Endometriosis: What are You Waiting For?
The last post discussed over-blowing the search for endometriosis. This post will discuss the opposite. The following is a typical example of what I see in my practice.
A woman in her late 20’s came to see me for fertility care. She had a past history of laparoscopy for mild endometriosis. It was treated, but still she could not conceive. I put her on Clomid and she got pregnant and had a baby. 3 years later she became pregnant on her own and had her second cesarean section and a tubal ligation. Now 3 years have past, and she called me with 6 months of terrible pelvic pain. The pain was the worse with her period, described as severe. She also had pain with ovulation and intercourse. I asked her to come in for a visit, and when I examined her she was very tender in the area of her cesarean section scar.
So I started asking questions. “What did your doctor do when you told him about the pain?” “He told me to take Motrin,” she said. “But you told him you couldn’t function?” “Yes, but he told me there was nothing wrong.” “Did he offer you a laparoscopy to look for endometriosis or scar tissue?” “No, he didn’t think that it was an issue.”
I was in shock. How is it that many healthy women get laparoscopies, and yet some women with a clear indication for surgery are ignored? I still don’t have an answer.
Last week I performed a laparoscopy on this woman and sure enough she had a tremendous amount of scar tissue near her c section scar. I cut it away and even in the recovery room she felt better than she did before surgery. I didn’t see much endometriosis, but I suspect her scarring was made much worse by small amounts of it.
Pelvic pain is not normal. Periods with severe pain, or pain that lasts for more that 2 days, are not normal. I don’t want anyone to get surgery that doesn’t need it, and surgery doesn’t guarantee pain relief. But when pain interferes with the quality of ones life, a laparoscopy may result in tremendous relief. In some cases, alternatives to surgery, such as hormonal therapy, may also be beneficial.
A woman in her late 20’s came to see me for fertility care. She had a past history of laparoscopy for mild endometriosis. It was treated, but still she could not conceive. I put her on Clomid and she got pregnant and had a baby. 3 years later she became pregnant on her own and had her second cesarean section and a tubal ligation. Now 3 years have past, and she called me with 6 months of terrible pelvic pain. The pain was the worse with her period, described as severe. She also had pain with ovulation and intercourse. I asked her to come in for a visit, and when I examined her she was very tender in the area of her cesarean section scar.
So I started asking questions. “What did your doctor do when you told him about the pain?” “He told me to take Motrin,” she said. “But you told him you couldn’t function?” “Yes, but he told me there was nothing wrong.” “Did he offer you a laparoscopy to look for endometriosis or scar tissue?” “No, he didn’t think that it was an issue.”
I was in shock. How is it that many healthy women get laparoscopies, and yet some women with a clear indication for surgery are ignored? I still don’t have an answer.
Last week I performed a laparoscopy on this woman and sure enough she had a tremendous amount of scar tissue near her c section scar. I cut it away and even in the recovery room she felt better than she did before surgery. I didn’t see much endometriosis, but I suspect her scarring was made much worse by small amounts of it.
Pelvic pain is not normal. Periods with severe pain, or pain that lasts for more that 2 days, are not normal. I don’t want anyone to get surgery that doesn’t need it, and surgery doesn’t guarantee pain relief. But when pain interferes with the quality of ones life, a laparoscopy may result in tremendous relief. In some cases, alternatives to surgery, such as hormonal therapy, may also be beneficial.
posted by Dr. Licciardi at 6:41 PM
5 Comments:
Thank you Dr. Licciardi. Your interest in creating such a site shows your consideration and concern for those of us in this difficult situation. I am a patient of yours and appreciate and look forward to reading your posts. I have shared your site with others I know who would be interested.
Hi,Dr. Licciardi, I am so glad to see a doctor in this setting. I am new to the blog scene, and recently have written an inspirational book of encouragement for women concerning speaking positively about the health and future of their wombs from today, as some wombs seem to have serious gynocological appointments assigned to them in the future. I am an example, I had to comfort my womb with prayer and medicine, and was able through the myomectomies to give birth! I have a 16yrs old and a 11 years old . SO I have been there! Ovarian problems, misscarriage, etc. It was surgery, prayer, birth; misscariage,2nd birth, 2nd myomectomy..(done) 7 yrs after hysterectomy. I want women to take a hold of the future of their wombs.
Dr. Licciardi,
I must say I am so pleased to see content such as this on the web. I am part of the Endometriosis Community, on a large scale as the Program Director for the Endometriosis Research Center's GirlTalk Program (www.endocenter.org/girltalk.html). I come across many Endo Victims who have doctors with a complete lack of bedside manner. They not only ignore their complaints and problems, but really have no clue how to fix them. Instead of sending these patients to someone who can help, they reap in the insurance money by having them come in for useless visits. Meanwhile, these patients are dropping out of school, losing their jobs and distancing themselves from family and loved ones. It is a common scene that can easily be prevented if the doctors were as more caring and thorough as you obviously are with your patients!
Thank you, Dr. Licciardi for being such a compassionate doctor. It is doctors like you that help the patients with life-altering conditions and diseases have some hope in their treatments!
Hi,Dr. Licciardi,
I saw you on cable tv a few weeks ago. I wanted to know how you would go about treating uterine scarring. My cervix is completely shut from scarring from a previous misscarriage. I had placenta previa. My doctor wasn't even able to insert an IUD. Is there any hope?
I was with Kaiser Permanente for a while and they had me seeing a different doctor every time I came in (which was almost weekly) that all thought it was endometriosis without having any proof aside from pain and abnormal periods. They put me on hormones to stop my period (which made me very sick), yet, they never recommended any tests. Now there is evidence on the sonogram and the doctor treating me has told me that insurance companies wont pay for these tests unless I'm trying to get pregnant... What you wrote just hit home, I guess.
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