Although the procedure is a generally safe one, some women should definitely avoid laparoscopy:

• Obese women are not good candidates for laparoscopy. The amount of body fat makes it difficult for the doctor to position the instrument correctly.

• Women with a history of extensive abdominal forgery arc at greater risk for complications. This is because pelvic adhesions (soar tissue) may exist as a result of previous operations. The combination of endometrial growths and adhesions on the bowel can bind it down, making surgery complicated and bowel perforation possible. If the bowel is perforated when a laparoscope is inserted, a chain of needless problems can arise, including serious infection.

• Women with cardiovascular disease and/or high blood pressure are also at greater risk and should not agree to this procedure.

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It is best to shop around by talking to friends and relatives — in particular those who have either been diagnosed as having endometriosis or those who suffer from menstrual problems. These women are more likely to have had previous contact with a specialist and can perhaps make recommendations for you. Think about whether you are likely to feel more comfortable with a female or a male specialist.

Once you have decided on a doctor you would like to consult, you need to visit your GP to obtain a referral. It is helpful if your GP is familiar with the specialist you plan to visit as the pair should be in constant communication about your treatment and progress over the coming months.

There are several points to consider when choosing the doctor who will manage your illness and its treatment and help you plan for the future. However, there is no such thing as the perfect doctor — or the perfect patient — so the material in this chapter is merely a guide.

What to look f o r

You and the specialist you select will be working together to improve your health and well-being, so it is important you feel comfortable and can talk openly. At your first visit, ask yourself the following questions:

Does the doctor appear interested in me as an individual and show concern with my general well-being.

Does she or he communicate and explain in a way I can understand.

Are all my problems taken seriously or do I feel patronised.

Has the doctor explained all the options of diagnosis, treatment, etc. thoroughly so that I understand.

Does the doctor encourage questions and then answer them completely and in easily understood language.

Has further reading been suggested, along with the names of self-help groups for further education and support.

Does the doctor show sympathy and understanding and provide some genuine comfort.

It is important to remember that your doctor should let you talk freely and should listen closely to your concerns. It is not unreasonable to expect your doctor to spend some time explaining and talking over concerns and problems with you. After all, you need to develop a relationship where you can feel confident in the doctor’s skills and where mutual respect exists.

There should be enough time during the appointment for you to ask questions. Do not feel intimidated. You may feel the doctor is rushing you and that your time is up but if you have questions you want answered and concerns that need to be cleared up, then you have every right to continue the consultation.

Questions to ask

Some of the questions that you might like to ask your doctor include:

Does the doctor have a partner who knows about you and can treat you if your own specialist is unavailable.

Can the doctor see you immediately if you have an urgent or serious problem.

Will the doctor personally answer and return phone calls or will those phone calls be taken and answered by a secretary.

Are phone calls answered promptly; does your doctor receive messages to contact you when requested.

Can the doctor be contacted out of hours.

Will the doctor see you out of hours.

Will the doctor read out to you the results of pathology reports or referrals, etc., or will the results be given via the doctor’s secretary.

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The number and severity of side effects experienced may be related to the dosage being taken, so reducing your dose to the lowest needed to stop your periods may reduce the side effects experienced.

Some of Danazol’s side effects are due to the fact that it is a weak synthetic male hormone. It may cause both androgenic side effects (male characteristics) and anabolic side effects (bodybuilding effects).

The most common androgenic and anabolic side effects are weight gain, fluid retention, acne, oily skin and/or hair, bloating, decreased breast size, increase in facial and/or body hair, increased muscle bulk, deepening of the voice, change in appetite and enlargement of the clitoris.

Weight gain is by far the most common side effect of Danazol. The vast majority of women experience a significant gain in weight — usually one to five kilograms but occasionally more. Some women put on all or most of the increased weight quickly, while others gain weight gradually. Once treatment has finished most women lose the weight gain within a month or two but it often takes some time to lose the last kilogram.

Some women experience an increased growth of facial hair while on Danazol. This does not mean that you will grow a ‘beard’. The facial hair is not normally noticeable to other people as there is usually only slightly more than normal and it is very fine and downy. Some women also experience an increase in the amount of body hair, particularly on their legs and around their nipples.

If you experience profuse hair growth you should notify your gynaecologist as this side effect is sometimes not reversible.

Some women experience a change in their voice. The change may involve a loss of the higher notes, or the voice may become husky, or you may find that it peters out at times. Often the changes are only evident when you have been using your voice for some time or when you are trying to project your voice. The changes are often quite subtle so it is probably worthwhile organising with someone who is close to you to monitor your voice for any possible changes. If you notice any changes notify your gynaecologist immediately as they may be irreversible.

