Gynecology Endometriosis Treatment

What are the symptoms of Endometriosis?

• Constipation
• Bloating
• Fatigue
• Painful bowel movements
• Painful intercourse usually with deep insertion or certain positions
• Infertility
• Right and/or Left sided pelvic and abdominal pain
• Diarrhea
• Pelvic pain during menses, before menses, after menses and/or anytime during the month
• Urinary frequency, and/or urgency, and/or painful voiding
• Malaise
• Lower back pain
• Heavy or irregular periods
  
  

The symptoms of endometriosis are related to the areas where endometriosis invades. Endometriosis of the uterosacral ligaments/cul-de-sac leads to painful intercourse, constipation, diarrhea and painful defecation. Endometriosis on the ovary can lead to left sided or right sided pain. Bladder endometriosis may lead to urinary frequency or urgency. You may have only one of the above symptoms or many. Even one symptom can be suggestive of Endometriosis.

Some women have no symptoms yet suffer from infertility. And many women do not have any symptoms, but discover they have endometriosis when are having trouble conceiving. If your doctor told you that you have ‘unexplained infertility’, endometriosis is the culprit in 40-50% of cases of unexplained infertility. If you need an endometriosis specialist in Fort Myers, Naples or Cape Coral, make an appointment with Dr. Bloy. His excision and medical treatment of endometriosis decreases inflammation, pain and will improve fertility.

Risk Factors for Endometriosis

Endometriosis is most often found in women of reproductive age, but it also affects teenage girls who have not yet menstruated, post-menopausal women, and women who have had their uterus or ovaries removed. While the following risk factors increase the likelihood for endometriosis, there are many women who develop endometriosis without any of the following risk factors:

• Family history, especially mother or sister.
• If your mother has endometriosis, you have a 7 times higher risk of developing endometriosis
• Beginning menstruation at an early age
• Congenital genital anomalies
• Early onset painful periods
• Short frequent menstrual cycles
• Mullerian abnormalities
• Not having birthed a child
• Autoimmune disorders (thyroid, rheumatoid, eczema, food allergies/sensitivities)
  
  

How is Endometriosis diagnosed?

Currently, the best-accepted way to diagnose endometriosis is by laparoscopy, a minimally invasive surgical procedure, to visualize and biopsy suspicious lesions, which are then confirmed by microscopic evaluation. There is not yet a non-invasive diagnostic test for endometriosis.

Endometriosis commonly goes undiagnosed or is misdiagnosed and it typically takes 6 to 10 years from the time a woman experiences her first symptoms to the time she receives a diagnosis. Imaging (Ultrasound, CT, MRI) is usually normal and does not show endometriosis. This is the reason for a delay in diagnosis in many women.

Can you believe in the United States, there is a lag of 10-11 YEARS from symptom onset to diagnosis!! The diagnosis of endometriosis can only be made by laparoscopic excision of tissue with pathological confirmation. Laparoscopy is both diagnostic and therapeutic. Dr. Bloy will take an extensive history and perform a thorough physical exam before deciding whether surgical therapy is beneficial. A physical exam combined with an extensive history can predict endometriosis in most cases.

Medical Management

Pain relievers and hormonal treatments can be effective at lessening symptoms, especially after laparoscopic
surgery.

• Non-steroidal anti-inflammatories (NSAID’s)
• Oral contraceptive pills
• Androgens
• Progestins
• GnRH agonists and antagonists
• Aromatase inhibitors
• Surgical Management
  
  

Treatment of Endometriosis What treatment options does Dr. Bloy offer for endometriosis?

Laparoscopic surgery is the definitive method to diagnose and treat endometriosis. Excision of Endometriosis is the gold standard treatment for endometriosis. Ideally all endometrial lesions should be excised or destroyed. Surgery is outpatient, and in most cases you will go home on the same day as surgery.

More and more, most general ob/gynecologists are not trained in advanced endometriosis cases and are less skilled in ablative surgery. Advanced devices such as the Harmonic Scalpel can destroy or remove endometriosis without damage or risks to the underlying organs or vessels.
Deep fibrotic endometriosis usually does not respond well to hormonal suppressive therapy. Suppressive therapy may be desirable as a follow up to surgical excision to prevent the endometriosis from recurring.

Effective surgical excision of endometrial implants provides the best symptomatic relief and long term results. In addition, surgical excision has been shown to improve fertility rates in women. Medical therapy can effectively suppress endometriosis but may not eradicate endometriosis.

What is the best way to treat endometriosis?

The standard of care is to perform minimally invasive surgery to destroy endometriosis implants by ablation (vaporization) and resection (excision). The goal is to restore normal anatomy and organ function, to reduce pain, and to preserve fertility. In experienced hands, the benefits of surgery outweigh the risks.

