Chapter 13: To Excise or To Ablate?

Note: I am not a doctor and this is not intended to be medical advice. It's simply meant to help you begin your research to educate yourself so that an ignorant OB/GYN doesn't give you bad advice.

There are currently 2 camps on how to best treat (not cure... there is no cure) endometriosis. According to my own extensive research, excision is the gold standard in endometriosis care. That means that if an OB/GYN suggests ablation to you, you should get up out of their office and not come back. So, what's the difference?

Ablation:

Endometrial ablation seems to be the treatment that gynecologists that don't understand what's causing a woman's extreme menstrual pain use as a fall back. It can actually make endometriosis patients' symptoms worse, which is why you should run from doctors that suggest it. The OB/GYN that I hated the most suggested it to me, and I'm so glad that I listened to my gut and declined this option.

Ablations are usually performed under general anesthesia. No incisions are needed as the doctor goes in through the vagina and cervix. Then some sort of tool (my doctor mentioned burning, but other options are available) is used to ablate the endometrium tissue in the uterus. The only problem is that by its very definition, endometriosis occurs outside the uterus. Endometriosis is when endometrial-like tissue grows outside the uterus, so removing the actual endometrial tissue inside the uterus is not an effective course of treatment. In fact, patients with endometriosis often report an increase in their symptoms due to the creation of scar tissue and the additional pain that can cause.

The thing that initially dissuaded me from getting an ablation was that it can decrease your fertility, but if you do get pregnant, it increases your chances of a high risk pregnancy. I don't want children. I also hate being on birth control. Why on earth would I do something to myself that made it dangerous to get pregnant?

Dr. Ghomi, the surgeon who ended up performing my excision surgery, told me that ablation is the worst possible thing an endometriosis patient can do. We had a discussion about it during my pelvic exam and he literally stopped what he was doing and told me to never let my regular gynecologist talk me into one.

This leads me to my next point, if you suspect that you have endometriosis, do not go to your regular OB/GYN. Find an excision specialist. I found Dr. Ghomi on Nancy's Nook Endometriosis Education group on Facebook. I cannot emphasize how important this is, so I'm going to say it again. DO NOT GO TO YOUR REGULAR GYNO FOR AN EXCISION. GO TO A SPECIALIST.

Excision:

Excision is a surgical procedure done under general anesthesia, usually laparoscopically. During my procedure, 5 holes (one in my belly button and 2 on each side) were cut into my abdomen. A camera was inserted after my abdomen was inflated with gas for better visibility. The endometriosis tissue was removed from both ovaries, both fallopian tubes, the bladder and the top of my uterus. It was then sent to pathology, which confirmed that it was endometriosis. This is the only way to diagnose endometriosis. It's also the best way to remove it. As endometriosis can produce its own estrogen, the hormone it needs to grow, removing its source of growth is the best way to try to prevent it from growing back. This is not always successful, as there is no cure. However, it gives you the best chance of having a decrease in symptoms.

It takes a skilled surgeon knowledgable in the latest literature on the subject to do this surgeon. That's why it's important to FIND A SPECIALIST. There is outdated information about what endometriosis looks like inside the body, and an untrained surgeon may miss things that don't look like outdated information described. As I mentioned above, endometriosis can produce the hormone it needs to grow, so missing any bad tissue can be a recipe for disaster for the patient and their symptoms.