they are not here yet.  Pain relievers are mainly a symptom reducing band-aid and are not intended to treat, so we will not discuss them here either.  They can certainly help in overall management, but we will focus on “treatment” in this article.  

Hormones aim to either shut down ovarian function (in other words, cut off estrogen) or at least regulate the menstrual cycle, and progesterone analogs, to potentially reduce the growth of endometriosis tissue. 

Surgery is used for definitive diagnosis of endo as well as treatment by removing any lesions or implants that are found.  In some cases, the two modalities can be used hand in hand, but the order in which they are used, and the nature of the proposed hormonal therapy are important considerations.  

Hormonal Treatment

International guidelines are very confusing and inconsistent regarding hormonal therapy for endometriosis. Because of this, recommendations can vary between practitioners.  We won’t delve into all these options here, but the following are excellent summary articles on this important topic. 

The important points to consider are as follows:

1. The ONLY way currently to definitively diagnose endometriosis is through biopsy, usually performed during surgery.
2. Starting treatment that can cause extreme side effects and potential long-term harm without first getting a definitive diagnosis seems imprudent.  So, if a practitioner offers hormones because they “think” you have endo based on history, examination and perhaps some scans, at least get a second opinion from an endometriosis specialist.  This approach is within international guidelines but can cause you a world of misery and potential harm if not managed in expert hands. 
3. Hormone therapy for endo boils down to either reducing estrogen levels or eliminating estrogen altogether or increasing progestational agent levels to try to medically eliminate endo lesions. Reducing estrogen levels is not possible since there are different types of estrogen, different sources of estrogen and endo lesions themselves can influence local production of estrogen. 
4. Endometriosis cells differ from endometrial cells that are found in the uterus by being relatively resistant to synthetic progestin or natural micronized progesterone therapy. 
5. Hormonal therapy is known to reduce pain when endometriosis is the cause. However, studies have shown that pain relief is possible but hormonal therapy fails to significantly retard the growth of endometriosis tissue when objectively tested in pathology laboratories.  Further, hormonal therapy cannot eliminate scar tissue or fibrosis caused by endo and this fibrosis by itself can be a cause for pain.
6. While unproven, under some circumstances it may be prudent to use less toxic hormonal therapy options to potentially reduce the risk of endo recurrence after surgery.  

Surgical Treatment 

When symptoms, history, physical exam, scans and laboratory evidence all point to endometriosis as a strong possibility to be the root cause of pain, and/or infertility, minimally invasive surgery should be considered to find out for sure.  If endo is diagnosed, then medical hormonal therapy may make sense as part of a highly individualized treatment plan under the guidance of an endo specialist. 

The caveat to considering endometriosis surgery is that there are, of course, potential risks and complications even though it is minimally invasive.  These risks can be minimized in the hands of an expert surgeon, but they should be considered in a risk-benefit discussion.  

More importantly, assuming you have identified an expert endo excision surgeon, surgery is the cornerstone to current effective treatment.  While incompletely proven, for many reasons, it appears that excision of endo lesions and scar tissue (fibrosis) rather than burning them away (fulguration) is a better and safer approach.  To discover more about surgical considerations, consider the following articles. 

Integrative Holistic View of Endometriosis

Since the cause of endo is incompletely understood, but highly multifactorial, and because the reason endo is present in any given individual may vary, either surgery or hormonal therapy or both may fail.  Failure is relative. In other words, failure may be defined as no immediate pain improvement, persistent subfertility, or it may mean recurrence years later.  These are very different scenarios, requiring different approaches.  Also, it’s important to consider whether or not associated conditions have been addressed, such as SIBO or other microbiome irregularities, other inflammatory immune-modulated disease and so on.  Finally, pelvic floor physical therapy is not just a symptom band-aid but a critical co-treatment for pelvic floor function before and after surgery. These topics are all beyond the scope of this article, but you can discover more by reading the following articles. 

