Treating Endometriosis

with Grace Janik, M.D., Obstetrics and Gynecology, Columbia St. Mary's

Last Updated: Oct. 1, 2003

Endometriosis is a common disorder in women of childbearing age that occurs when endometrial tissue, which is normal in the uterus, travels outside the uterus and implants in other parts of the body. Regardless of where it’s located, the tissue responds to menstrual hormones, and acts as it would if correctly located. Each month, it builds up and then breaks down, causing bleeding wherever it’s situated.

Symptoms range from nonexistent to extreme. They can include painful menstrual cramps, pain during intercourse and/or elimination, abnormal uterine bleeding and infertility.

Grace Janik, M.D., Obstetrics and Gynecology, Director of Reproductive Endocrinology, Columbia St. Mary's "The symptoms can be so devastating that people have incapacitating pelvic pain. They can't have intercourse, they can't work. It interferes with their daily lives." Dr. Janik presents: Treatment Options for Women with Endometriosis November 12, 2003 7-8 p.m. Columbia St. Mary's Milwaukee Campus, Brady Hall Search for additional events

The condition is often misdiagnosed or under treated, said Dr. Grace Janik, director of reproductive endocrinology at Columbia St. Mary’s. About one-third of Janik’s patients suffer from severe endometriosis, and many have sought multiple solutions before being referred to her office.

Endometrial growths – referred to as lesions, cysts or nodules – are most commonly found in the abdominal cavity on the ovaries, fallopian tubes, ligaments supporting the uterus, the cul-de-sac (the area between the vagina and rectum), outer surface of the uterus and the lining of the pelvic cavity. Growths have also been found in surgical scars, on the intestines, in the rectum and on the bladder, vagina, cervix and vulva. It rare cases, it can be found in the lung, thigh or arm.

For women with no symptoms, treatment is unnecessary, says Janik. Another 10% to 15% of women with endometriosis only discover they have the disorder when they are unable to conceive, and seek treatment at that point. But for those who live with constant pain, endometriosis is debilitating.

Treatment options
Conventional therapies to manage severe symptoms include suppressive medications such as birth control pills, which stop cyclic bleeding. Traditional surgical treatments include cauterization or, in extreme cases, hysterectomy. But cauterization isn’t a permanent fix and if the endometriosis has spread beyond the reproductive organs, hysterectomy is not a completely effective treatment, Dr. Janik said.

“Laparascopic surgery using peritoneal resection and removing the endometrial disease wherever it may be is the key to having good surgical results,” she explained.

For the past 12 years, Dr. Janik and her colleague Dr. Charles Koh have been using laparascopic surgery to treat severe endometriosis. She became aware of the treatment during a fellowship in reproductive endocrinology and surgery at Michael Reese Hospital in Chicago.

The procedure sparked her interest because it combined two of her professional interests – delicate surgical technique and a more aggressive and effective treatment of endometriosis. Patient response sealed the deal.

“The number of patients out there with the need for this is tremendous,” she said, “and the number of doctors who do this kind of work isn’t, so there’s a high demand.”

Dr. Janik makes small incisions in the abdomen, between 5 and 10 millimeters long, through which she is able to operate. Dr. Janik emphasized that the key to her success with endometriosis patients is the total removal of the endometrial tissue.

“We resect down to the normal tissue, and sometimes it means taking out a part of the bladder or rectum, but unless you resect it completely, the patient keeps having symptoms and problems.” she said.

Because the procedure is not as invasive as conventional surgery, recovery time is shortened. Most patients, she said, are able to leave the hospital in less than 24 hours.

Successful results
Over the past 10 years, Janik and Koh have tracked the treatment and long-term prognosis of more than 1,000 patients. Of those, about 400 had deep, infiltrating endometriosis in the cul-de-sac, the area behind the uterus and over the bowel.

In those cases, she and Koh completely removed the endometrial tissue. In all but 12 of the 400 cases, Dr. Janik said, she and her colleagues were able to remove the tissue and retain the entire bowel area. In the extreme cases, bowel was removed and the remaining portions reunited. In non-surgical terms, Dr. Janik said the procedure could be compared to splicing a tape.

Because of their success rate – 85% of the women are pain-free five years after the procedure – and because of the number of women they see who have been misdiagnosed or under treated, Janik and Koh have worked to raise awareness about endometriosis. In addition to lecturing to the public and colleagues on the topic, they’ve published their findings in medical journals, earning accolades from their peers.

Their study on endometriosis in teenage girls garnered a first place for Scientific Merit at the Pediatric Gynecology Association in 2002. In September 2003, they were presented with another first place award at the American Society of Reproductive Medicine for a paper detailing the lack of adhesion formation (scar tissue) after surgery to treat deep rectovaginal endometriosis.

We Have Answers Do you have medical questions or need help finding a doctor? The experts at Columbia St. Mary's and Advanced Healthcare can help. Click here.