The female reproductive system has two ovaries, two fallopian tubes and a uterus (womb).

• Ovaries are where eggs are made.
• The fallopian tubes provide a pathway for the eggs to travel from the ovaries to the uterus.
• The uterus is where a baby grows during pregnancy. The endometrium is the lining of the uterus.

Endometriosis is a condition that occurs when the cells that normally line the inside of the uterus grow outside the uterus. They can be found attached to other organs that are commonly found near or attached to the uterus. This includes the ovaries, fallopian tubes, bladder, ureters, intestines and rectum.

• Even though the cells from the endometrium are outside the uterus, they can still respond to monthly hormone changes. These changes can cause the cells to swell and bleed.
• These cells are not part of the lining of the uterus, so they are not expelled from the body during menstruation. Fluctuations in hormone levels can cause changes in these cells, which cause many of the symptoms of endometriosis (such as, pelvic pain and heavy periods).

A hysteroscopy and laparoscopy are outpatient surgical procedures that can be done to help decrease the symptoms associated with endometriosis.

• A hysteroscopy is an exam of the inside lining of the uterus. It is done using a thin, lighted tube with a camera on the end (hysteroscope). The hysteroscope is inserted into the vagina and is advanced through the cervix into the uterus.
• After the uterus is examined, a laparoscopy, the use of small medical instruments and a camera inserted into three or four small cuts in the lower abdomen, may be needed to treat any endometrial tissue that is found outside the uterus.
• A hysteroscopy and laparoscopy with removal of endometrial implants does not cure endometriosis. Sometimes, not all of the endometrial tissue can be removed, so new implants can develop.
• Symptoms can also occur from the scar tissue, or adhesions, that can develop in response to endometriosis.

Endometriosis is common and the symptoms can vary widely from minimal to severe. Some of the symptoms include:

• Lower abdominal pain and cramping, especially before and during your period
• Painful intercourse
• Lower back pain
• Trouble with urination
• Painful bowel movements
• Difficulty getting pregnant (infertility)

The exact symptoms and severity of the symptoms frequently depends on where the cells implant. They are not always determined by the actual size of the implant.

Contact your healthcare provider if you have symptoms of endometriosis. They will perform a physical exam, which will include an examination of your pelvic area (internal exam). They may also order some tests, including:

• Blood work
• Urine tests
• Abdominal or vaginal ultrasounds to evaluate your uterus and surrounding tissues

Your healthcare provider may recommend a hysteroscopy and abdominal laparoscopy if you have severe symptoms that cannot be controlled with medication or other less invasive treatment options. Endometriosis often improves after menopause starts. This makes watching the condition with periodic examinations an option for some. The treatment option that is best for you depends on several factors, including:

• Your age
• Your overall health
• How bad your symptoms are
• If you plan on having children in the future

Prior to surgery, tell your healthcare provider about any medications you are taking (including over-the-counter medications and supplements). Ask about specific instructions you should follow before surgery. These may include:

• Medications you should not take before the surgery, such as blood thinners
• Regular medications you should take on the day of your surgery
• How many hours you should stop eating and drinking before surgery

If you are a smoker, you should quit smoking, as it can interfere with your recovery.

During your surgery, you will receive anesthesia to keep you comfortable and pain free.

• General anesthesia is the most common type of anesthesia for a laparoscopy. With this type of anesthesia, you are put into a deep sleep and are unable to see, hear or feel anything.
• Other types of anesthesia may be used during this surgery, but they are less common.
• There may be a small amount of bloody vaginal discharge and cramping after the surgery.
• You should arrange to have someone drive you home after the surgery.
• You may need pain medication and help at home while you recover.

Contact your healthcare provider if you have symptoms of endometriosis. Be prepared to discuss your symptoms and how long you have had them.

• Bring a copy of your medical history (past illnesses, surgeries, and hospitalizations).
• Make a list of your medications (including over-the-counter).
• Write down any questions, symptoms or concerns you want to talk about.
• If your healthcare provider prescribes a medication for you, ask for a generic version. If your doctor thinks that a generic version is not right for you, ask for a medication on the lowest available tier of your Prescription Drug List (PDL).

What should I ask my healthcare provider before having a laparoscopy?

• What is my diagnosis and reason for the surgery? What non-surgical alternatives are available to me? What are the possible complications of each?
• What happens if I do not go through with the surgery?
• What tests are you recommending and why? Will the test results change my treatment plan? If not, then why do I need them?
• What are the chances my symptoms will come back after surgery?
• How will I feel after the surgery? Will I have to modify my activity? How long until I can get back to my normal activities?
• What is your experience in doing this type of surgery? What is your complication rate?
• Is there any special preparation for the surgery? (If so, get clear instructions on what you need to do.)

Before you go home, make sure you understand all home care instructions (including medications and side effects) and follow-up plans. Your gynecologist should let your primary care physician know the details of your surgery and treatment plan.

Source UHC.com

Also known as:

Uterus Scope

Scope of Uterus

Lesion Removal

Laparoscopy

Hysteroscopy

Hysterectomy

Exam of Uterus

Endometriosis - Outpatient