If expert excision surgery and supportive hormonal therapy, when used, fails to alleviate pain then supportive pain management can still improve quality of life.  This can be mainstream pain and anti-inflammatory medications like non-steroidal anti-inflammatory (NSAID), nerve block injections, electrical stimulation modalities and/or more holistic approaches including acupuncture, acupressure, mind-body biofeedback approaches such as HeartMath, herbals, aromatherapy and more.  

Kicking it up a notch, here is something you do not see covered much other than in a very superficial manner.  It is not rocket science but is not simplistic at the potential treatment level either.  However, it is something you can implement in a proactive way at any point in your journey.  Specifically, this is the impact of nutrition and lifestyle choices, as well as well-selected and targeted supplements, but drilled down a lot further than simply eating right, exercising and de-stressing.

Upcoming bio-molecular therapies will target specific biological pathways that we are now beginning to better understand.  Many pathways are already identified, many not.  The problem is that there are no mainstream medical therapies, yet which can target these pathways safely and effectively.  We know from other related genomically modulated inflammatory diseases, like cancer and auto-immune disorders, that these treatments take a while to develop and offer safely.  Meanwhile, many of the genomic, metabolic and epigenetic abnormalities that influence endo are known or at least partly known.  With few exceptions, while it is too early to safely use pharmaceutical agents to modulate these abnormalities, nutrients, specific exercise, toxin avoidance, and even state of mind can affect the same pathways abnormalities without risk.  

Nutrigenomics and Epigenetics

How do toxins or stress adversely affect your health, while healthy diet and exercise positively influence your health? In large part, relatively new sciences like metabolomics and genomics, and their derivatives, explain this.  You are born with your genes and, so far, you can’t alter that deck of cards.  Some genes may be “bad” and increase your risk of endo, as well as other diseases. However, not everyone with some bad genes develops disease.  The most famous examples are identical twins who inherited the exact same genetics yet might look a little different (e.g. eye or hair color) and often get different diseases.  Why? 

Anything and everything you eat, drink, get exposed to via skin or breathing, or even think about or emote, can affect your genes through epigenetics.  This means these substances and neurochemicals, good or bad, can turn genes on and off.  Of course, it is infinitely more complex than that and multiple genes affect one process in many cases. However, you can actively modulate your inflammatory and oxidative state.  Do we know what veggie or what thought or what toxin turns what specific gene on or off?  No.  But we do know how these gene-controlled pathways synergize and work together to create health or facilitate disease.    

Conclusion

Surgery is a cornerstone to definitive diagnosis of endo and serves as very important part of treatment.  The path to success is a correct diagnosis, attention to detail and a highly individualized treatment plan.  This can only be carried out in consultation with endometriosis specialists in medical and surgical management.  

Unfortunately, it is not easy to find someone or a team that can fit your needs, but it is a crucial step forward to seek out the best you can.  The more complex your situation (e.g. possible advanced disease or repeat surgery) the more you need an excision surgeon with master surgeon skills.  Ideally you want a specialist who is not only a surgeon but also capable of guiding you through any additional treatment options you may need, mainstream and holistic.  While a master excision surgeon and integrative endo specialist is hard to come by, many have a team that can fulfill your needs.

References:

Endometriosis: Etiology, pathobiology, and therapeutic prospects

Brassica Bioactives Could Ameliorate the Chronic Inflammatory Condition of Endometriosis

Diet and risk of  endometriosis in a population-based case–control study

Emerging Drug Targets for  Endometriosis

The effect of dietary interventions on pain and quality of life in women diagnosed with  endometriosis: a prospective study with control group

Updated Post: July 09, 2024

1 year ago Treatment No comment

How to Treat Bowel Endometriosis: A Comprehensive Guide

Bowel endometriosis, a complex and severe variant of endometriosis, is a condition best navigated with a deep understanding of its details. This guide aims to shed light on the various aspects of bowel endometriosis, from its origins to symptoms, diagnostic approaches, and treatment options, to empower those affected.

Table of contents

• What is Bowel Endometriosis?
• How Common is Bowel Endometriosis?
• Recognizing the Symptoms
• Diagnosing Bowel Endometriosis
• Treating Bowel Endometriosis: An Overview
• Surgical Treatment Options
• Understanding the Risks of Surgery
• Hormone Treatment Options
• Managing Symptoms and Quality of Life
• Conclusion

What is Bowel Endometriosis?

