Endometriosis 101: An In-Depth Look At Treatment Options

Endometriosis 101: An In-Depth Look At Treatment Options

March 11th, 2022

Pain. It's a part of life all of us experience. However, just like life, pain isn’t fair. We don’t all live with the same amount. Just ask any of the over 6.5 million women living with endometriosis. At Women’s Surgery & Aesthetic Center, we are committed to helping these extraordinary women living with endo find relief, and we believe it is our responsibility to provide useful information to women not only in our community but around the world with useful information about treatment options.

You may remember that last year we started a blog series called “Endometriosis 101.” Our first blog in the series focused on the basics of endo, while our second covered pain management tips. In honor of March being Endometriosis Awareness Month, we are picking this series back up for a special third installment featuring answers to some of the questions you may have about the treatment options we offer. 

Q: What are some of the treatment options available for women with endometriosis?

A: Once endometriosis has been diagnosed, medications are the first-line treatment. Several medications (used alone or in combination) have been shown to help alleviate the symptoms of endometriosis.  Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen can help with cramping and inflammation associated with endometriosis. Hormonal contraceptives (birth control pills, Depo Povera shot) or the progesterone-releasing IUD are commonly prescribed to put the endometriosis in a “resting phase” so that the symptoms are less severe. If birth control pills do not work, stronger hormonal therapy is also available but has more bothersome side effects than birth control pills. Non-traditional therapies have been shown to have minimal benefit. These would include acupuncture, massage, special diets, and physical therapy.  

Q: How do you determine the best treatment option for the patient? Does a person’s age or symptoms play a role in that decision?

A: Many factors go into decision-making for determining the most appropriate treatment option for a woman with endometriosis. The severity of symptoms is probably the most important factor. If symptoms are mild, then you might start with more conservative measures. If symptoms are more severe or fertility has become an issue, then more conservative treatment methods are probably a waste of time and money. Treatment decisions should be individualized and made by the patient with the informed assistance of an expert provider.

Q: When is surgery appropriate for an endo patient?

A: When conservative treatments have been tried and do not help (or stop helping) to prevent the symptoms of endometriosis, surgery is necessary.

Q: What is excision surgery, and why is it considered the “Gold Standard.”

A: Most providers simply ablate endometriosis lesions with some sort of thermal energy device. This takes care of superficial lesions but does not treat the deeper, more invasive disease that causes scar tissue around nerves and compresses structures in which it is implanted such as ureters and bowels. You also cannot ablate endometriosis lesions that are implanted on sensitive structures such as ureters, bowel, bladder, and blood vessels. The result of this form of incomplete surgical management is that a person may feel no better (or sometimes worse) after ablative treatment, or more commonly, they feel better for 6 months to a year, and then the symptoms return.

Excision surgery for endometriosis takes a completely different approach to the surgical management of endometriosis. Expert excision surgeons, like Dr. Furr, treat endometriosis like cancer. No matter where the endometriosis is, it is removed in its entirety from the structures in which it is implanted (or embedded) with wide margins down to healthy, unaffected tissue. This is the only way to make sure you remove not only the visible lesion but also any microscopic disease around the lesion that you cannot see, as well as the scar tissue affecting the nerves and other structures that may be underneath or around the visible lesion. The result of this more comprehensive management is better long-term outcomes with longer pain-free intervals and far better fertility outcomes. 

Q: What is the difference between an excision surgeon and a regular Ob/Gyn?

A: There are only about 75-100 surgeons around the world who are vetted experts in endometriosis excision surgery. This means that they have had extensive training outside of Ob/Gyn residency in the surgical management of endometriosis. Most excision surgeons have completed formal fellowship training programs in laparoscopic management of endometriosis. However, this is not enough. In addition to formal training, most true excision surgeons have many years of experience, including thousands of cases, additional continuing medical/surgical education in endometriosis, and are experts in their field including research, publications, and authorship of textbook chapters. A good excision surgeon should be trained on how to manage the removal of endometriosis from delicate structures such as the diaphragm, the bowels, bladder, blood vessels, and ureters. In addition to removal of the endometriosis from these structures, a good excision surgeon should be qualified to repair the structures from which the endometriosis is removed and not have to rely on other specialists, except in extreme cases, to assist in surgery.

A list of vetted excision surgeons can be found on Nancy’s Nook on Facebook.

Q: How is excision surgery for endometriosis performed?

A: “Minimally invasive” (laparoscopic or robotic) surgery is the “gold standard” for surgical management of endometriosis. The reason for this is that it allows for superior visualization of the abdomen and pelvis through high-resolution, magnified imaging of the structures on which the endometriosis is located. Another major benefit of laparoscopic/robotic surgery is it allows for faster return to normal activities, less blood loss, and less pain than traditional surgery.

