Although virtually all gynecologists are familiar with the diagnosis of endometriosis, few truly understand all of the nuances of this common, but extremely variable condition. Most endo patients hear myths, half-truths, and misinformation every day. Here, we will discuss some of these.

It always "comes back" after treatment

Medical therapy (birth control pills, progesterone, lupron, etc.) all treat the sypmtoms of endometriosis, but none have been shown to eliminate endometrial implants. Some implants become smaller, less visible, and less hormonally active with medical therapy, but they do not disappear. Once medical therapy is stopped, symptoms usually reappear.

Surgical therapy is done by laparoscopy in the vast majority of cases. Unfortunately, patients often undergo repeated laparoscopies (sometimes as often as every 6 months). They are told their endometriosis keeps "coming back". If endometriosis implants are removed (excised) during laparoscopy, those implants are gone and will not recur anytime soon. If endometriosis is diagnosed 6 months after surgery, it was not seen during the first procedure, not removed then, or was never there in the first place. When endometriosis is adequately treated during laparoscopy, it will not "come back" within a few months.

"Laser" is the best way to treat endometriosis

It is absolutely critical for the gynecologist to recognize what is and is not endometriosis during laparoscopic surgery. Endo can present as red, clear, white, scarred, black, or any combination of these lesions. Conversely, what looks like endometriosis may be something else. It is necessary for specimens to be obtained for absolute confirmation.

Some implants are very superficial, others may penetrate one to two inches beneath the surface. Very superficial implants can be successfully destroyed by any number of methods. Deeper implants must be excised to assure that the entire nodule of endometriosis has been removed. Burning the surface of these deep implants with a laser or electrosurgery accomplishes little, leaving the majority of the endometriosis behind.

The laser is nothing more than a cutting tool, albeit a very accurate one. If the gynecologist is sufficiently skilled and experienced, endometrial implants (both superficial and deep) can be completely removed with lasers, scissors, electrosurgery, or the harmonic scalpel. All work equally well in experienced hands. None have any advantage over the others from the standpoint of postoperative adhesion formation.

Endometriosis can be accurately diagnosed by simply looking at it

Very recent studies have conclusively shown that the visual diagnosis of endometriosis is accurate only 60% of the time (at best). This is very important. A patient may be diagnosed with "extensive" endometriosis when little or none is actually present. Alternatively, widespread disease might be missed or mistaken for another condition.

Accurate diagnosis and staging is extremely important for the purpose of subsequent treatment and prognosis.

If you have endometriosis, you must get pregnant soon

Although endometriosis is a known factor in infertility, it does not necessarily progress (get worse) over time in everyone. We have all seen patients whose endometriosis remains virtually unchanged for years. We also see patients with stage 4 endometriosis attain pregnancy without problems. The diagnosis and treatment plan absolutely must be tailored and individualized for each patient.

If not treated, endometriosis grows, spreads, and gets worse every month

The signs, symptoms, and natural course of endometriosis varies tremendously from patient to patient. Currently, one cannot predict whether endo will progress, remain unchanged, cause fertility problems or pain, or require any surgery, much less hysterectomy. Once endometriosis has been diagnosed, many factors must be taken into account to determine the best course of action for each individual patient.

Hysterectomy cures endometriosis

Hysterectomy absolutely, positively will stop a woman from menstruating. Obviously, this also stops menstrual cramps. Removing the uterus, however, has no effect whatsoever on endometriosis. If the endometrial implants are responsible for symptoms (pain with intercourse, diarrhea, painful bowel movements, painful or frequent urination) and they are not removed along with the uterus, the symptoms will not change. Similarily, removing the ovaries and leaving endometrial implants behind is not likely to do anything but throw the patient into menopause, possibly creating a whole new set of problems.

When a hysterectomy is performed for endometriosis, removing the endometrial implants along with the uterus give the patient the best possible chance for relieving her symptoms. We always try to preserve the ovaries if possible, particularly in the younger patients.

Hysterectomy with or without removal of the ovaries does not, repeat does not, cure endometriosis.