Excision of Endometriosis

Laparoscopic surgery is the definitive method to diagnose and treat endometriosis. Excision of endometriosis is the gold standard treatment for endometriosis. Ideally all endometriosis lesions should be excised. Excision surgery makes sense. During a monthly cycle, a endometrium, or uterine lining builds up then is shed in the monthly flow of menses.

The endometriosis areas growing outside the uterus go through a similar cycle but are not shed and cannot leave the body. So, the endometrial implants get deeper and invade other tissue. Endometriosis lesions can irritate nearby tissue causing adhesions, scarring, and pain. Over time, endometriosis can grow into nodules causing scaring to invaded organs.

Excision of endometriosis is the only therapy to reliably and objectively eliminate the disease and improve quality of life.

What causes endometriosis?

Despite many hypotheses as to the causes of endometriosis, none of them have been definitively proven There is no full explanation of disease development. It seems to be multifactorial, involving:

• Retrograde menstruation
• Lymphatic and hematogenous spread
• Genetic predisposition and abnormal gene expression
• Environmental factors
• Immune system dysfunction.
  
  

Endometriosis implants are affected by monthly fluctuations of female sex hormones, can bleed, implant
elsewhere, and cause scar tissue and adhesions in an ongoing cycle.

Endometriosis in Teens and Adolescents

Endometriosis is common in adolescents, especially in those who have a history of painful periods and pelvic pain. This pain can be cyclical or non-cyclical. Other symptoms include painful bowel movements, constipation, intestinal cramps, and bladder pain. Sexually active adolescents may report pain during sex. Adolescents are regularly found to have early, superficial endometriosis. Articles suggest that in up to 70% of adolescents who do not respond to medical treatment for painful periods, endometriosis is discovered at the time of laparoscopy.

Most frequently, endometriosis symptoms do not improve with nonsteroidal anti-inflammatory (NSAIDs) and/or the birth control pill. Therefore, endometriosis may be progressing while just the symptoms are treated.

The laparoscopic findings of endometriosis in adolescents or teenagers can be different than in an adult. Endometrial lesions in teens or adolescents tend to be clear or red. A camera with 3-D HD magnification allows for better viewing of these clear and red lesions. Clear and precise visualization of these early lesions allows for superior surgical excision and a more successful outcome.

Dr. Bloy offers support and compassion in dealing with adolescents. Dr. Bloy has three daughters and relates well to adolescents. He is the medical director of experienced female nurse practitioners able to comfortably examine teen patients and begin the process of treating teens who are experiencing pain and are suspected to have endometriosis.

Endometriosis and Infertility

As much as 40% of unexplained infertility may be due to endometriosis. For some women, infertility may be the only symptom of endometriosis. In others, one or more of the following endometriosis symptoms may be present: painful periods, constipation, diarrhea, painful bowel movements, back pain, painful sex, abdominal pain, pelvic pain, bloating, urinary frequency, or painful urination. ‘Silent Endometriosis’ refers to women who suffer from infertility but are completely asymptomatic from endometriosis symptoms.

Infertility from endometriosis occurs due to inflammation and/or structural anatomical scaring/adhesions in the reproductive organs. Endometriosis is an inflammatory disorder that interferes with the process of the egg and sperm meeting, or implantation in the uterine lining. Endometriosis can also cause structural alterations to the pelvic organs—such as blocking the fallopian tubes or dilating fallopian tubes which cause infertility. Endometriosis can affect ovarian reserve and can lead to diminished egg quality.

Thankfully, excision of endometriosis and post-operative medical therapy often improves fertility by decreasing inflammation and can restore the proper structural foundations for fertility. Women often get pregnant after excision of endometriosis and may not require IVF. Please call today and schedule an appointment to learn how Dr Bloy can improve your fertility by treating your Endometriosis.

Dr. Richard Bloy specializes in the Treatment of Endometriosis and is the Medical Director of the Contemporary Health Center in Fort Myers, Naples and Cape Coral. Dr. Bloy has decades of expertise in identifying and treating endometriosis, and Laparoscopic and Laparoscopic Surgery.
Dr. Bloy specializes in pelvic pain and the treatment of endometriosis. He understands that endometriosis is a major reason woman experience pain. He strives to assess for all additional co-existing generators of pain in order to help women live pain free productive lives.

His training, with experts in the field of advanced laparoscopic surgery — allows Dr. Bloy to be one of a handful of physicians across the country trained to perform advanced minimally invasive procedures. Dr. Bloy provides both compassionate and individualized care while performing advanced laparoscopic techniques. Dr. Bloy operates in Lee Health System at Gulf Coast Hospital in Fort Myers, Florida. Dr. Bloy is board certified in OB/GYN. Dr. Bloy offers focused, individualized care with compassion.

