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Everything you ever wanted to know about endometriosis surgery

Operative procedures for endometriosis
by Ros Wood

Hormonal treatments have no long-term effect on endometriosis, so you may have to undergo surgery in order to treat your disease.

Surgery for endometriosis can be very complex, in particular if you also have fibroids and/or adenomyosis, and extensive disease may mean that surgery will involve repair to fix the rectum and/or the bladder.

Endometriosis surgery aims to reduce endometriosis-associated pain by removing or destroying all visible endometriosis and any associated adhesions.

New Approaches To Endometriosis Treatment: Mouse Experiments Point The Way

Possible new directions for the treatment of endometriosis, a painful condition associated with infertility that affects up to 15% of women of reproductive age, will be outlined in the presentation of two experimental studies at the 23rd annual conference of the European Society of Human Reproduction and Embryology (Tuesday July 3). Both concern targeting angiogenesis — the formation of new blood vessels — which is encourages endometriosis by providing a rich blood supply.

The scientists found that the blood vessel formation in the lesions was significantly decreased. “The percentage of new blood vessels in the two treatment groups was reduced in comparison to the control group, and we also found that the percentage of old blood vessels in these groups were higher”, says Dr. Novella-Maestre. “The total number of the blood vessels was not dissimilar in the treatment and control groups, but the ratio of new/old blood vessels, the numbers of cells growing in the endometrial area, and the area lesions were totally different, suggesting that there was inhibition of blood vessel replacement in the treatment group.”

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Endometriosis increases risk of certain cancers

Doctors in Sweden have shown for the first time that although endometriosis is associated with an increased risk of various cancers, this risk does not depend on the number of times women with the condition have given birth.

Dr Anna-Sofia Melin, told the 23rd annual meeting of the European Society of Human Reproduction and Embryology: “Several epidemiological studies have shown an increased cancer risk among women with endometriosis, especially ovarian cancer. Infertility and never having given birth (nulliparity) are also known risk factors for different types of cancer, such as breast and endometrial cancer. However, as far as we know, this is the first study to investigate cancer risk among women with endometriosis that also stratifies for parity.”

Dr Melin, a specialist doctor in the department of obstetrics and gynaecology at the Karolinska University Hospital in Stockholm, Sweden, and epidemiologists at the Karolinska Institute looked at data from 63,630 women who had been discharged from hospital with a diagnosis of endometriosis between 1969 and 2002. They were identified and followed up via the National Swedish Inpatient Register, the National Swedish Cancer Register and the Swedish Multi-Generation Register.

The researchers identified 3,822 cases of cancer amongst the women with endometriosis. While they found no overall increased risk of cancer, they did find that the women had an elevated risk of certain types of cancer, but that there was no significant difference in risk between women who had never given birth and those who had.

“We found that, contrary to what one might expect, endometriosis and nulliparity did not combine to give a higher risk of cancer,” said Dr Melin.

The researchers found that endometriosis increased the risk of developing ovarian cancer by more than a third (37%) above the risk for the normal population of women without endometriosis. There were similar increases in risk for endocrine tumours (38%), kidney cancer (36%) and thyroid cancer (33%). Slightly lower increases were found for brain tumours (27%) and malignant melanoma (23%), and there was a small increased risk of breast cancer (8%). Interestingly, women with endometriosis had a reduced risk of cervical cancer of just under a third (29%).

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The best new pain cures, with a focus on women

Zooming in on female pain

We know that men don’t suffer menstrual pain, but that’s not the only fun they’re missing. “Research is uncovering very dramatic differences in how the genders experience pain,” says Mark Allen Young, a professor at New York College of Podiatric Medicine and author of “Women and Pain: Why It Hurts and What You Can Do.”

It all starts with hormones. There is no getting around how profoundly hormones such as estrogen and testosterone affect the central nervous system, which is responsible for perceiving and transmitting the sensation of pain. According to experts, this is one reason why conditions such as osteoarthritis, headaches, and irritable bowel syndrome strike women at much higher rates than men.

Our physical differences really matter, too. “We’ve only recently begun to grasp that women’s body architecture is completely different from men’s,” Young says. Because women walk differently, for instance, they put pressure on joints, muscles, and bones in very different ways than men do. “Starting with the knees and hips and working up to the shoulders, spine, and neck, how a person walks can have a huge impact on how pain develops later in life,” Young says. Just last year, one medical-implant maker finally recognized this fact by creating a knee implant just for women.

Women are also more prone to conditions involving the immune system, says Deborah Metzger, M.D., an OB-GYN and specialist in integrative pain management in Los Altos, California. Scientists have long known that women have stronger immune systems than men, she says. That strength can backfire, though, leading women to suffer from far more autoimmune disorders — in which the immune system attacks itself — and the host of mysterious diseases thought to sometimes result from an overreactive immune system, such as celiac disease, irritable bowel syndrome, fibromyalgia, chronic fatigue syndrome, and many types of pelvic pain.

“Women tend to have hyperalert immune systems, which is good,” Metzger says. “But once the immune system gets stirred up, it can turn into a feeding frenzy.” The fired-up immune activity produces inflammatory chem­icals that fuel all types of muscle and joint pain; it can also activate nerves in vulnerable spots like the lower back (sciatica), the head (migraines), and the pelvis (endometriosis and pelvic pain).

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World Endometriosis Society publishes e-Journal with articles of diagnostic delay, and adhesions in endometriosis

CONTENT:

• News round up
• Can the delays in diagnosing endometriosis be reduced?
• Endometriosis and adhesions
• Highlights from the 2007 UCSF-CHE Summit on Environmental Challenges to Reproductive Health and Fertility
• Stakeholders in endometriosis come together in the European Parliament
• 10 Programme highlights for the upcoming WCE 2008
• Research highlights

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