At Women’s Surgery Center, Dr. Furr takes this a step further: he performs complicated endometriosis cases through a single 1-inch incision in the belly button.  Dr. Furr is a pioneer and national expert in single-site robotic surgery. His experience in single-site surgery puts in him the top 5% of ALL surgical specialties in the United States. The greatest benefit of single-site surgery is a very cosmetic, single incision in the belly button that is essentially invisible after it heals. Traditional laparoscopic and robotic surgery requires up to five incisions on the abdomen.

Q: What is the prognosis with this surgery, and would a person need additional surgeries in the future?

A: Probably the greatest benefit of excision surgery for endometriosis is not only the significant relief of pain and other symptoms but more importantly, the increased length of the pain-free interval. Many women who come to our office have had multiple surgeries (as many as 10-20 surgeries have been reported) oftentimes by the same provider. Dr. Furr has seen 18-year-old women who have had their uterus and ovaries removed, and when they still had symptoms, were told that they were “crazy and there is nothing else that can be done.” Likewise, it is critical for women to understand this disease and know where to look for help. Another very important benefit of excision surgery directly impacts any woman who suffers from infertility. When a woman has unexplained infertility, 40% of the time, she is ultimately diagnosed with endometriosis. It is crucial that these women see an experienced excision surgeon to have the best option to achieve fertility without having to go through in-vitro fertilization. There is no more rewarding outcome than when a couple struggling with infertility has endometriosis surgery and later notifies us that they are pregnant. Finally, excision surgery offers the best prognosis for not needing additional surgeries in the future for this disease. It is very rare that Dr. Furr has to operate more than once on a patient for endometriosis.

Q: How does your office take a team approach to treat women with endometriosis, and what do the individual team members do?

A: The Nurse Practitioners at Women’s Surgery Center have years of experience in the diagnosis and management of endometriosis and associated chronic pelvic pain. They understand and know when and how to implement each phase of care from conservative management to knowing when surgical options are best for a woman suffering from endometriosis. Our providers are also experienced in fertility issues that can be associated with endometriosis. Finally, we also work with expert pelvic floor physical therapists with extensive experience in treating not only pain associated with endometriosis but also other pelvic pain disorders.

Q: What are some of the misconceptions women have about treatments and surgery for endometriosis?

A: The things women have been told about treatment for endometriosis never cease to amaze us. Women who come to our office have reported being told some very bizarre things:

You have to get pregnant and then have a hysterectomy for your symptoms to go away.”

There is no way that endometriosis can be causing your painful bowel movements.”

You have IBS, that is why you have constipation and diarrhea during your periods.”

You probably were abused when you were little; that is why sex is painful.”

The only way to get rid of your pain is to have your uterus and ovaries removed.”

You just are trying to get out of school (or work) once a month.”

These are just a few of the silly things women have reported to Dr. Furr over the years that they were told by their doctors. Hysterectomy/removing ovaries is not a “cure” for endometriosis. In fact, this often leads to more harm than good in the long run. Endometriosis can reside essentially anywhere in the body. Although most common in the pelvis, it can be found outside of the pelvis on any structure in the abdominal cavity. It can also invade through the diaphragm and seed the thoracic cavity and lungs. Dr. Furr has treated multiple patients who have endometriosis in the bronchial tree in the lungs who cough up blood during their periods. Likewise, he very commonly removes endometriosis from the bowels, and a patient’s bloody stool and “IBS” magically disappear after excision surgery.

Q: What are other conditions that occur in women with endometriosis?

A: The most common condition we see in women with endometriosis is Painful Bladder Syndrome. This was formerly known as Interstitial Cystitis or “IC,” and is reported to occur in up to 85% of women with endometriosis. Painful Bladder Syndrome causes urinary frequency and urgency, pain when the bladder is full, relief when it is emptied, nocturia (getting up to pee after you have gone to sleep), painful urination, painful bladder spasms, and pain in the area of the bladder with intercourse. Oftentimes, women will report a history of “recurrent UTIs”. They go to the doctor and there may be a little blood in the urine. They get antibiotics and feel better for a little while, but the symptoms keep coming back.  Women should be sure to report these types of symptoms to their doctor because this condition can also be treated if appropriately diagnosed. 

We’re Here for You

Ladies, endometriosis does not have a right to control your life. We want to help you put endo in its place and enjoy life again. Give us a call at 423-899-6511 to schedule an appointment with one of our providers.