Endometriosis, a chronic health disorder predominantly affecting women in their reproductive years, is characterized by the growth of endometrial-like tissue, which usually lines the uterus in regions outside the uterus. This misplaced tissue prompts an inflammatory reaction, leading to distressing symptoms. When this aberrant tissue growth takes place on or inside the bowels, the condition is referred to as bowel endometriosis.

How Common is Bowel Endometriosis?

While the exact prevalence of bowel endometriosis remains uncertain, it’s estimated to occur in 5-15% of all endometriosis cases. Predominantly, it manifests on the rectum or sigmoid colon but can also affect the appendix or small intestine.

Read More: https://icarebetter.com/endometriosis-and-inflammatory-bowel-disease-distinguishing-the-differences/

Recognizing the Symptoms

Symptoms of bowel endometriosis may not always be apparent, especially in the early stages of the disease. However, as the condition progresses, women may experience discomfort associated with their menstrual cycle, sexual intercourse, bowel movements, and even infertility.

Symptoms commonly associated with bowel endometriosis include:

• Painful Bowel Movements: This is often accompanied by constipation or diarrhea.
• Rectal Bleeding: This symptom, which is more uncommon, usually occurs during menstruation.
• Infertility: Some women may experience difficulty conceiving.
• Pelvic Pain: Chronic pelvic pain is a common symptom associated with endometriosis, often more severe during menstruation or ovulation.
• Painful Intercourse: This is often due to the endometriosis lesion causing a distortion of the pelvic anatomy.

It’s important to note that bowel endometriosis can sometimes mimic symptoms of other gastrointestinal conditions, like irritable bowel syndrome (IBS), making it challenging to diagnose.

Diagnosing Bowel Endometriosis

A comprehensive diagnosis of bowel endometriosis usually involves a combination of physical examination, medical history analysis, and advanced imaging techniques. The diagnostic process may include:

• Physical Examination: This includes a manual check for growths in the rectum or vagina.
• Imaging Tests: These can include ultrasound, MRI, colonoscopy, and barium enema.
• Laparoscopy: This surgical procedure is considered the gold standard for diagnosing endometriosis, as it allows for visual examination of the uterus, ovaries, and other pelvic structures. And surgeons can take samples for histopathology evaluations.

Read More: Understanding Bowel Endometriosis

Treating Bowel Endometriosis: An Overview

Treatment for bowel endometriosis is complex and multifaceted. It requires a personalized approach, taking into account the severity of the disease, the patient’s age, fertility goals, and personal preferences. The primary treatment options include:

• Hormonal Therapy: This involves medications that control estrogen levels, which can influence the progression of endometriosis. These medications can help manage pain and other symptoms.
• Pain Management: Over-the-counter or prescription nonsteroidal anti-inflammatory drugs (NSAIDs) may be recommended to help alleviate pain.
• Surgery: Surgical interventions aim to remove as much endometrial tissue as possible while preserving organ function.

Surgical Treatment Options

Surgery is typically the primary treatment for bowel endometriosis, particularly for severe cases. The goal of surgery is to remove endometrial implants without compromising the functionality of the organs involved. There are three main surgical options:

• Segmental Bowel Resection: This involves removing the section of the bowel affected by endometriosis and reconnecting the healthy portions. This option is often recommended for larger areas of endometriosis.
• Rectal Shaving: This procedure involves shaving off the endometriosis from the top of the bowel without removing any portion of the intestines. It’s often used for smaller areas of endometriosis.
• Disc Resection: In this procedure, a surgeon cuts out a small disk where the endometriosis lesions appear and then closes the remaining hole.

Understanding the Risks of Surgery

Surgery for bowel endometriosis is a complex procedure associated with certain risks. These can include short-term complications such as infection, leakage of bowel content during the postoperative healing phase, peritonitis, and septicaemia. Long-term risks might include bowel dysfunction, characterized by frequency, urgency, and incontinence.