What is Endometriosis?

Endometriosis is a disease in which cells similar to the lining of the uterus (endometrium) are found outside of the uterus. It occurs when endometrial tissue, glands and stroma are found in locations other than the lining of the uterus: most commonly in the pelvic cavity, fallopian tubes and ovaries, but frequently in extra-genital areas such as the bowel, bladder, and ureters. It is, also, known to be found in the diaphragm, lungs, and other organs. Endometriosis is a chronic, progressive, estrogen-dependent inflammatory disease. Endometriosis is common and affects 176 million women worldwide. It is estimated that 15% of women have endometriosis.

There is no known cure for endometriosis, but it can be effectively managed medically and surgically.

What are the symptoms of Endometriosis?

• Constipation
• Bloating
• Fatigue
• Painful bowel movements
• Painful intercourse usually with deep insertion or certain positions
• Infertility
• Right and/or Left sided pelvic and abdominal pain
• Diarrhea
• Pelvic pain during menses, before menses, after menses and/or anytime during the month
• Urinary frequency, and/or urgency, and/or painful voiding
• Malaise
• Lower back pain
• Heavy or irregular periods
  
  

The symptoms of endometriosis are related to the areas where endometriosis invades. Endometriosis of the uterosacral ligaments/cul-de-sac leads to painful intercourse, constipation, diarrhea and painful defecation. Endometriosis on the ovary can lead to left sided or right sided pain. Bladder endometriosis may lead to urinary frequency or urgency. You may have only one of the above symptoms or many. Even one symptom can be
suggestive of Endometriosis.

Some women have no symptoms yet suffer from infertility. And many women do not have any symptoms, but discover they have endometriosis when are having trouble conceiving. If your doctor told you that you have ‘unexplained infertility’, endometriosis is the culprit in 40-50% of cases of unexplained infertility. If you need an endometriosis specialist in Fort Myers, Naples or Cape Coral, make an appointment with Dr. Bloy. His excision and medical treatment of endometriosis decreases inflammation, pain and will improve fertility.

Risk Factors for Endometriosis

Endometriosis is most often found in women of reproductive age, but it also affects teenage girls who have not yet menstruated, post-menopausal women, and women who have had their uterus or ovaries removed. While the following risk factors increase the likelihood for endometriosis, there are many women who develop endometriosis without any of the following risk factors:

• Family history, especially mother or sister.
• If your mother has endometriosis, you have a 7 times higher risk of developing endometriosis
• Beginning menstruation at an early age
• Congenital genital anomalies
• Early onset painful periods
• Short frequent menstrual cycles
• Mullerian abnormalities
• Not having birthed a child
• Autoimmune disorders (thyroid, rheumatoid, eczema, food allergies/sensitivities)
  
  

How is Endometriosis diagnosed?

Currently, the best-accepted way to diagnose endometriosis is by laparoscopy, a minimally invasive surgical procedure, to visualize and biopsy suspicious lesions, which are then confirmed by microscopic evaluation. There is not yet a non-invasive diagnostic test for endometriosis.

Endometriosis commonly goes undiagnosed or is misdiagnosed and it typically takes 6 to 10 years from the time a woman experiences her first symptoms to the time she receives a diagnosis. Imaging (Ultrasound, CT, MRI) is usually normal and does not show endometriosis. This is the reason for a delay in diagnosis in many women.

Can you believe in the United States, there is a lag of 10-11 YEARS from symptom onset to diagnosis!! The diagnosis of endometriosis can only be made by laparoscopic excision of tissue with pathological confirmation. Laparoscopy is both diagnostic and therapeutic. Dr. Bloy will take an extensive history and perform a thorough physical exam before deciding whether surgical therapy is beneficial. A physical exam combined with an extensive history can predict endometriosis in most cases.

Medical Management

Pain relievers and hormonal treatments can be effective at lessening symptoms, especially after laparoscopic
surgery.

• Non-steroidal anti-inflammatories (NSAID’s)
• Oral contraceptive pills
• Androgens
• Progestins
• GnRH agonists and antagonists
• Aromatase inhibitors
• Surgical Management
  
  

Treatment of Endometriosis What treatment options does Dr. Bloy offer for endometriosis?

Laparoscopic surgery is the definitive method to diagnose and treat endometriosis. Excision of Endometriosis is the gold standard treatment for endometriosis. Ideally all endometrial lesions should be excised or destroyed. Surgery is outpatient, and in most cases you will go home on the same day as surgery.

