The diagnosis of endometriosis is often strongly suspected from a patient’s initial history. For the vast majority of patients, endometriosis is included in the differential diagnosis of infertility or pelvic pain. An accurate diagnosis of endometriosis must be made by your gynecologist. He or she may perform a laparoscopy, which is an outpatient surgical procedure. A slim telescope is inserted through a very small opening made in the navel. This allows your doctor to examine the abdominal and pelvic organs and evaluate the extent of the disease. A biopsy is needed to make a definitive diagnosis, and that can be done during a laparoscopy or laparotomy (a more invasive surgical procedure which consists of pelvic or abdominal surgery).
Frequently medications are given that suppress ovulation and the normal menstrual process, usually birth control pills. Birth control pills have many problem attributed to them, including women who smoke and use OCs have a five-times greater risk of dying from a myocardial infarction than OC users who do not smoke. The use of the pill has been linked to circulatory problems especially blood clots. Oral contraceptives deplete the body of certain nutrients, mainly folate, pyridoxine which is vitamin B6, riboflavin, vitamin B12, vitamin C, magnesium and zinc.
Occasionally other drugs such as Nafarelin, a gonadotropin releasing hormone agonist are used which produce a relative menopausal- like state. These medications may induce breakthrough bleeding, bone loss and depression, the use is limited to 6 months or less.
Another drug that may be used to instill a low estrogen state is danzol, an analog of androgen, the male hormone. These drugs have the adverse effects such as weight gain, body hair growth, male pattern baldness, voice changes, edema and irritability.
Conservative surgery, where only the endometrial lesion are removed and the uterus and ovaries are left intact, is an option for those with significant pelvic adhesions, fallopian tube obstruction or incapacitating pain. Unfortunately most surgery increases the chance for new adhesions to develop. At times hysterectomy is warranted for women who have completed childbearing. If hysterectomy is performed on younger women hormone replacement therapy (i.e. premarin) may be advised.
Women should not accept drug therapy without a confirmed surgical or biospy diagnosis of endometriosis.