When it comes to treating endometriosis there is only one gold standard of treatment—excision of lesions. Other methods, like hormones/medications, diet/supplements, and laser ablation just aren’t effective.
My surgeon, Dr. Arrington, explains the different methods of treating endometriosis on his website in the form of an analogy, comparing endometriosis to a lawn full of dandelions. The various treatments available are the different ways to solve this weed problem.
Laparoscopic excision surgery
If you dig up a dandelion by the root it won’t grow back. Excision of endometriosis gets out the “root” and is the closest there is to a cure. Surgeons who perform excision are few and far between as it requires additional training to recognize typical and atypical appearing lesions and special skills to operate on and around many organs in the body. With excision, the endometriosis is not destroyed, so the extent of each lesion is very clear. The surgeon can see exactly how deep and wide every lesion is and determine the best way to remove it completely and safely. While the procedure is time consuming, difficult, and requires a longer healing period, all of the endometriosis is ideally removed in one surgery (which helps prevent scarring from repeat procedures), and it leaves as much of the underlying tissues and organs in tact. It’s the best way to preserve fertility as it is thorough (unlike laser ablation), but not destructive (like hysterectomy).
After the surgery, all tissue samples are sent off for pathology to verify endometriosis, rule out other diseases, and to ensure the borders of each tissue sample are clean (meaning no endometriosis was left inside the body).
THE OTHER OPTIONS (in order of what most OBGYNs will try first)
Do nothing
You can choose to ignore the dandelions or convince yourself you’re crazy, but they won’t go away. Likewise, dealing with the pain and other symptoms (that will only get worse) doesn’t do you any good. In my opinion, I would also classify trying to manage endo naturally through diet/supplements as doing nothing. While a healthy diet and lifestyle will obviously improve overall health, endometriosis just won’t go away by ignoring it or through wishful thinking.
If diet helped, I would know since I’m the first to try any natural remedy. Overall I eat pretty well—plant-based, low in sugar and processed foods, and I have completely eliminated soda, caffeine, candy, and fast foods. I also don’t smoke or drink, almost exclusively drink water, did allergy testing and cut out everything I'm allergic to (including chocolate ☹), and have researched and tried dozens of supplements, yet my endometriosis kept getting worse. Once you’ve seen what the disease looks like and the damage it causes, it’s pretty clear medical intervention is 100% necessary.
Hormone therapy and medications
If you paint the dandelions green you might not see them for a few days, but they’ll keep growing and the paint will eventually come off. Hormones aren’t a way to treat endometriosis, but rather a way of trying to manage symptoms. The idea is that by suppressing the natural hormones, you can shut down a woman’s period and the endometriosis lesions and cysts will stop growing. Sometimes this works to make a woman feel better, but it didn’t provide any relief for me. Hormones also have no effect on adhesions (scar tissue) that have developed and they obviously don’t work when trying to get pregnant.
Another hormonal medication doctors sometimes prescribe is Lupron. This can only be used for short periods of time (a year or less) and puts a woman into early menopause—hot flashes, mood swings, and all! While this menopause is usually reversible, Lupron is risky as it can cause infertility, bone loss, a permanent deepening of the voice and increased body and/or facial hair, and other side effects. Dr. Dawson described it to me as “a year of hell to get a year of relief.”
Sometimes pain relievers and anti-inflammatory medications are prescribed. Once again, these do nothing to treat the endo itself, but rather only treat the pain and symptoms caused by the disease.
Laparoscopic laser ablation surgery
If you mow the lawn it’ll look like the dandelion problem is gone, but they’ll just grow back within a few days. This is the surgical technique most OBGYNs use when treating endometriosis and it almost guarantees you’ll need repeat surgeries every year or two. With the laser you can’t see how deep the lesions go, so as you destroy the lesions and the surrounding tissue you can’t verify you’ve burned it all out. Ablation is essentially “cutting the tops off.” While the peritoneum (the pelvic lining) regenerates and heals quickly when lasered away, the laser can be seriously damaging to vital organs if the endometriosis is growing grow near, around, or on them. Treating disease near these organs requires special training that most OBGYNs don’t have, so rather than risk hurting you, he/she will just leave lesions in areas they aren’t comfortable lasering.
Hysterectomy
If your dandelion problem is really bad, the best course of action is to tear down your house, right? Wrong. This is like getting a hysterectomy.
Before I knew about excision, I thought I might need a hysterectomy. I knew endo was a hormonal disease and thought a hysterectomy put a woman into menopause. My thinking was no more uterus = menopause = no more hormones = no more endometriosis.
Then I learned endo is an estrogen-driven disease, and it’s the ovaries, not the uterus, that produce estrogen. So I revised my thinking: oophorectomy (removal of the ovaries) = no more estrogen = no more endometriosis. However, some postmenopausal women still suffer from endometriosis. How on earth is this possible? Unfortunately endometriosis lesions are very sneaky and can actually produce their own hormone supply. So removing the uterus doesn’t help (unless the endometriosis is only growing on the uterus) and removing the ovaries doesn’t help. This is just an extreme and invasive treatment and last-ditch effort of doctors who don’t know how to effectively treat the disease.
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