The treatment of endometriosis depends on the problems created by the disease. There are a variety of different strategies to manage each of the symptoms including infertility, painful periods, painful sex or abnormal uterine bleeding.
The possible treatments as as follows:-
Remove or destroy the endometriosis
- Destroying the disease at laparoscopy
This involves the use of electric current (diathermy), laser, or direct surgical dissection and removal. This can be achieved in over 80% of cases where infertility is the major problem. Laparoscopic treatment of endometriosis can usually be performed at the time of the initial diagnosis so that by the time you learn that you have the disease it has already being treated. Laparoscopic treatment helps with both pain and infertility. However, the nature of endometriosis does mean that it can recur with time.
- Excision of the disease at open operation (Laparotomy)
For substantial disease with extensive adhesions, deep invasion or ovarian cysts it may be necessary to undergo more extensive surgery to be able to fully treat endometriosis.
Remove or reduce the hormones that support endometriosis
Drugs which stop ovulation are able to suppress endometriosis. These treatments are most commonly used in patients who have pain or bleeding problems as symptoms of the disease. They are not used frequently for the treatment of the disease in patients with fertility problems. Suppressing ovulation is counterproductive and their use delays getting pregnant although there is some evidence that fertility rates are increased in the months that follow cessation of their use.
- Progestagens
Progestagens are hormones that closely resemble the natural hormone progesterone (which is produced in the second half of the menstrual cycle following ovulation). A number of different types exist: Norethisterone (brand name Primolut), Medroxyprogesterone acetate (Provera) and Dihydrogesterone (Duphaston) are but a few.
- Danazol or Gestrinone
These drugs have both progesterone and testosterone effects. They more profoundly suppress endometriosis but have a greater tendency to produce side effects.
- GnRH analogues (Synarel, Lucrin, Zoladex)
These drugs are almost identical to one of the hormones that is produced in a part of the brain known as the hypothalamus (Gonadotrophin Releasing Hormone - GnRH) which is responsible for the initial nervous messages that ultimately leads to ovulation. When GnRH analogues are used continuously they initially stimulate hormone release from the pituitary gland then they suppress it - this stops ovulation. As a result the growth of endometriosis is no longer stimulated and the disease is suppressed.
- Removal of the ovaries (oophorectomy)
Removing the ovaries is the ultimate in ovulation suppression. Clearly this treatment is of no use for fertility problems.
Relieve the symptoms of endometriosis
- Analgesics and anti-inflammatory drugs
Medications such as aspirin, paracetamol and Non Steroidal Anti-Inflammatory Drugs (NSAIDS) are often used to suppress the pain and discomforts of endometriosis
- IVF
Often when infertility is the main symptom the disease can be ignored and treatment is used to bypass the effect on fertility. Pregnancy rates with IVF are excellent. There is little evidence that treating endometriosis prior to IVF improves pregnancy rates. Pregnancy itself often improves symptoms of the disease.
Longer term
Priorities and attitudes will change with increasing age as fertility problems become less and pain management more important. Problems from the disease decline in the late 40’s. Menopause will almost always lead to complete remission. Hysterectomy can occasionally become necessary. Second look laparoscopy for preventative treatment can be considered in young women who do not yet wish to become pregnant.