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Diagnosis of Endometriosis: 1 of 5 things you really need to know about endometriosis

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 Your Comprehensive Guide to Understanding Endometriosis

(Eric Daiter MD, Board Certified in Reproductive Endocrinology and Infertility)

 

  • What is endometriosis?
  • Problems caused by endometriosis: its symptoms
  • Diagnosing endometriosis with laparoscopy
  • Treating endometriosis
  • What to expect after treatment for endometriosis

 

Diagnosing Endometriosis with Laparoscopy:

Endometriosis should be suspected whenever a woman has cyclic pelvic pain or abnormal function that involves the reproductive organs, bowel or urinary system.  Women, as well as their medical care providers, should maintain a high index of suspicion for endometriosis since specialists dedicated to the meticulous treatment of endometriosis can usually treat the troubling symptoms successfully.  Unfortunately, the diagnosis of endometriosis is not always confirmed early on and consequently women may suffer through years of frustration and symptoms. 

 

The likelihood of endometriosis is increased when there are cyclic symptoms, suspicious nodules on physical examination, characteristic appearances on radiological tests such as ultrasound, or certain abnormalities in blood work, but these findings cannot confirm the diagnosis.  Endometriosis can only be diagnosed by direct visualization or tissue biopsy.  Direct visualization is most often accomplished using a minimally invasive same day surgical procedure called laparoscopy and treatment is generally completed during the same procedure.  For best results, the doctor performing this surgery would have the experience and expertise to accurately diagnose and effectively treat all of the typical and atypical lesions of endometriosis.  Many experienced surgeons do not biopsy the lesions unless tissue confirmation is otherwise required. 

 

Different types and stages of endometriosis can be distinguished based on their location, the appearance of the lesions, or the size and depth of the lesions.  Endometriosis is usually located on the protective thin translucent peritoneal lining (called peritoneum) that covers the pelvic organs, including the reproductive organs, the distal bowel and the bladder.  This peritoneum normally contains an abundant supply of sensory nerves, nerves that can perceive inflammation or trauma to cause a pain sensation.  The inflammation caused by the endometriosis can also cause the underlying affected organs to malfunction, resulting in reproductive failure, irritable bowel symptoms or painful frequent urination.  The classic appearance of endometriosis is a powder burn lesion (thick black raised area that looks like charred tissue) but several “atypical” lesions have also been identified.  It is believed that early signs of recurrent inflammation due to endometriosis result in clear vesicles (look like blisters) along the peritoneum or red flame lesions.  Over time these lesions may develop into powder burn lesions or white scarred down lesions.  Advanced endometriosis lesions may also bleed into themselves, this blood eventually turns into a thick brown liquid that looks like chocolate syrup, and these lesions are consequently often called “chocolate cysts.”  Chocolate cysts can be found in the ovary (called endometriomas) or under the peritoneum.  Any of these endometriosis lesions may vary in size and depth of invasion.

 

Actual Surgical Photograph is available for viewing if you decide to download the Guide.  Some viewers may find the photographs overly graphic while most viewers find them informative and interesting.

 

In this surgical photograph of endometriosis on the ovary (above), clear vesicles on the ovary can be seen as well as filmy adhesions between the fallopian tube and the ovary.  These adhesions reduce the ability of the fallopian tube to function normally and can result in infertility or an ectopic pregnancy.

 

Actual Surgical Photograph is available for viewing if you decide to download the Guide.  Some viewers may find the photographs overly graphic while most viewers find them informative and interesting.

 

This surgical photograph of endometriosis on the uterus (above) shows clear vesicles covering most of the surface of the uterus, most likely forming as a result of longterm cyclic inflammation due to endometriosis.  This woman had tremendous ("killer") cramping with her menstrual flow that was completely relieved when this area was properly treated.

 

Actual Surgical Photograph is available for viewing if you decide to download the Guide.  Some viewers may find the photographs overly graphic while most viewers find them informative and interesting

 

This surgical photograph of endometriosis on the bladder (above) illustrates classic powder burn lesions on the bladder.  Whenever the bladder began to fill this woman had the urge to void (urinate)  and when the bladder was emptying she would have sharp stabbing pain in the region of her bladder.  Fortunately, these symptoms were eliminated after thoroughly treating these lesions.

 

Actual Surgical Photograph is available for viewing if you decide to download the Guide.  Some viewers may find the photographs overly graphic while most viewers find them informative and interesting

 

This surgical photograph of an endometrioma within the ovary (above) demonstrates the thick brown liquid that is released from these ovarian cysts when they rupture or are otherwise opened.  This brown fluid is very irritating to the peritoneum and severe lower pelvic pain can result from leakage of this fluid around the ovary.  When these cysts are removed it is important to try to remove the entire cyst wall to limit recurrence.  For this woman, menstrual cycles were irregular and very painful prior to surgery and they became much more regular with only mild cramps following the complete removal of endometriomas from both ovaries.

 

Actual Surgical Photograph is available for viewing if you decide to download the Guide.  Some viewers may find the photographs overly graphic while most viewers find them informative and interesting

 

This surgical photograph of advanced endometriosis (above) shows severe reactions to endometriosis within the cul de sac of Douglas behind the uterus, obliterating this space and resulting in a "frozen pelvis."  The ovaries, uterus, fallopian tubes and distal bowel are all stuck together in adhesions and large peritoneal cysts are developing in response to chronic inflammation.  Removing all of the dense adhesions to completely free up the pelvic structures, meticulously removing the endometriosis from the region, and removing the peritoneal cysts are the procedures required to optimize postoperative outcome.

 

Actual Surgical Photograph is available for viewing if you decide to download the Guide.  Some viewers may find the photographs overly graphic while most viewers find them informative and interesting

 

This surgical photograph of atypical endometriosis (above) shows some classic powder burn lesions next to some red flame lesions along the peritoneal surface of the bladder.  Endometriosis lesions are often thought to progress in appearance from clear vesicles (early lesions) to red flame lesions to powder burn lesions to white scarred down lesions (end stage lesions).  The powder burn lesions are the "typical" lesions of endometriosis.

 

Actual Surgical Photograph is available for viewing if you decide to download the Guide.  Some viewers may find the photographs overly graphic while most viewers find them informative and interesting

 

This surgical photograph of the reproductive organs (above) shows the uterus connected to the right fallopian tube and the fallopian tube lying adjacent to the right ovary.  There are a few small areas of endometriosis on the ovary that might develop into endometriomas if left untreated.  The irrigator aspirator tool is used to move the ovary anteriorly and laterally to visualize the undersurface of the ovary since these lesions would otherwise not be seen by the surgeon when the ovary is in its usual position tucked under the right side of the uterus.  The surgeon who takes the time to thoroughly search for, and appropriately treat, all endometriosis lesions is often rewarded by successfully reducing the woman's symptoms.

 

If you like what you have been reading then download your entire free copy of “A Comprehensive Guide to Understanding Endometriosis,” including actual surgical photographs of endometriosis taken by Dr. Daiter (warning: some consider these photos graphic or gross).

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A video testimonial that expert treatment of endometriosis can truly accomplish remarkable results!

These brave "real life" stories present examples of the kind of care that Dr. Daiter provides for his patients.