Women's Health Matters

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In October 2008, our guest expert in Le Club's Ask the Expert segment was Dr. Rose Kung, an urogynecologist at Sunnybrook Health Sciences Centre. She is situated at Women’s College Hospital.

Dr. Kung is an associate professor in the department of obstetrics and gynecology with the University of Toronto. Her main area of expertise is in urinary incontinence and pelvic floor relaxation.

She also has expertise in surgical treatment of women with endometriosis. As well, she is the fellowship director for Urogynecology and Minimally Invasive Surgery accredited by the AAGL (American Association of Gynecologic Laparoscopists). 

Here are Dr. Kung’s answers to your questions on Endometriosis:

Q: I am 50 years old and have been on the birth control pill since about age 13 because I would get VIOLENTLY ill when I got my period. The doctor wants me to stop taking it, but I am scared to death about getting so sick again. I stopped a couple of times when I was younger and I swore I would never try it again. What could I take so that I could be off of the pill and yet have no sickness? I missed my period last month. Help!

A: You can still continue with the birth control pill safely as long as you do not smoke or have any of the contraindications for taking the pill (e.g. blood clots, high blood pressure, stroke). Alternatively, you can try GnRH (gonadotropin-releasing hormone) therapy with add-back therapy. However, this may be more expensive.


Q: I had endometriosis stage 3 and had lived a life full of painful periods and clotting up until I had a hysterectomy at the age of 34. I have a 14 year old daughter who is also developing the symptoms I remember. Is there an early test that can detect this terrible disease? I have heard about children going on the pill. Any information would be appreciated.

A: The definitive diagnosis of endometriosis is still made surgically (i.e. by laparoscopy). Certainly a trial of oral contraceptives is a reasonable option. A pelvic ultrasound may be useful to detect ovarian cysts (endometriomas).


I have recently been prescribed the Pill for my endometriosis, and have felt that I don't have all the answers on how this will help me in the long term. What does the Pill do to improve the endometriosis, and what are the implications of not going on it for a long time? Will it return as soon as I stop the Pill? Also, what do you think of complementary treatments such as Chinese medicine, diet change, acupuncture, etc. What resources do you know with reliable information? Thanks very much!

A: Oral contraceptives can be safely used to minimize the symptoms of endometriosis by reducing the menstrual flow and suppressing ovarian function. Symptoms can recur once the medication is stopped. Usually the birth control pill is taken continuously so as to minimize the number of periods. The alternative treatments you mentioned may be useful, including a macrobiotic diet and Chi Kung.


Q: I was diagnosed with didelphus and endometriosis at the age of 13 (I am now 25). I have had numerous surgeries. I am continually tired, have back pain, no energy and feel sick all the time. Since July of this year I have had an ongoing bladder infection which has been treated with seven medications. I was put on a drip for seven days. This seemed to work for four days then the symptoms returned. I finally told my family doctor I could not put up with this anymore and I wished to see an urologist.

The urologist was very rude and more or less blamed sexual intercourse for my problem. I told him I had not had intercourse for quite some time as I feel very unwell. He is sending me for a scope and has put me on more medication. I left the office in tears. I feel that I am not being taken seriously. I also only have one kidney. At this point I am so defeated and feel nobody is taking me seriously. I am in pain daily. Please help me. Thank you.

A: Your pain may be due to endometriosis which can also affect your bladder. You should be seeing a gynaecologist who specializes in dealing with women who have this condition. If you are in Toronto, Dr. Kay Lie at Women’s College Hospital is an excellent choice.


Q: Hi. I'm 48 years old and have had no problem with my periods at all. They are on time and normal. However, I was just told I have cysts on my right ovary and may have endometriosis. Can you tell me what they will do about this?

A: Depending upon the description of the ovarian cyst, it may or may not be endometriosis. The only definitive method is to have surgery to remove the cyst (usually laparoscopically).


I am 35 years old and have been suffering from endometriosis since the young age of 16. A year ago I had a laparoscopy. A lot of endometrial tissue was found, especially around the bowel area that could not be removed. I also have a tipped uterus. I have no children and I am not planning to. What is the best course of action to take to relieve this pain at my age? I also have pain during ovulation.

A: If you have been diagnosed with endometriosis, you can try medical management. Usually that involves either GnRH agonists or a medication called Danazol. Surgical options are also available but, in your case, may involve a bowel resection.


Q: Is there a tendency for women with long-lasting, severe endometriosis to develop cancers of the reproductive system? (e.g. ovarian cancer)

A: Endometriosis is rarely associated with ovarian cancer.  However, women who undergo fertility treatments may have a higher than average risk for ovarian cancer.


Q: What's the best pain medication for endometriosis? I'm in menopause and my pain is associated with my period. Once my periods stop, I presume the endometriosis pain will stop. Since I won't need the medications in the long term, what pain medications are a good choice for the short term?

A: Usually pain management with NSAIDs (non-steroidal anti-inflammatory drugs) are effective but they may cause gastrointestinal side effects. Narcotics can also be used, but carefully, due to risk of addiction. If you are in menopause you should not have pain from endometriosis although you may still have pain from adhesions. You can also seek help from a pain clinic.


Q: I had a question about adhesions and endometriosis. I know that some drug therapies will shrink the endometriosis, or even make it go away completely, but does this affect the adhesions too? Or is surgery the only way to remove adhesions and/or scar tissue?

A: Adhesions do not usually respond to medication therapy. However, further surgery may cause more adhesion formation.


Q: I had excision surgery for endometriosis a couple of years ago, and the doctor said he got it all, except for some implants on my bowel. He said the only way to remove those completely would be to do a bowel resection, and that he didn't recommend that because it would be too high risk. I have two questions: 1. Do you ever recommend a bowel resection in endometriosis surgery? 2. Is there a stronger likelihood that the implants will grow back everywhere because the doctor couldn't remove it all?

A: Bowel surgery can be done for endometriosis that involves the bowel. Depending upon the size and location of the lesion, it may or may not involve a bowel resection. If the lesions are not completely removed at the time of surgery, they may recur.


Q: What is the relationship between endometriosis and andenomyosis? Is one more common than the other? Are they more common together?

A: Adenomyosis is a condition whereby the endometrial cells that make up the lining of the uterus are invading the wall of the uterus. This is a different condition from endometriosis in which the same cells are found outside the uterus. There does not appear to be a strong link between the two. Nor are they mutually exclusive.


Q: In 2006 I had a tubal ligation and had some endometrial tissue removed. I have never suffered severely from this like some women, so I would say I'm mild. For the past three months, about seven days after my period I have noticed about a teaspoon of a clear fluid discharge (gel like). Today there was blood in this discharge.

My husband and I had intercourse (he did not ejaculate inside me) in the morning. I noticed the blood about an hour later. Is this endometriosis? There is very mild pain but nothing to complain about. Thank you for your time.

A: It does not seem typical of endometriosis but it is also not normal. You should see your family doctor or gynecologist.


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