home Diagnostic Procedures For Endometriosis Laparoscopy. Diagnostic laparoscopy, an invasive surgical procedure, is currently the only definitive method for diagnosing endometriosis. Laparoscopy normally requires a general anesthetic, although the patient can go home the same day. The procedure is as follows: The surgeon makes tiny abdominal incisions through which a fiber optic tube, equipped with small camera lenses, is inserted. The physician uses these devices to view the uterus, ovaries, tubes, and peritoneum (lining of the pelvis) on a video monitor. If the surgeon needs to remove cysts or lesions during the procedure (operative laparoscopy), tiny instruments are passed through a tube. Smaller endometrial implants can often be removed at that time, either by excision (surgical removal) using a laser or scissors or by destroying the area with lasers or with electricity (or electrocautery). A blue dye may be flushed through the fallopian tubes to determine blockage; if there is an obstruction, the dye will not flow through the tube. Hysteroscopy. Hysteroscopy is a procedure that may be used to detect the presence of fibroids, polyps, or other causes of bleeding. (It may miss cases of uterine cancer, however, and is not a substitute for more invasive procedures, such as D&C or endometrial biopsy, if cancer is suspected.) It requires no incisions. The procedure uses a long flexible or rigid tube called a hysteroscope, which is inserted into the vagina and through the cervix to reach the uterus. A fiber optic light source and a tiny camera in the tube allow the physician to view the cavity. The uterus is filled with saline or carbon dioxide to inflate the cavity and provide better viewing. This can cause cramping. Hysteroscopy is non-invasive, but 30% of women report severe pain with the procedure. The use of an anesthetic spray such as lidocaine may be highly effective in preventing pain from this procedure. Other complications include excessive fluid absorption, infection, and uterine perforation. Hysteroscopy is also employed as part of surgical procedures. Imaging Techniques An ultrasound is performed in cases where other conditions are suspected, such as uterine fibroids, ovarian cysts, or ectopic pregnancy. This non-invasive imaging technique can detect endometriomas, or cysts that are usually located on the ovaries and filled with thick dark blood. Ultrasound can also pick up cysts larger than 1 cm (about 1/3 in.), but will miss smaller cysts, or small and shallow endometrial implants on the surface of ovaries, or on the peritoneum (lining of the pelvis). Once a diagnosis is made, more sophisticated imaging techniques, such as computed tomography (CT) scanning or magnetic resonance imaging (MRI), may be used to obtain a more accurate image of severe endometriosis, but these techniques are expensive and are not useful in reaching a diagnosis of endometriosis. Blood Tests for CA-125 Experts hope that in the near future, blood tests can be developed that will identify endometriosis by measuring high levels of specific chemical substances released by the implants. Some researchers believe that deep invasive endometriosis may be detected by using a combination of a vaginal examination during menstruation and a blood test for CA-125. This substance is elevated in women with ovarian endometriomas (cysts) and deep endometriosis. Higher levels of CA-125 occur in many other diseases, including ovarian cancer, so results using this test alone do not provide enough information for a definitive diagnosis of endometriosis. On the other hand, the test could be used to indicate whether there is need for more invasive tests in women who are infertile, and also for monitoring the effectiveness of treatments in women with severe endometriosis. WHAT ARE THE GENERAL GUIDELINES FOR TREATING ENDOMETRIOSIS? To date, there is no perfect way of managing endometriosis. There are basically three approaches to the treatment of endometriosis: 1.  Watchful Waiting. (Treatments involve relieving symptoms.) 2.  Hormonal Therapy. (Aimed at reducing endometrial implants.) 3.  Surgery. (Aimed at reducing endometrial implants, restoring fertility, or possible a cure.) The choice depends on a number of factors including the woman's symptoms, her age, whether fertility is a factor, and the severity of the disease. 1.  Watchful Waiting In general, watchful waiting is a good initial choice for the following: Women with mild pain and, if infertile, they do not wish to become pregnant. If women with mild endometriosis wish to become pregnant, the doctor may recommend unprotected sex for six months to year. If pregnancy does not occur, then treatment may be started. Women approaching menopause. Some experts believe that early diagnosis and treatment in young women without symptoms might prevent some cases of infertility later on. Unfortunately, however, some treatments for endometriosis may actually trigger symptoms in those who do not yet experience them. 2. Hormonal Therapy Hormone therapies are used to mimic states in which ovulation does not occur (such as pregnancy or menopause) or to directly block ovulation. Such agents include oral contraceptives, progestins, GnRH agonists, and danazol). They can by very effective in relieving endometriosis symptoms. Some of these drugs may also be used after surgery to help prevent recurrence of endometriosis. There is also some evidence that GnRH agonists and danazol may improve immune factors associated with endometriosis. But there are downsides: None of these agents can cure the problem. Symptoms recur in about half of patients within five years of treatment. They do not improve fertility rates and may even delay conception in women who use them. Side effects of these drugs can be distressing. There is a high dropout rate with the use of nearly all these hormonal treatments. Women who are taking GnRH agonists, danazol, or similar agents should use non-hormonal birth control methods (such as the diaphragm, cervical cap, or condoms) because these drugs can increase the risk for birth defects. 