When should you have surgery for endometriosis? Dr. Monica Diaz explains in Ask the Doctor.


When should a woman consider surgery? – I think always surveillance. I think once you and
your physician establish that you have a suspected diagnosis of endometriosis and you’ve
begun medical therapy I think there should
always be a surveillance of how that patient is doing, that their symptoms
continue to be controlled, that their priorities are being met. So that if it’s simply pain control, that as time goes by, the severity of their
pain is not worsening, and that the current medical modality that you’re using is continuing to work. I think at the point that
it is no longer effective then certainly there
can always be a change in the medication therapy. For instance, if you start
with a birth control pill, and that’s no longer
controlling their pain, you can try a continuous
birth control pill. If that’s not working,
you can always switch to, perhaps an injectable progestational agent such as Depo-Provera. I think if you get to a point where that perhaps is not as effective then you could switch to
something like a GnRH agonist, which is an injectable medication that suppresses hormone production and thereby suppresses the endometriosis. I think when medications
are failing a patient, whether you’ve tried one medication, or multiple medications, the definitive gold standard for diagnosis of endometriosis is
identifying it visually, but also biopsy, and having
histopathology confirmation that you are dealing
with endometrial glands instrument outside of the uterus. So I think that if
medication is not working for your patient, then
certainly you can consider a diagnostic evaluation for endometriosis and in that same process you can treat areas of endometriosis that you find surgically,
by removing those areas. Questions? Call 972-566-4862

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