Endometriosis - Treatment

There is no cure for endometriosis.

But treatment can help to:

ease and manage your symptoms, such as pain
slow the growth of endometriosis tissue
improve your fertility
reduce the chances of endometriosis or its symptoms coming back
improve your quality of life

Treatment may include:

medicines, such as painkillers and hormonal treatments
surgery

Most women with endometriosis will not need surgery to manage their symptoms.

Deciding on treatment

You can discuss treatment options with your doctor. They will explain the risks and benefits.

Deciding which treatment is right for you depends on your goals, preferences and situation.

Some things to consider include:

your age
if your main symptom is pain or difficulty getting pregnant
if you want to get pregnant - some treatments may stop you getting pregnant
how you feel about surgery
if you have tried any treatments before

You may not need treatment if your symptoms are mild. Most women find that they have fewer symptoms after menopause.

Medicines for endometriosis

You can treat endometriosis symptoms with medicines. Symptoms usually come back when you stop taking the medicines.

Pain medicine

Period pain that does not get better with regular painkillers (such as paracetamol and ibuprofen) may be a sign of endometriosis.

Tell your GP if you have been taking painkillers for a few months and you are still in pain. They may prescribe you stronger pain medicine or another treatment.

Hormonal treatment

Hormonal treatment can:

help control your symptoms
reduce bleeding and inflammation
reduce pain by stopping your periods

Some of the main hormonal treatments for endometriosis include:

the combined hormonal contraceptive pill, patch or ring
the progesterone-only pill
an intrauterine system that releases progesterone
an injection or implant that has progestogens (Provera or Depo Provera)
gonadotrophin-releasing hormone (GnRH) analogues (Decapeptyl or Zoladex)

All hormonal treatments have side effects. Your doctor will discuss the benefits and risks with you.

Most hormonal treatments are also contraceptives. This means they stop you getting pregnant while you are on the treatment. These treatments do not affect your fertility in the long term.

Surgery for endometriosis

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

Most women do not need surgery for endometriosis.

Your doctor may offer you surgery if:

you do not feel better after trying pain or hormonal medicines
your symptoms are severe
endometriosis is affecting other organs, such as your bladder or bowel (this is usually severe endometriosis)

Laparoscopy (keyhole surgery)

Surgery to treat endometriosis is usually a laparoscopy (keyhole surgery).

The surgeon makes small cuts (incisions) in your tummy to either:

remove all the endometriosis tissue or ovarian cysts (excision)
use heat to burn and destroy the endometriosis tissue or ovarian cysts (ablation)

A laparoscopy is done under general anaesthetic. You will be asleep and feel no pain during the surgery. Your surgeon will discuss the risks with you before the surgery.

The endometriosis tissue can grow again after surgery.

If you do not plan on getting pregnant, your doctor may recommend that you take a hormonal treatment after surgery. This is to prevent endometriosis coming back.

Find out if you can apply to get endometriosis surgery abroad through the Endometriosis Surgery Abroad Interim Scheme.

Hysterectomy

A hysterectomy is a major surgery to remove the uterus (womb). You cannot get pregnant after a hysterectomy.

Your doctor may recommend a hysterectomy if:

you still have symptoms
all other treatments have not helped

A hysterectomy on its own is not the first choice of treatment for managing endometriosis. A hysterectomy cannot be reversed.

Deciding to have a hysterectomy is a big decision. Discuss it with your doctor.

There is no guarantee that the endometriosis symptoms will not come back after the surgery. If your ovaries are left in place, endometriosis is more likely to return.

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

Surgery complications

Surgery for endometriosis has a risk of complications.

If your doctor recommends surgery, talk to them about the risks before you agree.

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

Some common complications are not usually serious.

For example:

a wound infection
minor bleeding
bruising around the wound

Less common, but more serious, complications include:

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

Where to get treatment for endometriosis

Where you get treatment for endometriosis depends on the stage of your endometriosis.

Minimal or mild endometriosis

Your GP or local gynaecology department will look after you if you have minimal (stage I) or mild (stage II) endometriosis.

Moderate endometriosis

If you have moderate endometriosis, you may get treatment at a regional specialist endometriosis centre. These centres have multidisciplinary teams who specialise in managing endometriosis.

There are 3 regional specialist endometriosis centres in Dublin and Limerick.

They are in:

Severe endometriosis

If you have severe (stage IV) endometriosis, you may be referred to a supra-regional specialist endometriosis centre.

There are 2 supra-regional specialist endometriosis centres.