No drug has been shown to improve pregnancy rates over no treatment at all. All of the drugs have been shown to provide pain relief in 80 to 100 percent of women, and this factor alone make drugs useful for crisis management. You have to carefully weigh the risks of side effects versus the benefits for your particular situation.
If you can't stand the side effects of provera, you might want to try danazol for a short time, say three to six months. Only as an absolute last and desperate resort should you consider the GNRH drugs since so much is unknown about them.
So called "conservative" surgery means removing endometrial implants while preserving your ovaries, tubes and uterus as much as possible and thus preserving your child-bearing ability. In the past, major abdominal surgery with a three or four inch bikini incision into the abdomen and removal of endometrial implants and scar tissue through cutting or burning was the main type of surgery available. These days it should be reserved for very large endometrial cysts or masses and deep bowel involvement.
The development of laparoscopic surgery has revolutionized the treatment of endometriosis. A video camera can now be attached to the laparoscope and the picture projected onto a television screen. This allows for excellent visualization and increased precision. Recovery from laparoscopic surgery is faster, and there is less scar tissue formed.
As the Endometriosis Association comments: "Operative laparoscopy offers better results than major abdominal surgery. Laparoscopy has been shown to lead to significantly less adhesions."
Another way to remove endometriosis is though using the laser. The laser beam is a high energy light than can be directed and controlled with pin-point accuracy of location and depth. The energy of the beam is absorbed by the water in cells causing them to vaporize.
The Association also says that some experts believe cutting the disease out is better then vaporizing with a laser. They also stress that all disease should be removed, including unusual appearances of endo, and, if possible, all tissue removed should be biopsied.
So called "radical" surgery or the removal of tubes, ovaries, and uterus is rarely necessary. As Dr. Herbert Goldfarb says in is book, THE NO HYSTERECTOMY OPTION (John Wiley and Sons 1990), "It is extremely rare person in this day and age who should ever need a hysterectomy for endometriosis, no matter how severe the condition."
Approach To Surgical Treatments
Surgery can be done for two reasons, to relieve pain or to enhance fertility.
According to Dr. David Olive, research has shown that surgery for infertility is most beneficial for women who have severe endometriosis or pelvic organs distorted out of shape, making pregnancy impossible.
If you are planning surgery for pain relief, find out what the track record is for the type of surgery you're getting five, ten and 15 years after surgery.
The experience of the surgeon is the single most important factor in determining the success of the surgery. The surgeon must be highly experienced and highly skilled in the use of the laparoscope and really committed to biopsying and getting rid of all suspicious abnormalities.
Laser has two disadvantages. The diagnosis cannot be checked through biopsy. Secondly, endometriosis has been discovered underneath carbon burns caused by the laser. However, in the hands of a skilled surgeon, laser can be an effective tool.
No one should consider surgery until they have read the Endometriosis Association's excellent and comprehensive guidelines on surgery and how to choose an experienced surgeon.
In 1991 Dr. David Adamsom, Director of the Fertility and Reproductive Health Unit in Palo Alto, California, estimated that of the 30,000 gynecologists in the U.S., there are perhaps 50 who have the determination and the skill to remove all of the endometriosis at surgery.
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