Read More: Finding an Excision Specialist: What you Need to Know

Hormone Treatment Options

Although hormonal treatments cannot halt the progression of endometriosis, they can help manage symptoms. Hormonal treatments for bowel endometriosis can include birth control pills, progestin injections, or, less favorably, gonadotropin-releasing hormone (GnRH) agonists.

Read more: What are the long-term side effects of Lupron?

Managing Symptoms and Quality of Life

Bowel endometriosis can significantly impact the quality of life of those affected. However, with appropriate treatment and management strategies, many women affected by this condition can lead fulfilling lives. Communication with your healthcare team, lifestyle modifications, and psychological support can all contribute to improving the quality of life.

Conclusion

Understanding how to treat bowel endometriosis is crucial for managing this complex and often painful condition. With the right approach, it’s possible to mitigate symptoms, improve fertility outcomes, and enhance the quality of life for those affected. If you suspect you have bowel endometriosis, it’s important to speak with a healthcare provider who can guide you through the diagnostic process and treatment options. With the right knowledge and resources, you can navigate this challenging condition and find a path to improved health and well-being.

References:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4229526/

https://weillcornell.org/news/what-is-bowel-endometriosis

https://www.webmd.com/women/endometriosis/bowel-endometriosis

https://www.healthline.com/health/womens-health/bowel-endometriosis

Bowel Endometriosis

1 year ago Treatment No comment

Endometriosis Diet: Low FODMAP, a Comprehensive Guide

Table of contents

• Understanding the Low FODMAP Endometriosis Diet
• What are FODMAPs?
  • Types of FODMAPs
• Exploring the Impacts of FODMAPs
  • High FODMAP Foods and Low FODMAP Alternatives
• Who Should Follow a Low FODMAP Endometriosis Diet?
• The Purpose of a Low FODMAP Endometriosis Diet
• How to Follow a Low FODMAP Diet
• The Effectiveness of Low FODMAP Endometriosis Diet Combined with Other Therapies

‍The Low FODMAP Diet, a revolutionary approach for managing symptoms associated with Irritable Bowel Syndrome (IBS), has gained substantial recognition and popularity in recent years. Developed by researchers at Monash University, this diet has offered hope to many individuals suffering from IBS, a common gastrointestinal disorder that affects the digestive system. So how can it help those with endometriosis? This article will focus on the diet itself, but a relatively recent systematic review of dietary approaches and endometriosis showed that the low FODMAP diet was most helpful in managing symptoms in those with endometriosis that complained of gastrointestinal symptoms and had good follow through in individuals who tried it. 

Understanding the Low FODMAP Endometriosis Diet

FODMAP is an acronym that stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols. These are certain types of carbohydrates that are either poorly absorbed or not absorbed at all in your intestines and can trigger symptoms in individuals with IBS.

What are FODMAPs?

FODMAPs are naturally occurring sugars found in a wide range of foods and food additives. When consumed, these sugars move slowly through the small intestine, attracting water. As they reach the large intestine, they are fermented by gut bacteria, resulting in gas production. This extra gas and water cause the intestinal wall to stretch and expand, which can cause pain and discomfort, especially in people with IBS.

Types of FODMAPs

Here are the different types of FODMAPs and examples of foods where they can be found:

• Oligosaccharides: These include Fructans and Galacto-Oligosaccharides (GOS) found in foods such as wheat, rye, onions, garlic, and legumes.
• Disaccharides: Lactose is a disaccharide found in dairy products like milk, soft cheeses, and yogurts.
• Monosaccharides: Fructose is an example, found in honey, apples, and high fructose corn syrups.
• Polyols: These include Sorbitol and Mannitol, found in some fruits, vegetables, and used as artificial sweeteners.

Exploring the Impacts of FODMAPs

When FODMAPs are consumed, they move slowly through the small intestine, attracting water. As they reach the large intestine, gut bacteria use these FODMAPs as a fuel source, fermenting them and producing gas. This process is normal but can cause problems in people with IBS due to issues with motility (the speed at which contents move through the intestines) or a highly sensitive gut wall.

