Many patients dislike taking medication, or they find that it is no longer working for them. Others suffer from undesirable side effects. Acupuncture is a relatively benign therapy that may help in some cases for pain management. A study done by Dr. Joseph M. Helms, a family practitioner in Berkeley. California, demonstrated how this ancient treatment may be effective for sufferers of dysmenorrhea.

Dr. Helms set up an experiment in which he divided forty-three women into four groups. One group got real acupuncture treatment at appropriate acupuncture points (specific points on the feet, knees, forearms, and lower abdomen). A second group was given false acupuncture, that is, at random points on their bodies. A third group was followed without medical attention or acupuncture, and the fourth group just “visited” the project doctor once a month. All of these women were regularly taking medication to control their monthly pain. (Remember, cramps are caused by high prostaglandin levels prompting the uterus to contract. Antidotes for cramps arc prostaglandin inhibitors.)

Dr. Helms’s study was undertaken for a period of twelve months before tabulating his results: 90.9 percent of those treated with mil acupuncture (ten out of eleven subjects) showed improvement; four out of eleven given false acupuncture said they felt improved. The real acupuncture group reported a decrease in cramping, pain, nausea, headache and backache, and premenstrual symptoms of fluid retention and breast tenderness, and they improved immediately. From his firsthand analysis. Dr. Helms theorises that acupuncture may work for any number of reasons, the concentration of prostaglandins in the endometrium is altered either directly by the stimulation of the acupuncture treatment or “indirectly via the concentration of estrogen or progesterone.” Again, he reported, it may be some other “neural mechanism triggered by the acupuncture treatments.”

Part of such a positive result of acupuncture treatment, Dr. Helms feels, is a “bias of self-selection.” This means chat it is possible that patients trilling to accept acupuncture as a valid medical treatment would be more willing to participate in such a study, while those who were against acupuncture were underrcpresented.

Nevertheless, the study had an interesting resolution, since most women in these groups wanted to stop taking medication and handle the treatment of pain in some other way. Dr. Hoffman feels that acupuncture can help in certain cases, but that women with endometriosis in an advanced state may get little pain relief Acupuncture has mystique, but it’s not a miracle cure.

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There are two main types of period pain or dysmenorrhoea (pronounced dis-men-or-eea). Primary dysmenorrhoea usually affects young women who have never been pregnant. It begins when bleeding starts or just beforehand and rarely lasts more than twenty-four hours. The pain is cramp-like and is usually felt in the lower abdomen, lower back or the insides of the thighs. Occasionally it is so severe that it causes fainting, nausea or vomiting. The cause of the pain is linked to an increase in contraction of the uterus. This may be related to excessive secretions of prostaglandin substances by the endometrium or an increased sensitivity of the uterus to them, causing stronger contractions. Secondary dysmenorrhoea is more often experienced by women whose periods have been painless for some years. The pain may last throughout the menstrual bleeding phase and is thought to be a symptom of something amiss in the reproductive system, for example tissue inflammation, endometriosis, pelvic infection or fibroids. Drugs with anti-prostaglandin activity are often used to treat dysmenorrhoea; in severe cases of primary dysmenorrhoea the pain can be stopped by the inhibition of ovulation through hormone treatments such as the contraceptive Pill.

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Who is suitable for a conservative laparotomy?

The reasons for having a conservative laparotomy vary widely and they may include any of the following:

• moderate or severe disease

• endometriomas or cysts greater than two centimeters in diameter

• adhesions, especially if they are causing pain or distortion of the reproductive organs

• involvement of other organs such as the bowel or bladder

• moderate or severe symptoms that have not responded to other treatments

• inability or unwillingness to take hormonal treatment

• desire to conceive immediately

• desire to avoid hysterectomy

• woman’s preference

• gynaecologist’s preference.

A conservative laparotomy is often the most appropriate form of treatment for more severe forms of endometriosis, particularly if large cysts or adhesions are present. Some gynaecologists believe that a conservative laparotomy is of little benefit for those with minimal or mild endometriosis and that in those cases it should only be used as a last resort if hormonal treatment or laparoscopic surgery is unsuccessful.

Hormonal treatment has little or no effect on adhesions or large cysts and endometriomas greater than two centimeters in diameter as they are made up largely of scar tissue. Surgery is the only way to remove or destroy any adhesions or large cysts and endometriomas.

If your endometriosis involves nearby organs such as the bowel or bladder, surgery may be necessary to ensure the normal functioning of those organs.

Things to discuss before conservative laparotomy

Before your operation it is important that you discuss with your gynaecologist what is intended to be done during the operation. Also ask any other questions or voice any concerns that you may have. In particular, you should make sure that you both agree on the purpose of the surgery and you should discuss what procedures are proposed and you should make it clear if there are any procedures that you particularly do or do not want carried out. You also need to remember that, because each case of endometriosis is unique, until your gynaecologist actually starts the surgery it is difficult to be certain what procedures will be needed.

If your symptoms are manageable and if you are contemplating becoming pregnant soon it may also be worthwhile discussing the timing of your surgery with your gynaecologist. Most infertile women with endometriosis who conceive following a conservative laparotomy do so in the first 12 months after their surgery and you are more likely to conceive after the first bout of surgery than subsequent surgeries. Some gynaecologists believe that, if possible, a conservative laparotomy should be timed for when the woman wishes to become pregnant.

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