Endometriosis can be treated medically or surgically. Medical treatments include hormones such as birth control pills, progesterone, or lupron. These forms of treatment help to improve and/or suppress the symptoms associated with endometriosis, but are not advisable while trying to conceive. Surgical treatment involves removing scar tissue and/or endometriosis lesions laparoscopically through small incisions in the abdomen. This is a minimally invasive outpatient procedure that typically involves a quick recovery. It's advantages are improved quality of life by way of improvement in pelvic pain and also aiding in the ability to conceive.
A pelvic pain diary can be helpful to keep track of the degree of pain, bleeding, and other associated symptoms of your monthly cycle. This may serve as a decision making tool for you and your doctor to help determine the best course of treatment for your pain. Should treatment be indicated for pelvic pain or endometriosis patients may be referred to their primary OBGYN for management.
Luteal phase defect- an insufficient response of the endometrial cavity to inadequate levels of progesterone can cause a poor environment for conception and can result in recurrent miscarriage. Diagnosis can be done with laboratory hormone assessment in combination with ultrasound monitoring at specific times during a menstrual cycle. Treatment is typically simple hormone supplementation.
There are many forms of uterine abnormalities that may affect a woman's fertility. Some of those abnormalities include:
Congenital uterine anomaly (birth defect)- one of the more common anomalies is a uterine septum which can be associated with miscarriage, recurrent miscarriage, fetal malpresentation, fetal growth restriction, and cesarean delivery. A septum is an area within the uterus which is felt to provide poor blood supply to a developing fetus. A uterine septum can be confused with a bicornuate uterus (heart-shaped). Diagnosis is made by ultrasound, hysterosalpingogram (HSG), MRI, hysteroscopy, laparoscopy or some combination of each. A septum can be surgically corrected with outpatient hysteroscopy and laparoscopy and has quick recovery and excellent prognosis.
Uterine tumors can cause problems such as abnormal uterine bleeding, miscarriage, and/or infertility. Common uterine tumors include:
Polyps-"tonsil-like" projections in the interior of the uterus. Polyps may or may not cause fertility issues. They are most often benign, but surgical removal may be medically necessary, as occasionally they can be associated with abnormal tissue changes that can be precancerous. Polyps are diagnosed by ultrasound, SIS (saline infused sonogram), hysterosalpingogram (HSG), or hysteroscopy. They can be treated surgically with outpatient hysteroscopy.
Fibroids (myomas)- benign tumors of the muscle and connective tissue that develop inside the uterus, within the muscle of the uterus, or are attached to the uterine wall. Women that have symptoms may report heavy menstrual bleeding; pelvic pressure, fullness, or pain; urinary frequency; constipation; or backache. Fibroids are diagnosed by ultrasound, hysterosalpingogram, MRI, surgically, or some combination of each. Size and location are generally the main determinant on how they impact fertility. This also affects the decision to surgically manage the fibroid/s or not. Surgery for fibroids is often an outpatient procedure, but at times requires a larger abdominal incision that involves an overnight stay in the hospital or surgical center. Providers at our RMCRM may discuss or diagnose fibroid; however, surgical management is most appropriate with a general gynecologist.
Synechiae- also known as scarring within the endometrial cavity rarely occurs as a result of an infection or bleeding complication following a miscarriage or delivery. Synechiae is commonly diagnosed with ultrasound and/or HSG. The scar tissue can be surgically removed and is done on an outpatient basis.