More and more, most general ob/gynecologists are not trained in advanced endometriosis cases and are less skilled in ablative surgery. Advanced devices such as the Harmonic Scalpel can destroy or remove endometriosis without damage or risks to the underlying organs or vessels.
Deep fibrotic endometriosis usually does not respond well to hormonal suppressive therapy. Suppressive therapy may be desirable as a follow up to surgical excision to prevent the endometriosis from recurring.

Effective surgical excision of endometrial implants provides the best symptomatic relief and long term results. In addition, surgical excision has been shown to improve fertility rates in women. Medical therapy can effectively suppress endometriosis but may not eradicate endometriosis.

What is the best way to treat endometriosis?

The standard of care is to perform minimally invasive surgery to destroy endometriosis implants by ablation (vaporization) and resection (excision). The goal is to restore normal anatomy and organ function, to reduce pain, and to preserve fertility. In experienced hands, the benefits of surgery outweigh the risks.

Excision of Endometriosis

Laparoscopic surgery is the definitive method to diagnose and treat endometriosis. Excision of endometriosis is the gold standard treatment for endometriosis. Ideally all endometriosis lesions should be excised. Excision surgery makes sense. During a monthly cycle, a endometrium, or uterine lining builds up then is shed in the monthly flow of menses.

The endometriosis areas growing outside the uterus go through a similar cycle but are not shed and cannot leave the body. So, the endometrial implants get deeper and invade other tissue. Endometriosis lesions can irritate nearby tissue causing adhesions, scarring, and pain. Over time, endometriosis can grow into nodules causing scaring to invaded organs.

Excision of endometriosis is the only therapy to reliably and objectively eliminate the disease and improve quality of life.

What causes endometriosis?

Despite many hypotheses as to the causes of endometriosis, none of them have been definitively proven There is no full explanation of disease development. It seems to be multifactorial, involving:

• Retrograde menstruation
• Lymphatic and hematogenous spread
• Genetic predisposition and abnormal gene expression
• Environmental factors
• Immune system dysfunction.
  
  

Endometriosis implants are affected by monthly fluctuations of female sex hormones, can bleed, implant
elsewhere, and cause scar tissue and adhesions in an ongoing cycle.

Endometriosis in Teens and Adolescents

Endometriosis is common in adolescents, especially in those who have a history of painful periods and pelvic pain. This pain can be cyclical or non-cyclical. Other symptoms include painful bowel movements, constipation, intestinal cramps, and bladder pain. Sexually active adolescents may report pain during sex. Adolescents are regularly found to have early, superficial endometriosis. Articles suggest that in up to 70% of adolescents who do not respond to medical treatment for painful periods, endometriosis is discovered at the time of laparoscopy.

Most frequently, endometriosis symptoms do not improve with nonsteroidal anti-inflammatory (NSAIDs) and/or the birth control pill. Therefore, endometriosis may be progressing while just the symptoms are treated.

The laparoscopic findings of endometriosis in adolescents or teenagers can be different than in an adult. Endometrial lesions in teens or adolescents tend to be clear or red. A camera with 3-D HD magnification allows for better viewing of these clear and red lesions. Clear and precise visualization of these early lesions allows for superior surgical excision and a more successful outcome.

Dr. Bloy offers support and compassion in dealing with adolescents. Dr. Bloy has three daughters and relates well to adolescents. He is the medical director of experienced female nurse practitioners able to comfortably examine teen patients and begin the process of treating teens who are experiencing pain and are suspected to have endometriosis.

Endometriosis and Infertility

As much as 40% of unexplained infertility may be due to endometriosis. For some women, infertility may be the only symptom of endometriosis. In others, one or more of the following endometriosis symptoms may be present: painful periods, constipation, diarrhea, painful bowel movements, back pain, painful sex, abdominal pain, pelvic pain, bloating, urinary frequency, or painful urination. ‘Silent Endometriosis’ refers to women who suffer from infertility but are completely asymptomatic from endometriosis symptoms.

Infertility from endometriosis occurs due to inflammation and/or structural anatomical scaring/adhesions in the reproductive organs. Endometriosis is an inflammatory disorder that interferes with the process of the egg and sperm meeting, or implantation in the uterine lining. Endometriosis can also cause structural alterations to the pelvic organs—such as blocking the fallopian tubes or dilating fallopian tubes which cause
infertility. Endometriosis can affect ovarian reserve and can lead to diminished egg quality.

Thankfully, excision of endometriosis and post-operative medical therapy often improves fertility by decreasing inflammation and can restore the proper structural foundations for fertility. Women often get pregnant after excision of endometriosis and may not require IVF. Please call today and schedule an appointment to learn how Dr Bloy can improve your fertility by treating your Endometriosis.