FODMAPs are found in a variety of foods, such as fruits, vegetables, bread, cereals, nuts, and legumes. It’s impossible to guess the FODMAP content of a food without careful laboratory analysis. Monash University has developed a mobile phone app, the Monash University FODMAP Diet App, which uses a simple traffic light system to indicate whether foods are low, moderate, or high in FODMAPs.

High FODMAP Foods and Low FODMAP Alternatives

Here’s a table showing some high FODMAP foods and their low FODMAP alternatives:

High FODMAP Foods	Low FODMAP Alternatives
Vegetables: Artichoke, Asparagus, Cauliflower, Garlic, Green Peas, Mushrooms, Onion, Sugar Snap Peas	Aubergine/Eggplant, Beans (Green), Bok Choy, Green Capsicum (Bell Pepper), Carrot, Cucumber, Lettuce, Potato, Zucchini
Fruits: Apples, Apple Juice, Cherries, Dried Fruit, Mango, Nectarines, Peaches, Pears, Plums, Watermelon	Cantaloupe, Kiwi Fruit (Green), Mandarin, Orange, Pineapple
Dairy & alternatives: Cow’s Milk, Custard, Evaporated Milk, Ice Cream, Soy Milk (Made from Whole Soybeans), Sweetened Condensed Milk, Yoghurt	Almond Milk, Brie/Camembert Cheese, Feta Cheese, Hard Cheeses, Lactose-Free Milk, Soy Milk (Made from Soy Protein)
Protein sources: Most Legumes/Pulses, Some Marinated Meats/Poultry/Seafood, Some Processed Meats	Eggs, Firm Tofu, Plain Cooked Meats/Poultry/Seafood, Tempeh
Breads & Cereals: Wheat/Rye/Barley Based Breads, Breakfast Cereals, Biscuits and Snack Products	Corn Flakes, Oats, Quinoa Flakes, Quinoa/Rice/Corn Pasta, Rice Cakes (Plain), Sourdough Spelt Bread, Wheat/Rye/Barley Free Breads
Sugars, Sweeteners & Confectionery: High Fructose Corn Syrup, Honey, Sugar Free Confectionery	Dark Chocolate, Maple Syrup, Rice Malt Syrup, Table Sugar
Nuts & Seeds: Cashews, Pistachios	Macadamias, Peanuts, Pumpkin Seeds/Pepitas, Walnuts

Who Should Follow a Low FODMAP Endometriosis Diet?

The Low FODMAP diet is specifically designed for individuals with medically diagnosed IBS. It is not recommended for people to self-diagnose and start this diet without the proper medical guidance. There are many conditions with symptoms similar to IBS, such as coeliac disease, inflammatory bowel disease, endometriosis, and bowel cancer. Therefore, it is crucial to get a clear diagnosis of IBS from a medical doctor before starting this diet.

The Purpose of a Low FODMAP Endometriosis Diet

The Low FODMAP diet is essentially a three-step diet used to manage symptoms of IBS, which can include abdominal pain, bloating, wind (farting) and changes in bowel habit (diarrhea, constipation, or both). The main goals of this diet are:

• Understand which foods and FODMAPs you tolerate and which ones trigger your IBS symptoms.
• Determine whether your IBS symptoms are sensitive to FODMAPs.
• Implement a less restrictive, more nutritionally balanced diet for the long term that only restricts foods that trigger your IBS symptoms.

How to Follow a Low FODMAP Diet

The Low FODMAP diet is a three-step diet, typically encompassing the following steps:

Step 1: Follow the Monash University Low FODMAP Diet by replacing high FODMAP foods in your diet with low FODMAP alternatives. This step usually lasts for 2-6 weeks.

Step 2: Continue your low FODMAP diet and complete a series of ‘FODMAP challenges’ to identify which FODMAPs you tolerate and which trigger symptoms.

Step 3: Relax dietary restrictions as much as possible, reintroduce well-tolerated foods and FODMAPs to your diet, and establish a ‘personalized FODMAP diet’ for the long term.

It is recommended to follow a Low FODMAP diet under the guidance of a dietitian who has specialty skills in managing IBS and using a FODMAP diet. Monash University’s FODMAP Dietitian Directory can be a useful resource to find such dietitians.

