As with laparoscopy, there is a range of therapeutic procedures, though more limited, that may be performed while the culdoscope is in place, fine operating instruments may be inserted through it for use in minor operations, the most common of which are tubal sterilization and the removal of small adhesions.

Aftereffects of culdoscopy are usually not troublesome. If you are scheduled for one, expect minimal pelvic pain for a day or two after surgery. Doctors will advise abstinence from intercourse for three or four weeks or until complete healing has occurred. Unlike laparoscopy, which is not as debilitating, culdoscopy will require rest at home for a week or two and avoidance of stress-filled work schedules.

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Position in the pelvis. Some women can accurately locate the position of their uterus because of the contractions they feel during orgasm or menstruation. These uterine contractions can be like pleasant ripples and are an enjoyable part of sex for some, while other women find them painful. For women who don’t experience these clues, it can be helpful to picture where the uterus sits inside the abdomen: the vagina is below, the bladder in front, the loops of the bowel above, and the rectum behind.

Strong support tissues called ligaments hold the uterus in place in the pelvis. If these ligaments are not able to provide the necessary support and the uterus becomes displaced (this is one type of prolapse), this can create pain or changed function in the four surrounding organs. For example, pain during sex may result from the uterus pressing on and even into the vagina, while pressure on the bladder from the uterus can lead to urinary incontinence.

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An injection of Depo-Provera consists of thousands of very small crystals of the drug suspended in a solution of water. When the drug is injected into the body the crystals are slowly released into the bloodstream over a period of weeks or months. The time that the drug remains in the body depends on how fast it releases the crystals and how fast the body removes the drug from the bloodstream.

There has been considerable controversy over the last decade regarding the unapproved use of Depo-Provera for contraceptive purposes. However, Depo-Provera has long been approved in this country for the treatment of endometriosis.

How Depo-Provera works

Depo-Provera presumably eradicates endometrial implants in the same way as Provera.

Dosages of Depo-Provera generally used

Dosages vary. Some gynecologists recommend one injection every two weeks for the first two to three months followed by one injection every month for the rest of the course of treatment. Others recommend one injection every two weeks throughout the course of treatment. The recommended length of treatment may vary from six months to a year.

It is important to remember that because Depo-Provera is a long-acting injection, any side effects will persist until all the crystals of the drug have been removed from the body. There is no way to remove the drug from your body once you have had an injection and there is no antidote.

Some gynecologists suggest that you try taking a short-term course of Provera tablets before you embark on a long-term course of Depo-Provera as this should enable you to find out how your body responds to the drug and whether or not the side effects are likely to cause problems.

Side effects of Depo-Provera

Side effects of Depo-Provera include vaginal bleeding, weight gain, depression, headaches, nausea, lethargy and tiredness, decreased libido, acne, abdominal discomfort and breast tenderness.

Vaginal bleeding is common and may be troublesome. The bleeding may be heavy and prolonged, or erratic with episodes of light bleeding or spotting. The bleeding may sometimes persist after the course of treatment has finished.

Weight gain is also common — usually only about two or three kilograms but sometimes more.

Most women will start ovulating and menstruating again within several months of their last injection. Depo-Provera sometimes causes a prolonged delay in the return of menstruation and a few women will not menstruate for more than a year following their last injection. Depo-Provera is not recommended for women who may wish to become pregnant soon after their treatment has ceased.

How effective is Depo-Provera

Studies indicate that Depo-Provera relieves the symptoms of endometriosis in 60% to 80% of women and that approximately 50% of women desiring pregnancy will conceive. There are no figures on the rate of recurrence of endometriosis following treatment.

Depo-Provera, pregnancy and breastfeeding

The manufacturers state that Depo-Provera should not be used if there is any possibility that you may be pregnant, as progestogens may cause abnormalities in the developing foetus. However, some gynecologists believe that Depo-Provera causes no risks to the foetus.

The use of Depo-Provera while breastfeeding is probably safe.

Interaction with other drugs, alcohol or foods

There are no known interactions of Depo-Provera with any foods, alcohol or other drugs.

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