3.  Surgery Surgery is an option for the following women *  Women with severe pain that does not respond to watchful waiting and medical treatment. * Women who want to become pregnant and endometriosis is most likely the major contributor to infertility. There are two basic surgical approaches for endometriosis: *  Conservative Surgery . This approach removes the endometriosis implants without removing any other reproductive organs and is a good option for women who wish to become pregnant or who cannot tolerate hormone therapy. Endometriosis often recurs after conservative surgery, however. Recurrence rates at two years range from 2% to 47%. The risk for recurrence or residual pain after any procedure increases with the severity of the condition, particularly if endometriosis has affected areas outside the uterus. * Definitive Surgical Therapy . This should only be considered for endometriosis when all other management treatments are no longer controling the symptoms & condition. It involves hysterectomy with removal of ovaries (oophorectomy) along with all endometrial implants. (Removing only the uterus with hysterectomy is only as effective as conservative surgery and recurrence is a high risk.) In choosing between hysterectomy (with or without oophorectomy) and conservative surgeries, age and the desire for children are important factors. One study reported a greater sense of loss, more residual symptoms, and more pain in younger women (under 30) who have undergone hysterectomy than in older women. In one study, 37% of such younger women regretted their decision to have a hysterectomy. Once careful instruction is given for all the risks and benefits of the different surgical options, the physician must then respect any decision a patient makes to retain as much of her reproductive system as she wants, even if she is past menopause. Both the patient and the physician should also be clear about the possibility of changing procedures once the operation has begun, depending on what the surgeon may observe. For example, the surgeon may find abnormalities that require more extensive surgery. Much of the success of any procedure relies on the experience of the surgeon. A woman should always ask for a doctor's track record, or the number of times he or she has performed the procedure in question. The more, the better. Asking for complication rates may be helpful, but a patient should realize that an experienced surgeon may have a higher number of high-risk patients, and therefore, a higher complication rate than a less experienced surgeon with fewer serious cases. Options for Treating Infertility Hormonal agents have no effect on infertility, while in many cases, conservative surgery may restore fertility. Fertility treatments using assisted reproductive techniques may be helpful for women with late-stage endometriosis. It is not clear in such women whether surgery for removing endometrial implants or fertility has different or better advantages. It is also not clear if women with early-stage endometriosis do any better with fertility treatment than simply trying to become pregnant through non-aggressive means.  WHAT ARE THE LIFESTYLE MANAGEMENT OPTIONS FOR ENDOMETRIOSIS? Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) and Pain Relief Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) may be sufficient for some women with endometrial pain. Aspirin is the most common NSAID, but there are dozens of others, including ibuprofen (Advil, Motrin, Rufen) and naproxen (Aleve, Anaprox, Naprosyn), both of which are often recommended for menstrual pain. Such drugs block prostaglandins, inflammatory factors strongly associated with endometriosis and which increase uterine contractions and cause cramping and pain. Note: Drugs containing codeine should not generally be used for endometriosis pain management. They can cause pelvic congestion and constipation, which could exacerbate symptoms in patients with gastrointestinal distress. Dietary Factors Some women report relief by avoiding dairy products and having a diet rich in fiber and low in saturated (animal) fats. Fiber-rich foods (such as fruits and vegetables) along with plenty of fluids (water or juice, not caffeine) are not only healthy but help prevent constipation, which can intensify symptoms. If women choose a diet that limits dairy products, they should be sure to have sufficient calcium from other sources. Certain fat compounds called omega-3 fatty acids, which are in fish oils, may have specific anti-inflammatory effects. They are found in certain oily fish (sardines, mackerel) and can be obtained in supplements. Supplements may be labeled either omega-3 fatty acids or EPA-DHA (which are the important compounds). People with endometriosis should avoid alcohol, caffeine, and chocolate.