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How Do I Know If I Have It?

Typically, your doctor will perform a pelvic exam to rule out other potential causes of your symptoms. But a doctor won't know that it's endometriosis until a surgical procedure can be done. This procedure is called a laparoscopy, or visual examination with a slim, lighted instrument that the doctor inserts into the abdominal cavity through a small incision. Women are usually unconscious when it's done, and many doctors remove a small piece of tissue and test it to confirm the diagnosis.

What Are the Treatments?

Here are some things to remember about treating endometriosis:

• Treatment depends on the desired outcome: pain relief or fertility.
• The condition is managed, not cured; symptoms often return when treatment is stopped.
• Menopause usually ends the symptoms, but in women who take estrogen during and after menopause, symptoms may continue.

Since endometriosis often recurs and often causes infertility, you may wish to join an endometriosis support group to get help in coping with the uncertainties of the condition. Many hospitals can refer you to a support group. There are three ways to treat endometriosis: watchful waiting, hormonal treatments and surgery. The choice depends on a number of factors including the woman's symptoms, her age, whether fertility is a factor, and the severity of the disease.

Watchful waiting is a good option for women with mild disease who don't want to bear children, and women approaching menopause. Hormonal treatment is based on the concept of reducing the cyclical hormonal stimulation to endometrial tissue.

For women who can conceive and want a child, pregnancy may alleviate symptoms, probably because it temporarily stops menstrual cycles. In some women, endometriosis symptoms does not return after they have given birth. Alternatively, your doctor may have you take birth-control pills continuously for nine months or more. This treatment can be effective, but in many cases, symptoms return after you stop taking the pill.

If a continuous course of birth-control pills fails to bring relief, your doctor may advise treatment with other types of hormonal agents. Available hormonal therapies, in addition to oral contraceptives, are medroxyprogesterone (Provera) and gonadotropin-releasing hormone agonists (Lupron, Synarel and Zoladex). Two others include danazol and gestrinone, which are derivatives of male hormones. The use of medications to prevent the making of estrogen such like those used in breast cancer are undergoing study (e.g.femara).

All of these regimens have unwanted side effects to varying degrees, such as weight gain, depression, acne, increased body hair and irregular bleeding. With all such drug therapies, complete cure is uncommon, since the implants remain attached to organs and may resume monthly bleeding when therapy ends.

Pain medications such as ibuprofen and naproxen may relieve the discomfort of cramps but will not affect the implants' cyclic changes, so again, they address the symptoms without addressing the underlying cause.

If tissue growth is rampant and drug treatment is ineffective, your doctor may advise surgery. If all the implanted tissue is removed, your symptoms should disappear. However, some tissue fragments may remain and regrow and your symptoms may recur, even after a hysterectomy. Your doctor may want to combine surgery with continued drug therapy.

Also, there is no conclusive evidence that nonsurgical treatment improves fertility rates. For women with mild disease who wish to conceive, conservative treatment is best. Many of these women can conceive without any treatment. Laparoscopic surgery may be successful for some women with infertility problems.

At-Home Treatments

The following may help relieve symptoms of endometriosis:

• Take medicines such as ibuprofen or naproxen for pain relief.
• Apply a heating pad or moist heat and drink warm beverages to help relax cramping muscles.
• Exercise moderately to increase endorphins, your body's natural painkillers.

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