If you are a professional or amateur singer you should think carefully about taking Danazol because the voice changes are sometimes irreversible even if you cease treatment as soon as you notice any change.

Enlargement of the clitoris is rare but, as it may be irreversible, if you notice an enlargement you should contact your gynaecologist immediately.

Some of the side effects of Danazol are due to the low levels of oestrogen in the body. These side effects are those usually associated with the menopause and they include hot flushes, night sweats and vaginal dryness.

Danazol may also affect blood sugar levels and the way that the body uses sugars. In particular, it can cause a decreased glucose tolerance. Women with diabetes should be monitored carefully while taking Danazol.

Danazol also alters the levels of fats and cholesterol in the blood during treatment in the same way as people who are at risk of developing heart disease. Although there is no proof that longer treatment is harmful, most doctors are not prepared to continue Danazol treatment for more than six to nine months at a time because of the possibility that it may increase your risk of developing heart disease later in life.

Danazol can also cause a wide range of miscellaneous side effects including vaginal bleeding, muscle cramps, nausea, vomiting, headache, dizziness, depression, skin rash, fatigue, irritability, mood swings, decreased libido, insomnia, jaundice and liver disease.

Vaginal bleeding is common, particularly in the first two months of treatment. The bleeding may be intermittent spotting or staining, or it may be like a scant period. Generally, this does not mean that the treatment is not working. It usually resolves itself in time and most women will stop bleeding by the end of the second month of treatment.

Muscle cramps, which are common, may be severe and distressing.

You can stop taking Danazol at any stage if you are unable to cope with the side effects. First contact your gynaecologist and discuss your problems as there may be ways to manage the symptoms.

When you stop taking Danazol you will usually start ovulating and menstruating within four to six weeks. Most of the side effects of Danazol will disappear soon after you have completed your course of treatment.

Most women who become pregnant do so within six to twelve months of completing their treatment of Danazol. In the past there has been some controversy regarding how soon after completing treatment you should try to conceive. Some gynaecologists believed that it was probably best to avoid becoming pregnant until you had one normal period in order to allow the Danazol to be completely cleared from your body before you became pregnant. Most gynaecologists now believe that there is no advantage in delaying conception and that you can start trying to conceive as soon as you have finished your course of Danazol.

There is no information available about the long-term side effects of taking a single course of Danazol therapy and even less is known about the long-term effects of taking repeated or prolonged courses.

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Danazol may also affect blood sugar levels and the way that the body uses sugars. In particular, it can cause a decreased glucose tolerance. Women with diabetes should be monitored carefully while taking Danazol.

Danazol also alters the levels of fats and cholesterol in the blood during treatment in the same way as people who are at risk of developing heart disease. Although there is no proof that longer treatment is harmful, most doctors are not prepared to continue Danazol treatment for more than six to nine months at a time because of the possibility that it may increase your risk of developing heart disease later in life.

Danazol can also cause a wide range of miscellaneous side effects including vaginal bleeding, muscle cramps, nausea, vomiting, headache, dizziness, depression, skin rash, fatigue, irritability, mood swings, decreased libido, insomnia, jaundice and liver disease.

Vaginal bleeding is common, particularly in the first two months of treatment. The bleeding may be intermittent spotting or staining, or it may be like a scant period. Generally, this does not mean that the treatment is not working. It usually resolves itself in time and most women will stop bleeding by the end of the second month of treatment.

Muscle cramps, which are common, may be severe and distressing.

You can stop taking Danazol at any stage if you are unable to cope with the side effects. First contact your gynecologist and discuss your problems as there may be ways to manage the symptoms.

When you stop taking Danazol you will usually start ovulating and menstruating within four to six weeks. Most of the side effects of Danazol will disappear soon after you have completed your course of treatment.

Most women who become pregnant do so within six to twelve months of completing their treatment of Danazol. In the past there has been some controversy regarding how soon after completing treatment you should try to conceive. Some gynecologists believed that it was probably best to avoid becoming pregnant until you had one normal period in order to allow the Danazol to be completely cleared from your body before you became pregnant. Most gynecologists now believe that there is no advantage in delaying conception and that you can start trying to conceive as soon as you have finished your course of Danazol.

There is no information available about the long-term side effects of taking a single course of Danazol therapy and even less is known about the long-term effects of taking repeated or prolonged courses.

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