Treatment

In most women with endometriosis, preservation of reproductive function is desirable. The least invasive approach that is effective, with the least risks in the long run, should be chosen. It is essential that you are involved in the decision taken about your treatment options. Symptomatic endometriosis patients can be treated by analgesics, hormones, surgery, assisted reproduction or a combination of these. Many women with endometriosis have pain and sub fertility at the same time, which complicates the choice of treatment. Unfortunately, as endometriosis is a chronic disease, elimination of the endometriotic implants by surgical or medical treatment often provides only temporary relief. Therefore, the goal should be to eliminate the endometriotic lesions and, more importantly, to treat the symptoms (pain and sub fertility) and prevent recurrence. It has to be kept in mind that endometriosis is a chronic disease, although it is not life threatening, and the recurrence rate is high after both hormonal and surgical treatment.

It is your doctor’s role to help you manage your disease, which, depending on your aims, may mean one of the following:-

  • Relief of symptoms
  • Achieving a pregnancy
  • Improving your quality of life
  • Providing high quality information about treatment options
  • Involving you in the decision process

The key issue, however, is that you open up a dialogue with your doctor so that he/she understands:-

  • What concerns you and what you want from the consultation
  • The impact of the disease on your quality of life
  • What your aims and objectives are
  • How much you already know about endometriosis and your options

Every woman has a unique set of problems and concerns.  Not all woman respond in the same way to treatment, the decisions are often complex. Discrepancies may exist between your and your doctor’s aims.  You and your gynaecologist should agree on the aims of your treatment and why treatment is being offered.  Since the introduction of the new informed consent forms for surgical treatment, it is much easier to have the intended benefits and the major risks and complications explained to you.  It is not standard treatment to do this for medical treatment, but it is in everyone’s interest to do so.

Teenagers and Endometriosis

If you are a teenager with menstrual pain that prevents you from doing day to day activities and keeps you away from school you should discuss these symptoms with your GP who could then refer you on to an endometriosis specialist.  It is always useful to keep a diary of your symptoms for a month before you see the doctor.  It is also a good idea to take a parent or a friend with you so that you don't miss anything.  Don't be afraid to ask questions.  Endometriosis New Zealand has developed a new website specifically for teenagers with endometriosis.  It's fun and informative.

 

What treatments are available?

 

Treatment   Advantages Disadvantages
Non hormonal treatment i.e. alternative therapies like Chinese medicine, Reiki, reflexology, aromatherapy, herbal remedies, dietary manipulation, acupuncture and vitamin/mineral supplements
  • Avoids medical intervention
  • May allow disease to progress
  • May not provide symptom relief
Pain Killers i.e. non-steroidal anti inflammatory drugs(NSAIDS)such as Mefenamic Acid(Ponstan), Naproxen(Naprosyn) and Diclofenac(Volterol)            
  • Avoids hormonal drugs and surgery
  • Painkillers may be inadequate
  • No effect on the disease itself
Hormonal drugs i.e. the pill, progestagens, the Mirena coil, Danazol, gonadotrophin-releasing hormone agonists(GnRHa)
  • Effective pain relief in most cases
  • Stops periods
  • Fertility not improved
  • Symptom recurrence is common
  • Little effect on endometriomas
  • Cannot conceive on treatment
  • Side effects
Conservative laparoscopic surgery
  • Removes all endometriosis
  • Restores normal anatomy
  • Conserves as much normal tissue as possible
  • Can be done by laparoscopy
  • Effective pain relief in most cases
  • May improve fertility
  • May avoid need for hormonal drugs
  • Risks of surgery
  • Risk of recurrence

Radical laparoscopic surgery or

Open Surgery(done for severe endometriosis with large fibroids, cysts etc)
      

  • Hysterectomy with removal of both ovaries and all endometriomas
  • No more periods
  • Risks of surgery and long term HRT
  • Small risk of reactivating disease not removed at surgery
  • Lost ability to conceive
Assisted reproduction (IUI or IVF)
  • Effective treatment
  • Emotional and financial costs
  • Small risk of making disease worse

The management of severe/deeply infiltrating endometriosis is complex.  Surgery is usually required and multiple organs are sometimes involved. Therefore, if disease of such severity is suspected or diagnosed referral to a centre of excellence where relevant multi disciplinary clinical expertise is available, including advanced laparoscopic surgery.

Coping with the disease

The role of complimentary therapies in relieving endometriosis associated pain is unclear.  There is evidence that TENS (transcutaneous electrical nerve stimulation) , acupuncture, vitamin B1 and magnesium may help to relieve dysmenorrhoea..  Many women with endometriosis report that complementary therapies such as homeopathy, reflexology, traditional Chinese medicine or herbal treatment, do improve pain symptoms.  If a woman believes that these are beneficial to her overall pain management and/or quality of life or work in conjunction with other therapies she be encouraged to try these treatments

The role of patient-support groups in the management of women with endometriosis should also be encouraged.

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