Endometriosis Treatment: Know Causes, Symptoms and Diagnosis
Overview
The disease endometriosis treatment is best understood only by the women who suffer from it and the gynecologist who is treating them.
According to WHO; endometriosis treatment affects roughly 10% (190 million) of reproductive-age women and girls globally.
Though endometriosis treatment in itself is not a life-threatening condition it can cause a lot of suffering in form of pain and infertility.
ICD-10 Codes for Endometriosis:
Endometriosis can occur in different areas of the body, and the ICD-10 codes reflect this. The primary codes for endometriosis are in the N80 series:
- N80.0: Endometriosis of the uterus
- N80.1: Endometriosis of the ovary
- N80.2: Endometriosis of the fallopian tube
- N80.3: Endometriosis of the pelvic peritoneum
- N80.4: Endometriosis of the rectovaginal septum and vagina
- N80.5: Endometriosis of the intestine
- N80.6: Endometriosis in cutaneous scar
- N80.8: Other endometriosis
- N80.9: Endometriosis, unspecified
CPT Codes for Endometriosis Treatment:
The treatment of endometriosis can involve different procedures, depending on the severity of the condition and its location. Some of the common CPT codes used in endometriosis treatment include:
- 58660: Laparoscopy, surgical; with lysis of adhesions (salpingolysis, ovariolysis)
- 58662: Laparoscopy, surgical; with fulguration or excision of lesions of the ovary, pelvic viscera, or peritoneal surface by any method (e.g., treatment of endometriosis)
- 58670: Laparoscopy, surgical; with fulguration of oviducts (with or without transection)
- 58671: Laparoscopy, surgical; with occlusion of oviducts (partial or total occlusion) by device (e.g., band, clip, or Falope ring)
- 58356: Endometrial ablation (when treating symptoms such as abnormal bleeding associated with endometriosis)
- 58140: Myomectomy, excision of fibroids, which can sometimes be part of endometriosis treatment when fibroids are present.
Dr. Dimple Doshi at Vardaan Hospital; believes prevention is better than cure, and thus apart from the precise treatment guidelines; preventive measures are an essential part of our consultations with the patients who have either had it or want to know more about it.
What Is Endometriosis
Endometriosis is a disorder in which the tissue which lines the inside of the uterus grows outside the uterus and it is often found on the ovaries, fallopian tubes or anywhere in the pelvis and very rarely upper abdomen . This endometrial tissue is hormone responsive and it bleeds in response to the cyclical hormonal changes.
It is this trapped bleeding inside the abdomen that leads to pain ;sometimes excruciating cramps during the periods. Not only the cramps it can lead to the inner structures getting stuck to each other also called adhesions.
Causes of Endometriosis
- Retrograde or reverse menstruation, which is when menstrual blood flows back through the fallopian tubes and into the pelvic cavity during periods. And this results in endometrial-like cells being deposited outside the uterus where they can implant and grow.
- Cellular metaplasia, which is when cells change from one form to another. Cells outside the uterus change into endometrial-like cells and start to grow.
- Stem cells spreading through the body via blood and lymphatic vessels. These stem cells are capable to turn into the cells responsible for the development of endometriosis.Endometriosis is a complex disease that globally affects some women in the reproductive age group regardless of their ethnic origin or social status.
- Endometriosis is a heritable condition.Children or siblings of people with endometriosis are at higher risk of developing endometriosis. There is about six fold increased incidence of endometriosis in women with the affected first-degree relative.
- Prolonged exposure to estrogen as in late menopause or early onset of menses.
- Congenital abnormalities of the uterus and vagina
- Other causes include altered or impaired immunity, localized complex hormonal influences, , environmental contaminants etc.
The theories behind the development of endometriosis are:
Endometriosis can be staged according to American Society of Reproductive Medicines (ASRM) as stage 1 to 4. This staging assesses the damage done by endometriosis and not the level of pain or infertility; as a woman with endomeriosis stage 1 may be having more severe pain than a woman with endometriosis stage 4.
Stage I (Minimal)
It includes only superficial lesions and possibly a few filmy adhesions.
Stage II (Mild)
In addition to stage I, some deep lesions are present in the pelvis.
Stage III (Moderate)
As above, plus the presence of chocolate cysts on the ovary and more adhesions.
Stage IV (Severe)
As above, plus large endometriomas or chocolate cysts, extensive adhesions. Medically known as frozen pelvis.
Age at Which Endometriosis Shows Up
Endometriosis is a disease of significance in the reproductive age group of 25 to 35 years.And its been reported as early as 11 years. Endometriosis is rare after menopause or before a girl starts having periods (menarche.)
Endometriois lies dormant in a woman s body until a girl attains menses. In the initial years, the severity of the disease may be mild but as deeper invasion takes place; symptoms of varying degrees happen.
Symptoms of Endometriosis
- Painful periods
- Pain during sexual intercourse
- Not being able to get pregnant
- Chronic pelvic pain
- Constipation ; bloatedness ; bloody stools or diarrhea
- Difficult urination ; bloody urine.
Sites of Endometriosis
Most commonly endometriosis is seen
- In pelvis ;especially on the tissues that hold the uterus in place ; also called ligaments.
- Outer surface of the uterus
- Ovaries
- Fallopain tubes
- Rectum .Rectovaginal endometriosis can cause severe pain with bowel movements also.
- Bladder
- On scars from gynecological surgeries like cesarean scar
- It can rarely happen at other sites also
Other methods for diagnosis are:
- Physical examination by your gynecologist upon suspicion of presence of endometriosis.
- Ultrasonography may help in the diagnosis of endometriosis if there is presence of chocolate cysts; also called endometriomas.
- MRI: It may be more informative to find out the depth and extent of the endometriosis.
- Laparoscopy: Laparoscopy is the final way to diagnosis and treat endometriosis. Laparoscopy allows your gynecologist to inspect the abdomen completely and also to confirm the diagnosis.. Laparoscopy can provide information about the location, extent and size of endometrial implants. And in expert hands, endometriosis can almost be completely treated in first surgery only.
- Endometriosis markers: These include blood tests like s.ca 125. S. micro RNA is a new test but the sensitivity of these tests is still not proven to be very accurate.
Prevention of Endometriosis
You cannot prevent endometriosis.
But it is possible to prevent further damage by early diagnosis and treatment by an expert gynecologist. By early treatment, it’s possible to it starts to invade deeper into the tissues.
Dr. Dimple Doshi is an expert gynecologist having a vast experience of dealing with cases of endometriosis.Our NABH accredited Vardaan hospital Goregaon west Mumbai ; is a well equipped centre for minimally invasive surgeries .
You can reduce your chances of developing it by lowering the levels of the hormone estrogen in your body. Estrogen helps to thicken the lining of your uterus during your menstrual cycle.
To keep lower estrogen levels in your body, you can:
- Talk to your doctor about hormonal birth control methods,such as pills, patches or rings with lower doses of estrogen.
- Exercise regularly (more than 4 hours a week).This will also help you keep a low percentage of body fat. Regular exercise and a lower amount of body fat help decrease the amount of estrogen circulating through the body.
- Avoid large amounts of alcohol. Alcohol raises estrogen levels.No more than one drink per day is recommended for women who choose to drink alcohol.
Avoid large amount of drinks with caffeine. Studies show that drinking more than one caffeinated drink a day, especially sodas and green tea, can raise estrogen levels.
You also have to reduce estrogen rich foods like soy milk, TOFU, soyabean ,Flax seeds, sesame seeds, garlic, dried fruits etc.