Treatment - Endometriosis

There is currently no cure for endometriosis and it can be difficult to treat. There are treatments that can help ease and manage the symptoms of endometriosis and slow down the progression of the disease.

Treatment can be given to:

• relieve pain
• slow the growth of endometriosis tissue
• improve fertility
• reduce the likelihood of the condition returning

Treatments include:

• painkillers and anti-inflammatories – ibuprofen, paracetamol hormone medicines
• contraceptives such as the oral contraceptive pill
• surgery to remove patches of endometriosis tissue, often by keyhole surgery

In extreme cases, you may need an operation to remove the endometriosis tissue on the affected organs. Most women with endometriosis will not need an operation to manage their symptoms. Your doctor will discuss the best options with you for your situation.

Deciding on treatment

Your doctor will discuss the treatment options with you. They will outline the risks and benefits of each. All women with symptoms of endometriosis should have the condition ruled out.

When deciding which treatment is right for you, there are several things to consider.

These include:

• your age
• whether your main symptom is pain or difficulty getting pregnant
• whether you want to become pregnant – some treatments may stop you getting pregnant
• how you feel about surgery
• whether you've tried any of the treatments before

Treatment may not be needed if your symptoms are mild. Nearly all women find that their symptoms decrease after menopause.

Support from groups can be useful if you're learning how to manage the condition.

Endometriosis Association of Ireland - endometriosis.ie

Pain medication

If your period pains do not get better with mild painkillers, talk to your GP to rule out endometriosis. They may recommend anti-inflammatories (such as ibuprofen) or paracetamol to see if they help reduce your pain.

Tell your GP if you've been taking painkillers for a few months and you're still in pain. They may prescribe you stronger pain medication.

Hormone treatment

The aim of hormone treatment is to stop your periods and stop the thickening of the lining of your womb. If pain improves or disappears when periods are stopped, this strongly suggests that endometriosis is present.

Hormone treatment will not improve your fertility. It also has no effect on adhesions – 'sticky' areas of tissue that can cause organs to fuse together.

Some of the main hormone treatments for endometriosis include:

• the combined oral contraceptive pill or contraceptive patch
• a levonorgestrel-releasing intrauterine system (LNG-IUS), for example Mirena
• gonadotrophin-releasing hormone (GnRH) analogues, for example Decapeptyl, Zoladex
• progestogens (Provera, Depo Provera)

Hormone treatment may be effective in treating endometriosis symptoms in the short term. Symptoms will only be improved while taking the medication. All hormone treatments have side effects. It is important that you discuss these with your treating doctor before starting hormone treatment.

Most hormone treatments reduce your chance of pregnancy while using them, but only the contraceptive pill or patch and LNG-IUS are licensed as contraceptives (will stop you getting pregnant).

None of the hormone treatments have a permanent effect on your fertility.

Surgery

Surgery can be used to remove or destroy areas of endometriosis tissue. This can help improve symptoms and fertility. 

Surgery is carried out using a keyhole procedure called laparoscopy. During the surgery, the gynaecologist would either excise or ablate the endometriosis tissue.

Excision is a type of surgery that removes all of the endometriosis tissue. It ensures that tissue can be sent to the laboratory for examination.

Ablation is a type of surgery that uses heat to 'burn' and destroy the endometriosis tissue. It can leave endometriosis tissue in place.

Any surgical procedure carries risks. Discuss these with your surgeon before undergoing treatment.

Laparoscopy

During laparoscopy, also known as keyhole surgery, small cuts (incisions) are made in your tummy. The endometriosis tissue can then be destroyed or cut out.

During laparoscopy, fine instruments are used to apply heat, a laser, an electric current (diathermy), or a beam of special gas to the patches of tissue to destroy or remove them.

Ovarian cysts, or endometriomas, which are formed as a result of endometriosis, can also be removed using this technique.

The procedure is carried out under general anaesthetic, so you'll be asleep and will not feel any pain as it's carried out.

Although this kind of surgery can help your symptoms and can sometimes help improve fertility, problems can return. Endometriosis is a long-term condition while you still have periods. The endometriosis tissue can regrow after surgery.

Your surgeon may recommend taking a hormonal treatment after your surgery. Hormonal treatments are recommended for those with recurring endometrioma (chocolate cysts).

Hysterectomy

A hysterectomy may be recommended if you continue to have symptoms and if all other suitable treatment options have not helped. Hysterectomy on its own is not the first choice of treatment for managing endometriosis.

A hysterectomy is a surgical procedure to remove the uterus (womb). You will not be able to carry a child after a hysterectomy.

A hysterectomy is a major operation that will have a significant impact on your body. Deciding to have a hysterectomy is a big decision. Discuss it with your doctor.

Hysterectomies cannot be reversed. There is no guarantee the endometriosis symptoms will not return after the operation. If the ovaries are left in place, the endometriosis is more likely to return.

HRT after a hysterectomy

If your ovaries are removed during a hysterectomy, you may need hormone replacement therapy (HRT) afterwards. Your doctor will discuss this with you.

Surgery complications

Like all types of surgery, surgery for endometriosis carries a risk of complications.

If surgery is recommended for you, talk to your surgeon about the possible risks before agreeing to treatment.

The more surgery you have, the more likely that both complications and long-term side effects can happen.

The more common complications are not usually serious, and can include:

• a wound infection
• minor bleeding
• bruising around the wound

Less common, but more serious, risks include:

• damage to an organ, such as a hole accidentally being made in the womb, bladder or bowel
• severe bleeding inside the tummy
• a blood clot in the leg (deep vein thrombosis) or lungs (pulmonary embolism)

Bladder and bowel problems

Endometriosis affecting the bladder or bowel can be difficult to treat and may require major surgery. This is usually severe endometriosis.

You are likely to be referred to a specialist endometriosis service if your bladder or bowel is affected.

Your doctor will talk to you about the side effects of having bowel or bladder surgery.