Pain Isn't Normal: Gynecology Insights on Endometriosis and Isthmocele

Explore why ongoing pain that requires multiple painkillers isn't normal and learn about expert approaches to managing endometriosis and isthmocele, featuring insights from minimally invasive gynecology specialist Dr. Santiago Artazcoz. Discover the importance of individualized treatment plans and multidisciplinary care for maintaining health and fertility.

INFERTILITYENDOMETRIOSIS

Mitchell Bitran MD

9/27/20242 min read

Top 3 Takeaways

  1. Pain Isn’t Normal: Experiencing severe pain requiring more than one or two ibuprofen pills is not normal. If you're told otherwise, it's time to seek another opinion.

  2. Individualized Treatment Plans: Both endometriosis and isthmocele call for personalized treatment strategies. These should be tailored to your specific symptoms, life goals, and overall health needs.

  3. Team Approach Benefits: Successfully managing these conditions often involves a team of specialists, such as gynecologists, fertility experts, and pain management professionals.

Endometriosis: A Complex, Hormone-Dependent Disease

Endometriosis affects about 10% of women of reproductive age and can often be asymptomatic, making diagnosis tricky. Here’s what Dr. Artos had to say:

  • Diagnosis: It begins with a detailed patient history and physical examination. While ultrasounds can be useful, they aren’t always necessary.

  • Treatment Approach: Dr. Artos emphasizes a multi-step approach which includes:

    • Managing pain with anti-inflammatory treatments

    • Adjusting diet for anti-inflammatory benefits

    • Engaging in regular exercise

    • Utilizing pelvic floor therapy

    • Considering hormonal treatments

    • Keeping surgery as a last resort for cases with persistent pain or fertility challenges

  • Fertility Considerations: For women under 35 trying to conceive, IVF can be a recommendation after 6 months of unsuccessful attempts, unless pain severely impacts daily living.

  • Hormonal Treatment: Despite controversies, hormonal treatments are essential in managing endometriosis symptoms due to the disease’s hormone-dependent nature.

Isthmocele: A Defect in the Cesarean Section Scar

With the rise in C-section rates, isthmocele is becoming more common. Here's what you should know:

  • Symptoms: These may include prolonged spotting after periods, pelvic pain, and fertility challenges.

  • Diagnosis: Typically identified through ultrasound or MRI.

  • Treatment Options:

    • Hysteroscopic Approach: Recommended for defects with more than 3mm of remaining myometrium. This method reshapes the cavity for better blood flow.

    • Laparoscopic/Robotic Approach: Used when the remaining myometrium is under 3mm.

    • Treatment Considerations: Asymptomatic cases may not need intervention. For those with symptoms or fertility issues, treatments should be customized.

Final Thoughts

Both endometriosis and isthmocele demand individualized treatment strategies and benefit from a multidisciplinary team approach. Education is crucial; patients should be fully informed about all their treatment options, understanding both the risks and benefits.

Pain should never be accepted as normal, and finding a knowledgeable specialist like Dr. Artos can significantly improve the management of these conditions. Work closely with your healthcare team to develop the most effective treatment strategy tailored to your needs.

Together, with the right guidance and treatment, you can achieve improved health outcomes and enjoy a better quality of life.