When the modern and very versatile laparoscope was invented in Sweden about twenty years ago, it was the culmination of a long medical quest to look into and observe the living human body. It is fiber optics, or cold light, that made the laparoscope possible and practical to make. The laparoscope is a long rigid tube equipped with thin glass fibers (along which light travels to “spotlight” organs) and a periscopelike attachment that allows doctors to see into the pelvis and

abdomen. Lightweight and flexible (it can be maneuvered into various positions), the laparoscope not only makes it possible to see into the abdominal cavity but can also be used along with surgical instruments, if necessary, for further medical procedures. Therefore, laparoscopy—the technique that employs the tool—can be performed for either a diagnostic or a therapeutic procedure.

The most frequent candidates for laparoscopy are women with fertility problems, but the number of women who are suspected of having endometriosis and are undergoing the technique to confirm it is growing apace. Laparoscopy, it has been found, benefits women with either problem (or both) in this way: since the technique allows a visual inspection of pelvic organs and subsequent diagnosis, it can avert major surgery. For patients with persistently misdiagnosed and undiagnosed pelvic pain, it may finally provide an answer. Doctors can look for signs of endometriosis in its varying stages—from a reddened inflamed appearance of organs to the existence of pepper spots to greater gluelike adhesions to more massive chocolate cysts and tumors. Laparoscopy allows the sighting of such conditions, but remember, it is surgery, though on a lesser scale.

Currently, laparoscopy, familiarly called the Band-Aid procedure, is considered by most doctors to be the only absolute method of detection for endometriosis. Would that it were absolute! As it turns out, laparoscopy is only as good as the practitioner doing the viewing and diagnosing. Endometriosis is sometimes difficult to identify. Endometriosis that is growing on the ligaments behind the uterus or hidden inside tissue can be difficult to spot. To locate such growths, a doctor needs skill and dexterity. The scope must be positioned well below the uterus to catch sight of hard-to-see implants.

Unfortunately, some physicians either are inexperienced or may not fully understand the procedure or the female anatomy, or both. Because of these shortcomings, a number of complications can occur during laparoscopy. If it is not conducted under proper sterile techniques, the procedure can lead to abdominal and pelvic infections. Internal bleeding is a possibility from an incorrectly placed laparoscope; the device can lacerate, perforate, or traumatize the organs. Laparoscopy can cause serious problems like these in the hands of an unskilled physician. Then again, he may be knowledgeable enough about the procedure itself, but lacking as a diagnostician.

Cases of women undergoing this procedure and being told they are free of the disease when, in fact, they are not are not uncommon. One reason, as mentioned, is the surgeon’s skill in detecting it. Another is that the endometriosis may be microscopic and not visible to the eye. This means that evidence of the disease may not be revealed with laparoscopy, although it exists. Otherwise, the disease is officially described at four different stages of severity (I, II, III, and IV), as recently classified by the American Fertility Society.

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Then, you get ‘Oh, but you look fine’. I almost scream with frustration. They’re fishing for an explanation. So, should I explain or not? Well…in the interests of helping them to understand (hopefully), here goes with the justification speech yet again! I spiel off: ‘Well, I’ve got endometriosis (only some know what it is and even less understand the implications) and it is caused by… and it makes you have…symptoms, etc. etc.’. I would usually like to add, but prudently don’t, ‘I look “fine” because…

I have become determined to beat it!’.

I have my outward “facade” on today, which is a fake expression, accompanied by make-up, that says “I’m fine, I have no pain or problems at all’”;

the fact is I don’t venture out when I’m really feeling dreadful so you don’t see the real evidence of endometriosis’, or

I’ve taken a painkiller!’

You come away feeling guilty because you don’t look sick enough for them to believe or understand.

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The low levels of oestrogen mean that the endometrial implants are no longer stimulated to grow and break-down each month. Therefore, they become inactive and begin to gradually waste away.

Ovulation and menstruation usually cease by the end of the second month of treatment though this may depend on the dosage being taken. The symptoms of endometriosis usually begin to decrease by the end of the second month of treatment and then continue to improve throughout the course of treatment.

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It is thought that Danazol eradicates endometrial implants in several ways. The net result is that the production of oestrogen is suppressed and the levels of oestrogen in the body decrease to the low levels found in women following the menopause. Hence, Danazol treatment is sometimes referred to as pseudo-menopausal treatment because it mimics the hormonal condition of menopause.

The low levels of oestrogen mean that the endometrial implants are no longer stimulated to grow and break-down each month. Therefore, they become inactive and begin to gradually waste away.

Ovulation and menstruation usually cease by the end of the second month of treatment though this may depend on the dosage being taken. The symptoms of endometriosis usually begin to decrease by the end of the second month of treatment and then continue to improve throughout the course of treatment.

Dosages of Danazol generally used

The dosage and length of your treatment will depend on a variety of factors including the severity of your disease, your response to the treatment and your gynecologist’s preferences.

Most gynecologists recommend that you start with a dosage of 600 to 800 milligrams per day (three or four 200 milligram capsules per day). Some research studies have suggested that Danazol is equally effective at lower dosages if your periods are suppressed. Your gynecologist may decrease your dosage to 600 milligrams or even 400 milligrams per day once your periods have stopped.

In order to increase the effectiveness of the drug it is best to take the capsules at fairly evenly spaced times throughout the day — in other words one capsule every eight hours if you are on 600 milligrams per day or every six hours if you are on 800 milligrams per day.

The usual length of a course of treatment with Danazol is three to nine months — the average length being about six months. A further course of Danazol may be used if you have a recurrence of your endometriosis as there is no evidence to suggest that the implants become resistant to the drug. Because so little is known about the effects of repeated or long-term use of Danazol you should probably only have two or three courses in your lifetime and you should not have a prolonged course of treatment beyond twelve months.

You should start your course of Danazol on the first day of your period to minimize the likelihood of taking the drug while you are pregnant. If you do not begin the treatment at the start of a period you should have a pregnancy test to make sure that you are not pregnant.

Although it is unlikely that you will conceive during your course of treatment with Danazol every care should still be taken to avoid pregnancy. The manufacturers of Danazol recommend that some form of barrier contraception (e.g. condom or diaphragm) be used while taking the drug, particularly during the first two months of treatment or if you are taking less than 800 milligrams per day. The oral contraceptive (the Pill) should not be taken at the same time as Danazol.

You should see your gynecologist about six to eight weeks after beginning your course of Danazol to discuss how the treatment is progressing and any problems that you may be having. Thereafter, you should see him or her every two to three months for the remainder of your course of Danazol.

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