Taking charge of the disease involves change. There is no getting away from it. it requires a real willingness to invest in yourself and alter some daily routines and ways of thinking about the disease, as follows.

• Build a support system. This begins with finding a doctor who understands endometriosis and how it has affected you in particular. There is no use in convincing skeptical practitioners that you are suffering from a real condition if they persist in believing that your symptoms are psychosomatic.

Discuss your condition with family members and friends in a calm and tactual manner. Explain what you have learned about the disease and why you are feeling the way you do. Severe menstrual camping attributed to prostaglandin levels, painful intercourse, and mood swings due to hormone fluctuations are real factors ha die disease. Now that your loved ones know it’s not “in your head,” ask for their help in getting you through any especially difficult time. If you feel you need pyschological counseling either alone or in ramify therapy to help sort out your feelings shout the impact of the condition on you and on others, seek help now.

The “career woman’s disease” touches the lives of millions of women who must deal with their condition and continue to work efficiently. This can be a problem. Many employers are not interested in hearing that employees suffer from chronic disorders such as endometriosis. As with sufferers of PMS, women with endometriosis may be assumed to be overly self-indulgent during menstruation. It has been estimated that 140 million work hours are lost each year to the symptoms of endometriosis, a fact that the business world cannot ignore.

Yet, they do. Now it is up to you. Your wisest strategy is to be consistently reasonable at work and prudent about whom you inform of your condition. Although your impulse may be to educate your employers and coworkers, many of whom may have the disease or know others who might, not everyone may be sympathetic to you. They are two schools of thought about discussing this disease and its effect on women, and doing so on the job. Some avoid public disclosure, feeling it is best to be discreet. They are concerned that knowledge of their condition may he used against them, that is, used as a reason to bold them hack from greater responsibility and promotions.

Other women fed that having endometriosis is not a stigmatizing factor and that a calm, honest, and educational approach will not hinder their career advancement. These women are bolder about their approach to the disease. They may disseminate information about endometriosis, or post notices of discussion groups to alert women to what they can do for themselves and for others, too. Knowing they do not have to keep silent about their condition and finding even one other woman at work who shares their problem gives them a psychological boost and an important sense of supportiveness. The action you do or do not take at work will depend entirely on the kind of job you have and the general tone of your workplace. You will know best what to do in this case.

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Displacement of the uterus also occurs if there is a lump or growth in a neighbouring organ. For example, a lump in the vagina pushes the uterus upwards. On the other hand, if there is a growth in the bowel the uterus is pushed forwards, and in the bladder, backwards. The uterus is also able to rotate around the point where the cervix meets the rest of the body. A forwards rotation is called anteversion, and a backwards rotation, retroversion. Some women find these movements uncomfortable if they occur during sexual activity or when a doctor is examining their uterus to see if its ability to move is restricted in any way. In most cases women are largely unaware of these movements, although they may account for some of the pelvic ‘twinges’ or abdominal pain that is sometimes experienced.

For the uterus to contract successfully—which occurs during menstrual bleeds, childbirth and, in perhaps a third of women, during orgasm — the muscle tissue of the uterus and of the surrounding ligaments must work harmoniously. Women do not have conscious control over these contractions; this is exercised by nerves and hormones. Some aspects of uterine function are under dual control of both hormones and nerves, while others are influenced mainly by one or the other.

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Laparoscopy was originally only used as a means of diagnosing endometriosis but over the years it has been used increasingly as a way of surgically treating the condition. It is now common for some laparoscopic surgery to be performed at the time of a diagnostic laparoscopy – assuming the woman agrees and laparoscopic treatment is appropriate.

In the early days of laparoscopic surgery only simple procedures were performed but as experience with the technique has increased surgeons have treated increasingly severe cases and performed more complex procedures. The complexity of the procedures that your gynecologist will attempt will depend on his or her level of training and experience.

Who is suitable for laparoscopic surgery?

Laparoscopic surgery is generally only suitable for women with minimal or mild endometriosis, though in some cases it may also be appropriate for women with moderate disease.

Things to discuss before laparoscopic surgery

Before your operation you should discuss with your gynecologist what he intends to do during the operation and what should be done if more extensive surgery is necessary.

What happens with laparoscopic surgery?

The basic routine for laparoscopic surgery is the same as that described for a diagnostic laparoscopy except that in addition to inspecting the pelvic organs, one or more of the treatment procedures outlined below will be performed.

Procedures that may be performed include the removal or destruction of superficial implants and small cysts, the removal of adhesions, the removal or destruction of endometriomas and the removal of an ovary. Few gynecologists are able to perform the latter two procedures but it is possible that in the future more surgeons will be able to do so.

Any superficial implants and small cysts on the peritoneum and ovary will usually be destroyed by cauterization. Cauterization involves the use of a heat source or electrical current to destroy or ‘burn’ the implants or cysts. As the depth of the burn cannot be precisely controlled cauterization is not used if there is any danger of damaging any important underlying organs, such as the fallopian tubes, bowel or bladder. It is not always possible to destroy all the implants and cysts present. Larger cysts may be removed by cutting them out.

Adhesions can be removed by cutting or cauterization but again it may not be possible to remove all the adhesions present.

Effectiveness of laparoscopic surgery

Laparoscopic surgery has several advantages over conservative laparotomy because being minor surgery as opposed to major surgery it is associated with fewer risks and complications, causes less discomfort and has a shorter recovery period. It can also readily be done at the time of diagnosis which means that only one bout of surgery, one hospital stay and one recovery period are needed.

It is not possible to compare the results of laparoscopic surgery with other forms of treatment as there are no reliable figures available at present. The impression of many gynecologists is that laparoscopic surgery relieves the symptoms in many cases and it restores fertility in some cases.

Risks and complications of laparoscopic surgery

The risks and complications of laparoscopic surgery are the same as those associated with a diagnostic laparoscopy except that there is the additional risk of damaging organs during cauterization.

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