Endometriosis - Treatment

Highlights	Complications	Conservative Surgery
Introduction	Diagnosis	Hysterectomy
Causes	Treatment	Resources
Symptoms	Lifestyle Changes	References
Risk Factors	Medications

Treatment

To date, there is no perfect way of managing endometriosis. There are basically three approaches to the treatment of endometriosis:

Watchful waiting. (Treatments involve relieving symptoms.)
Hormonal therapy. (Aimed at reducing endometrial implants.)
Surgery. (Aimed at reducing endometrial implants, restoring fertility, or possible a cure.)

The choice depends on a number of factors including the woman's symptoms, her age, whether fertility is a factor, and the severity of the disease.

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Watchful Waiting

In general, watchful waiting is a good initial choice for the following:

Women with mild pain and, if infertile, they do not wish to become pregnant. If women with mild endometriosis wish to become pregnant, the doctor may recommend unprotected sex for six months to year. If pregnancy does not occur, then treatment may be started.
Women approaching menopause.

Some experts believe that early diagnosis and treatment in young women without symptoms might prevent some cases of infertility later on. Unfortunately, however, some treatments for endometriosis may actually trigger symptoms in those who do not yet experience them.

Hormonal Therapy

Hormone therapies are used to mimic states in which ovulation does not occur (such as pregnancy or menopause) or to directly block ovulation. Such agents include oral contraceptives, progestins, GnRH agonists, and danazol). They can by very effective in relieving endometriosis symptoms. Some of these drugs may also be used after surgery to help prevent recurrence of endometriosis. There is also some evidence that GnRH agonists and danazol may improve immune factors associated with endometriosis. But there are downsides:

None of these agents can cure the problem. Symptoms recur in about half of patients within five years of treatment.
They do not improve fertility rates and may even delay conception in women who use them.
Side effects of these drugs can be distressing. There is a high dropout rate with the use of nearly all these hormonal treatments.
Women who are taking GnRH agonists, danazol, or similar agents should use non-hormonal birth control methods (such as the diaphragm, cervical cap, or condoms) because these drugs can increase the risk for birth defects.

Surgery

Surgery is an option for the following women:

Women with severe pain that does not respond to watchful waiting and medical treatment.
Women who want to become pregnant and endometriosis is most likely the major contributor to infertility.