/ by Dr. Peter Movilla
Peter R. Movilla, MD, is an obstetrician-gynecologist with UK HealthCare Women’s Health Obstetrics & Gynecology. A graduate of Weill Cornell Medical College, New York, he specializes in the treatment of endometriosis and has completed a two-year fellowship in minimally invasive surgery at Newton-Wellesley Hospital, Newton, Mass.
An estimated 10 percent of women in the United States have endometriosis, a painful disorder that occurs when endometrial tissue migrates from the uterine lining and lands in places where it doesn’t belong.
The tissue can go anywhere in the abdomen. It often attaches to the fallopian tubes, the ovaries, the outer wall of the uterus and other organs, including the bladder and ureters, the intestines and the rectum. As it grows, the endometrial tissue causes inflammation, scarring and injury to organs. Blood vessels and nerves can also be damaged.
The most common symptoms of endometriosis are severe pain during menstrual periods, heavy bleeding, chronic pelvic pain that’s not tied to periods, pain during intercourse and pain during urination or bowel movements. Less common, but not unheard of, is infertility.
Endometriosis is tricky to diagnose because there are no tests that provide an absolute diagnosis. In fact, it can take women five to 10 years to get an accurate diagnosis.
A complete patient history, tests and a thorough physical exam can build evidence that endometriosis is the problem, but the only way to know for sure is by doing surgery.
Medical management first
Instead of surgery, most providers take a more conservative treatment approach. Nonsurgical interventions, particularly hormone therapy, are often effective. Because estrogen triggers endometrial cell growth, some women get good results by taking medications that decrease the blood levels of estrogen. These medications can delay or eliminate the need for surgery.
A good response to hormone therapy is also another indication that endometriosis is the problem.
If nonsurgical interventions don’t work, minimally invasive surgery is the next step. During these surgeries, instead of a large abdominal incision, surgeons make small incisions in the abdomen and naval naveland insert a laparoscope – a video camera – and small surgical instruments through them.
Most women go home the day of surgery, and their recovery time is shorter than it would be with abdominal surgery. It’s usually about two weeks before they can go back to work and about six weeks before they are completely back to normal.
It takes a team of experts
When symptoms indicate that tissue is growing in and around organs beyond the gynecological system, specialists in those areas should be involved in a patient’s care and treatment.
They can also help determine that the pain isn’t rooted in another cause. Specialists can ensure that pain tied to the urinary tract isn’t being caused by a urinary tract infection or other infection or that bowel problems aren’t being caused by irritable bowel syndrome, ulcerative colitis or other disorders.
Having a team of specialists work together means surgeons have a better idea of whether endometriosis is the issue and,if so, where tissue is growing, before they do surgery. Patients will feel better going into surgery, knowing that a team of specialists will remove endometrial tissue – for example, a gynecological surgeon will excise tissue growing around reproductive organs and a gastroenterological surgeon will remove tissue growing around the colon. This multidisciplinary approach to complex surgeries ensures better outcomes for patients.
In our specialty practice at UK HealthCare Women’s Health Obstetrics & Gynecology, we focus on gynecological disorders, including endometriosis. It is one of my areas of expertise as a minimally invasive gynecological surgeon.
During a patient’s first appointment, I spend most of my time listening and asking questions as patients describe their pain and how their quality of life has been affected by endometriosis. These initial visits can easily be done virtually, through UK TeleCare, so patients don’t have to leave home or miss work. If they live out of town, I can put in orders for blood work and other tests at facilities close to their home so that we will have those results in hand when they come in for their physical exam.
I am honest with our patients about expectations in regard to minimally invasive surgery for endometriosis. Women don’t always get complete relief from their pain. But if they don’t, we continue to work with them toward a better outcome. We pull in our multidisciplinary experts and specialists to get to the root of a patient’s problem and improve her quality of life.
To learn more about endometriosis treatment, visit ukhealthcare.com/endometriosis. To make an appointment, call 859-323-0005.