The Effectiveness of Low FODMAP Endometriosis Diet Combined with Other Therapies

The Low FODMAP diet has shown promising results in managing IBS symptoms. However, in some cases, the diet alone may not be sufficient, and other therapies may be required. One such therapy that has shown positive results in treating IBS is Gut Focused Hypnotherapy.

Understanding Gut Focused Hypnotherapy

Gut Focused Hypnotherapy is a type of treatment where patients are asked to visualize their gut as a perfectly slimy set of passages where all the digesting food slips through smoothly. This treatment has been proven to reduce symptoms of IBS by 70% in patients.

Combining Low FODMAP Diet and Gut Focused Hypnotherapy

Researchers at Monash University conducted a study combining the Low FODMAP diet and Gut Focused Hypnotherapy. The study resulted in a significant improvement in the overall and individual gut symptoms of the participants by the end of the six-week study.

Comparing the Low FODMAP Diet with Other IBS Diets

When comparing the Low FODMAP diet with other diets for IBS, it has been noted that the Low FODMAP diet seems to be superior to a gluten-free diet for patients with non-celiac gluten sensitivity. This is likely due to the comprehensive approach of the Low FODMAP diet, which considers all types of carbohydrates that could potentially trigger IBS symptoms.

The Low FODMAP diet has been shown to be effective in managing IBS symptoms, with studies showing improvement in pain, discomfort, bloating, and other GI symptoms. However, it is essential to follow this diet under the guidance of a trained dietitian and in conjunction with other therapies if necessary. As with any diet, the Low FODMAP diet should be personalized to fit the individual’s needs and tolerance levels.

If  you are suffering from IBS-like symptoms and you have endometriosis or are just starting in your journey for a diagnosis, it may be worth seeking out professional guidance to see if the low FODMAP diet may be helpful. As a reminder – it is not going to treat your endometriosis and is used primarily for symptom management. It does not replace seeking out the root cause of both endometriosis and your GI dysfunction. 

Disclaimer: This article is intended for informational purposes only and is not a substitute for professional medical advice. Always consult your doctor or a dietitian before making any changes to your diet.

References:

1. https://www.monashfodmap.com/about-fodmap-and-ibs/
2. https://www.monashfodmap.com/ibs-central/i-have-ibs/starting-the-low-fodmap-diet/

Molina-Infante, J., Serra, J., Fernandez-Banares, F., & Mearin, F. (2016). The low-FODMAP diet for irritable bowel syndrome: Lights and shadows. Gastroenterol Hepatol, 39(2), 55-65. https://doi.org/10.1016/j.gastrohep.2015.07.009

1 year ago Treatment No comment

Finding an Excision Specialist: What you Need to Know

Table of contents

• Excision vs. Ablation
• Important Terms and Approaches
• What if I Cannot Afford to see an Excision Specialist?
• Other Considerations: Some Tips on Navigating the System

Finding a true excision specialist is difficult for many reasons, including the paucity of skilled surgeons and the financial burden that may come with when you find one that is a good fit for you.  So, the first step is to find the right surgeon and the second step is determining how to navigate the financial implications. It’s important not to do it the other way around because initial botched surgery and treatment can make it that much more difficult to find relief.  Surgery is never easier the second or third time around. 

There are a small handful of carefully monitored sites with very helpful information and a listing of qualified surgeons based mainly on patient outcomes feedback, none better than Nancy’s Nook. While there may be a few others that share patient experiences and some information, most are not well monitored or refereed, and thus, information and surgeon leads must be viewed with caution.  Nancy Petersen has a vested personal interest in endometriosis and a deep understanding of the disease based on her work for many years with Dr. David Redwine, a pioneer in the field.  Thus the information which is refereed by Nancy and her hand-picked editors forms a solid base.  However, patient feedback, while important,  is not the only way to determine who to pick as your surgeon.   

