Endometriosis has no cure, so treatment focuses on improving symptoms. Menopause often abates this condition, whether it’s through natural or surgical means. However, the treatment of endometriosis is more a matter of management for women in their reproductive years. That means the goal of treatment is to slow the disease’s progression, relieve pain, restore and preserve fertility.
Once a practitioner confirms the diagnosis through laparoscopy, the next step primarily depends on whether the patient is infertile. Infertile women require surgery to remove endometrial tissue while preserving the ovaries and minimizing damage to healthy tissue. The surgeon can accomplish this through either ablation or excision. Ablation involves burning and vaporizing the lesions with an electric device, which has a high rate of short-term recurrence. Excision is the physical cutting and removal of this tissue, which has a much lower rate of recurrence than ablation.
In cases where infertility isn’t an issue, endometriosis can be managed with hormonal medication that suppresses the menstrual cycle. Infertile women may also be treated with medication after their surgery.
Surgery for endometriosis is typically performed laparoscopically, commonly known as keyhole surgery. This process consists of the removal of small lesions and resection of endometriomas, after which the surgeon restores pelvic anatomy as much as possible. Endometriomas on the ovaries require surgical removal, as hormonal treatments will be insufficient by themselves. It’s particularly important to remove cysts before they rupture, which causes acute pain and internal bleeding.
Laparoscopic surgery is considered minimally invasive since the surgeon makes a very small incision at or near the navel. A laparoscope is then inserted through the incision, allowing the surgeon to locate endometrial lesions. The next step is to insert various other instruments through the incision to remove the tissue. After surgery, the incision heals, leaving only a small scar. Like other laparoscopic procedures, recovery is faster than with open surgery and has a lower risk of complications.
Medical treatment for endometriosis primarily consists of hormonal birth control therapy to reduce menstrual pain, which is typically a combination of estrogen and progesterone. This therapy reduces menstrual flow or completely eliminates it, and also provides additional estrogen for patients whose natural levels are too low. This is the most common medical treatment for endometriosis because it can be used for a long period of time, is easy to use and relatively inexpensive.
Progestogens like progesterone inhibit endometrial growth, allowing a practitioner to reduce menstruation in a controlled, reversible manner. Progestins are chemicals that are closely related to natural progesterone and have similar effects. These commonly include dienogest, which is sold under the trade name Visanne. Progestins are typically combined with estrogen, but may also be an acceptable treatment for endometriosis by themselves.
For more information, please visit our complete Endometriosis Guide.