There is currently no cure for endometriosis and it can be difficult to treat. Treatment aims to ease symptoms so the condition does not interfere with your daily life.
Treatment can be given to:
- relieve pain
- slow the growth of endometriosis tissue
- improve fertility
- reduce the likelihood of condition returning
Deciding which treatment
Your treating physician will discuss the treatment options with you. They will outline the risks and benefits of each.
When deciding which treatment is right for you, there are several things to consider.
- 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 necessary if your symptoms are mild. For some women their symptoms decrease after the menopause. All women with symptoms of endometriosis should have the condition ruled out.
Support from self-help groups, such as the Endometriosis Association of Ireland, can be very useful if you're learning how to manage the condition.
Your doctor might recommend anti-inflammatories (such as ibuprofen, Ponstan, Difene, Voltarol) or paracetamol to see if they help reduce your pain.
If period pains do not subside with mild painkillers, you should see your GP to rule out endometriosis as a cause of your pain.
Tell your GP if you've been taking painkillers for a few months and you're still in pain. Your GP may prescribe you stronger pain medication.
For more information, read about pain relief for endometriosis on the Endometriosis Association of Ireland website.
The aim of hormone treatment is to to stop your periods and prevent seeding of the lining of the womb.
Hormone treatment has no effect on adhesions – 'sticky' areas of tissue that can cause organs to fuse together – and can't improve fertility.
Some of the main hormone-based 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 treatments may be effective in treating endometriosis symptoms in the short term. They are only effective while using the treatment. All hormone treatments have side effects.
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.
None of the hormone treatments have a permanent effect on your fertility.
The combined oral contraceptive pill or patch
The combined contraceptive pill and contraceptive patch contain the hormones oestrogen and progestogen.
They can help relieve milder symptoms, and can be used over long periods of time. They stop eggs being released (ovulation) and make periods lighter and less painful. If they are taken back to back (2 packs in a row) they prevent periods and seeding of the lining outside the womb.
These contraceptives can have side effects. Try different brands until you find one that suits you.
Your doctor may recommend taking 3 packs of the pill in a row without a break to minimise the bleeding and improve any symptoms related to the bleeding.
Levonorgestrel-releasing intrauterine system (LNG-IUS)
The Mirena levonorgestrel-releasing intrauterine system (LNG-IUS) is a t-shaped contraceptive device that fits into the womb. It releases a type of progestogen hormone called levonorgestrel.
This hormone prevents the lining of your womb growing and greatly reduces or even stops periods.
The device is put into the womb by a doctor. Once in place, it can remain effective for up to 5 years.
Possible side effects of using LNG-IUS include irregular bleeding that may last more than 6 months, breast tenderness and acne.
GnRH (Gonadotrophin-releasing hormone) analogues are synthetic hormones that bring on a temporary menopause by reducing the production of oestrogen. They're usually taken as an injection. The purpose of this treatment is to stop periods and see if the pain disappears. This will suggest that endometriosis is present.
Menopause-like side effects of GnRH analogues include hot flushes, vaginal dryness and low libido.
Sometimes low doses of hormone replacement therapy (HRT) may be recommended in addition to GnRH analogues to prevent these side effects.
They're only prescribed on a short-term basis – normally 3 months to a maximum of 6 months at a time. Your symptoms may return after treatment is stopped.
GnRH analogues aren't licensed as a form of contraception. You should still use contraception in the first month while taking GNRH analogues until they take full effect.
Examples of GnRH analogues include:
Progestogens, such as norethisterone, are synthetic hormones that behave like the natural hormone progesterone.
They work by slowing the growth of the lining of your womb and any endometriosis tissue.
But they can have side effects, such as:
- mood changes
- irregular bleeding
- weight gain
Progestogens are usually taken daily in tablet form.
Progestogen tablets aren't an effective form of contraception. You'll still need to use contraception while taking progestogen tablets if you don't want to get pregnant.
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. It's important to discuss these with your surgeon before undergoing treatment.
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.
Large incisions are avoided because the surgeon uses an instrument called a laparoscope. This is a small tube with a light source and a camera, which sends images of the inside of your tummy or pelvis to a television monitor.
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 won't feel any pain as it's carried out.
Although this kind of surgery can relieve your symptoms and can sometimes help improve fertility, problems can recur, as endometriosis is a chronic condition while the woman still menstruates.
Your surgeon may recommend taking a hormonal treatment after your surgery. Hormonal treatments are recommended for those with recurring endometrioma (chocolate cysts).
A hysterectomy may be recommended if you continue to have symptoms. Particularly after previous surgery showed severe endometriosis. Or if your doctor says you have adenomyosis or other sources of uterine issues.
A hysterectomy is a surgical procedure to remove the uterus (womb). You will not be able to have 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 GP or gynaecologist.
Hysterectomies cannot be reversed. There is no guarantee the endometriosis symptoms won't 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, the possibility of needing HRT afterwards should be discussed with you. But it's not clear what course of HRT is best for women who have endometriosis.
For example, oestrogen-only HRT may cause your symptoms to return if any endometriosis patches remain after the operation.
This risk is reduced by the use of a combined course of HRT (oestrogen and progesterone). But this can increase your risk of developing breast cancer.
The risk of breast cancer is not significantly increased until you've reached the normal age for the menopause. Talk to your doctor about the best treatment for you.
Like all types of surgery, surgery for endometriosis carries a risk of complications.
If surgery is recommended for you, speak to your surgeon about the possible risks before agreeing to treatment.
The more surgery you have the more likely that both complication and long term side effects can occur.
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)
Before having surgery, talk to your surgeon about the benefits and possible risks involved.
Bladder and bowel problems
Endometriosis affecting the bladder or bowel can be difficult to treat and may require major surgery.
You may be referred to a specialist endometriosis service if your bladder or bowel is affected.
Surgery for endometriosis in the bladder may involve cutting away part of the bladder.
A tube called a urinary catheter may be placed in your bladder to help you pee in the days after surgery.
In a few cases, you may need to pee into a bag attached to a small hole made in your tummy. This is called a urostomy and it's usually temporary.
Treatment for endometriosis in the bowel may involve removing a section of bowel.
Some women need to have a temporary colostomy while their bowel heals. This is where the bowel is diverted through a hole in the tummy and waste products are collected in a bag.
Content supplied by the NHS and adapted for Ireland by the HSE