The degree of a surgeon’s true technical skills is not easy to judge,  especially if you are in the majority of not being medically trained yourself.  Review of resumes and asking questions such as where did you go to school or train or how many cases do you do leaves a lot to be desired.  It is simply not an accurate reflection, although knowing the surgeon’s background and pedigree can help.  So, what else can be done to help find the right surgeon for you?  

iCarebetter was created to help those in need find a specialist with a bit more objective information than patient recommendations alone. iCarebetter includes surgeons who are video-vetted by a peer review process.  This means that acknowledged experts review surgical videos submitted by surgeons who wish to be vetted and are objectively either verified or not as possessing a high level of surgical capabilities.  Of course, this does not reflect total patient management and bedside manner and more subjective skills.  However, you want someone who can get the surgery properly done at the highest possible level for your needs. There is something to be said about a surgeon who is not afraid of showing other, perhaps better, surgeons what they’ve got, so to speak.    

Additional related reading: Why was iCarebetter built?

Not too long ago, it used to be that when you showed up to your appointment and asked the surgeon what type of surgery they perform, you typically would hear ablation or excision. More recently, many more have adopted excision as the preferred method, or at least talk that way.  But outcomes are variable among those receiving “excision surgery,” why?  This article will help you better understand some of the key takeaways in finding the right surgeon for you.  Some are simply not at a high enough skill level to help you, and others do not walk the talk. 

Additional related reading: Laparoscopy: A Common Treatment for Endometriosis

Excision vs. Ablation

Excision is the removal of tissue diseased with endo, whereas ablation is the burning or fulguration of endo lesions and surrounding tissue and organs, usually using electrocautery. Research shows both may be effective for superficial endometriosis and not near delicate structures such as bowel and ureters; however, it is usually not possible to accurately determine which are superficial or deep infiltrating lesions based on looking at them.

While some patients do symptomatically improve with ablation surgery, clinically, it is recommended that excision is the preferred method because you really cannot know if a lesion invades deeper into the tissue, until you remove it. It is likely that those who have benefited from ablation surgery probably only had superficial lesions, and those who did not improve likely had more extensive endometriosis that was missed or not fully eradicated. While this is clinically accepted, we need more research to confirm this and show it truly is the preferred method.  The problem with designing an accurate research study for this question is that the skill of surgeons participating in clinical trials is highly variable, so the results can be completely wrong because it almost entirely depends on surgical skill.  More importantly, one size does not fit all, and everyone is different.  Hence, a truly expert surgeon who can determine and act appropriately on findings and nuances is critical to your personal success. 

Important Terms and Approaches 

• Wide excision is a term you may hear which means that there is a wide margin of tissue that is removed to ensure that only healthy tissue remains. There is no consensus on this topic. Some surgeons will adopt wide excision, while others will remove the individual lesions, perhaps leaving micro-diseased tissue behind that is difficult to visualize during surgery. These areas may develop endometriosis in the future.  In an expert’s hands, it is a judgment call as to how wide any given area of excision should be.  There is a balance of too much and not enough, and this requires a high level of expertise to optimize benefits and minimize harm.
  
• Combination of excision and ablation. The other consideration when it comes to excision surgery is that some surgeons adopt a combination of excision and ablation.  Some tissue will be excised for histological confirmation of the disease, but then many lesions may be ablated instead of excised.  This generally does not make sense unless the surgeon simply does not believe that excision is better.  The only exception is the ablation of tiny lesions on sensitive areas, such as the ovarian surface, where fertility preservation is a concern.
  
• Incomplete removal of lesions.  Most general gynecologic surgeons will not be able to excise very many lesions and will handle them by fulguration or ablation.  Some surgeons may be able to excise the majority of lesions but do not have extensive training to remove all lesions.  Hopefully, your surgeon will advise you of their limitations prior to rather than after your incomplete surgery.  However, in some cases, endometriosis is not suspected prior to surgery, and a general gynecologist, who is most often not trained in higher-level excision techniques, is caught by surprise.  In that case it is better to biopsy, prove that endo exists, and refer to a specialist rather than poorly perform an incomplete surgery.
  

