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What is Diaphragmatic Endometriosis?

Endometriosis is most commonly found within the pelvic cavity but occasionally it occurs in other parts of the body like the lungs, heart and diaphragm. Diaphragmatic endometriosis can be diagnosed by comparing the symptoms of the patient with the classic endometriosis symptoms of heavy or irregular periods and cramping pelvic pain, in conjunction with other symptoms.

The diaphragm is the large muscle which divides the abdominal cavity from the chest cavity. It is the muscle that is used in breathing, where it works rather like a large bellows, moving up and down with each inward and outward breath. Diaphragmatic endometriosis is fairly rare, with specialists possibly only ever seeing a few cases in their career.

Diaphragmatic endometriosis patients all have a similar medical history; they have been treated for endometriosis in the pelvic area in the past which had been diagnosed during laparoscopy surgery. The reason the endometriosis on the diaphragm was not detected at that time is that most gynecologists do not expect lesions to be present in the upper part of the abdomen.

A gynecologist is a specialist in female reproductive medicine and so generally does not search for problems elsewhere. Another common symptom with diaphragmatic endometriosis patients is that their pain began earlier than the pain from the endometriosis of the diaphragm; the gynecologist would not have suspected any problems in the upper abdominal area.

A classic diaphragmatic endometriosis symptom is pain in the right shoulder which coincides with menstruation. This pain may take several months, or even years, to develop to the point where the patient seeks medical advice. Women describe this shoulder pain as being deep inside the shoulder and possibly radiating from the right side of the chest. This pain will often travel down the right arm or up into the right side of the neck.

There may be difficulty getting comfortable in bed or with sleeping because of the pain. As the lesions spread and deepen, this shoulder pain lasts longer than just during her period and may be present all the time to a lesser degree, becoming worse as her period approaches.

Once it is properly diagnosed, diaphragmatic endometriosis may be treated with any of the endometriosis methods. The first treatment option suggested by doctors is often oral contraceptive drugs which prevent ovulation. This means that endometriosis lesions are not subjected to monthly hormonal irritation which lessens the symptoms, especially the cramping pain which is so disruptive to sufferer's lives.

Other endometriosis treatment options include hormone therapy with a range of medications which include Danazol and GnRH agonists. These often prove to be very effective at shrinking endometrial implants and so relieve symptoms. Surgery is also an option with endometriosis of the diaphragm but is best performed by an experienced surgeon who knows where to look for lesions.

These are frequently located behind the liver and would normally not be visible with conventional laparoscopic techniques. It is often necessary for the surgeon to make an abdominal incision to be able to reach and excise diaphragmatic endometriosis lesions, because of the difficulty of their location.

This type of surgery appears to relieve the shoulder pain associated with the disease and shows that it is the best treatment option for diaphragmatic endometriosis. Laparoscopy surgery, so useful in cases of pelvic endometriosis, just isn't the answer for endometriosis in the chest cavity.

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