What is Endometriosis?

During a woman's menstrual cycle, the lining of the uterus thickens as it gets ready to nourish the embryo that will ultimately become a growing baby. If the woman doesn't get pregnant, than the lining will come off causing bleeding and a "period" happens. Endometriosis is a condition where the glands and tissue that are normally found inside the lining of the uterus, grow outside the uterus. This tissue responds to the hormonal changes and causes significant inflammation and discomfort.

One of the most common reasons you will hear as the cause of endometriosis is Retrograde Menstruation. When some of those endometrial cells from the lining travel backwards up through the fallopian tubes they can implant on other organs inside the pelvis. While this may be a contributing factor, I don’t believe it’s that simple. We see this happen in healthy women without endometriosis too. So there must be other factors and causes.

Dr. Stepp believes embryologic development plays a key role. During fetal development, certain cells in the pelvis similar to uterine cells can transform into endometrial-like cells under the influence of hormonal or environmental factors. This can show up in early adolescence as a woman’s hormones start to change. The truth is endometriosis is likely influenced by a combination of genetic, hormonal, immune, and environmental factors.

When endometriosis is present outside the uterus, the endometriosis implants grow and respond to the hormonal cycle just like if they were in the uterus. This can lead to the formation of adhesions, scar tissue invasion, and inflammation. This can cause pain, especially during menstruation, and may contribute to fertility issues. If the endometriosis is on the ovary, they can grow to form cysts called endometriomas. This can be very painful around the time of a woman's period. Some of the most painful areas are the uterosacral ligaments, behind the cervix or vagina, and by the bowel. And unfortunately, these are the most commonly missed lesions with routine gynecology surgery.

How is Endometriosis treated?

Diagnosis of endometriosis often involves a combination of medical history review, physical examination, and imaging studies. The gold standard and only sure way for definitive diagnosis is laparoscopy, a surgical procedure in which a thin tube with a camera is inserted through a small incision to visualize, biopsy, potentially treat endometriosis.

If you have been diagnosed with endometriosis, you should understand the treatment options available. Some patients do very well with medications to treat the pain and hormones to suppress the symptoms of endometriosis. However, if surgery is indicated to confirm the diagnosis or actually remove the lesions, Dr. Stepp feels strongly that endometriosis should be excised. Because the depth of endometriosis lesions is difficult to detect, Dr. Stepp does NOT burn, ablate, laser or cauterize the surface.

Although surgically removing the implants is more difficult, he has been excising endometriosis for over 20 years. Patients do better if all the endometriosis is removed. This is especially true for patients that have had prior surgery for endometriosis. Dr. Stepp is specifically trained in advanced laparoscopy to remove endometriosis while minimizing risk to the delicate structures of the pelvic anatomy and preserving fertility.

If you are considering surgical intervention for endometriosis, it is essential to discuss the pros and cons of each approach with your healthcare provider to make an informed decision based on your individual needs and circumstances. Dr. Stepp is one of the busiest endometriosis surgeons in the country. If you have been told that some or all of your endometriosis couldn’t be removed from the ovaries, ureter, bladder, bowel, appendix, colon or rectum, please contact Dr. Stepp for complete removal.

Key reasons why excision stands out as a more effective and beneficial option compared to ablation.

• Complete Removal of Lesions:
  • Excision surgery involves cutting out and removing endometriotic lesions entirely, ensuring a more comprehensive treatment.
  • Removes the inflammatory lesions.
  • Ablation, on the other hand, uses heat or energy to destroy the lesions superficially, often leaving behind residual tissue that may continue to cause symptoms.
• Reduced Recurrence Rates:
  • Studies have shown that excision surgery is associated with lower recurrence rates compared to ablation.
  • By removing lesions completely, excision addresses the root cause of endometriosis, leading to more lasting relief.
• Preservation of Healthy Tissue:
  • Excision focuses on preserving healthy surrounding tissue while removing only the affected areas, minimizing the impact on the normal anatomy.
  • Ablation, being a more superficial method, may inadvertently damage healthy tissue or structures surrounding the lesions.
• Improved Symptom Relief:
  • Complete removal of lesions contributes to a more effective reduction in symptoms compared to the temporary relief provided by ablation.
• Enhanced Fertility Outcomes:
  • For individuals seeking to preserve fertility, excision is often the preferred option as it allows for more complete removal of the tissue causing inflammation.
• Accurate Diagnosis and Staging:
  • Excision surgery provides a clearer view of the extent and severity of endometriosis, aiding in accurate diagnosis and staging.
  • Ablation may not provide as detailed information, potentially leading to underestimation of the disease extent.