Complete excision, especially in a difficult case where there is a lot of disease or perhaps in case of distorted anatomy due to repeat surgery, will only occur with a surgeon who has been additionally trained not just in MIGS (minimally invasive gynecologic surgery) but in endo excision per se.  The main surgeon has to be an expert because it is never possible to predict how much endo there is, even if imaging scans are negative.  Beyond that, if the main surgeon is not trained to perform bowel or urologic surgery, then a well-coordinated team is mandatory.  The problem is that this coordination is not too tightly organized in many centers.  Ask questions about who can do what, if any required supporting surgeons are in surgery from the beginning or “on call” when needed.  The latter does not often work out too well because of other commitments that might be conflicting.  

What if I Cannot Afford to see an Excision Specialist?

It is true that many of the surgeons that specialize in excision surgery are out-of-network providers. However, in the past couple of years there have been more surgeons that do take insurance and hopefully, with legislative efforts and more education, this trend will continue to grow. 

That being said, there is a good reason why many do not take insurance, and even if you have the option of an in-network provider, it may not be the right surgeon for you. Currently, there is no difference in the coding when undergoing laparoscopic or robotic surgery for endometriosis that discriminates between ablation versus excision. Ablating lesions takes far less skill, time and effort than excision does. Meaning, that an in-network surgeon who performs an ablation surgery that takes one hour will get paid the same as an in-network surgeon who does an excision surgery that takes four hours. Becoming a trained excision specialist costs money to the provider to undergo extra training to be able to perform these types of procedures, and even more training to become an expert in robotics.

Until our payment, insurance, and coding systems catch up to what is required, we will likely not see a dramatic shift in those who take insurance.  

Aside from the financial difference, those who are in-network may not be able to spend the amount of time you may want during office visits to discuss the details of your surgery and your overall case as those who are out-of-network. Out-of-network doctors are usually able to provide longer visits to address your concerns in depth instead of the standard 15-20 minutes you typically get with your regular OBGYN. Some choose cost over this important treatment planning time, but there are many people who value a personalized approach which takes more time over the cost of the surgery.   It is not just excision surgery that will get you to where you want to be, and this personalized treatment planning includes very important discussion about pre-operative and post-operative healing options.  

Whatever you choose, you want to feel comfortable with your surgeon and find the right fit for you. 

Other Considerations: Some Tips on Navigating the System

• Change your insurance provider.  I know this is easier said than done, but for those with HMOs who are only allowed to stay within a small network, it may be worthwhile to talk to your employer, or partner (if applicable), or do some research on what other insurances are available to you.  PPO plans include their list of in-network providers but also often provide some reimbursement for out-of-network providers, especially if their surgeons are not at the skill level that you need or are not within a reasonable geographic range. Open enrollment is typically once a year, or when you change jobs, or due to other qualifying life-changing events.   So consider this as an option that may allow you to have more latitude and choice when planning for surgery.
  
• Work with your insurance company. This does not always work, and is time-consuming, but can have a big payoff at the end. There have been patients who have communicated and worked with their insurance companies when there is no available specialist around to cover your out-of-network provider services. While this has worked for some, be ready for a time commitment and likely many phone calls to get to the person who can help you.  

• Ask the doctor you have selected.   Some excision specialists have been helping patients with this insurance negotiation conundrum for many years. Because of that, some have teams that help you get an exception and lower your out of pocket costs tremendously.  

• Adopt a new perspective. Lastly, this will not necessarily save you money, but looking at your surgery as an investment in your health may make it seem more doable. We often do not think twice about financing $30-$40k on a car or the thousands of dollars we spend on “stuff,” but we often hesitate when it comes to our health.  Without health, nothing else matters. For many, excision surgery has been life-changing, and thinking of paying for your surgery as an investment in your health, may be the best thing for you.  Again, while upfront costs may seem high, a concerted effort to find the right surgeon, advocate for yourself, and ideally find a surgeon’s office that can help you negotiate and advocate can lead to lower final out-of-pocket costs than you might think. 

Whatever route you take, it needs to be the best route for you, with a full understanding of the pros and cons. Take your time when finding the right surgeon, and don’t rush into something you are not comfortable with. 

Additional reading: 7 Ways to Prepare For First Endometriosis Specialist Appointment

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