Table of Contents
Hormonal therapies are used to mimic states in which ovulation does not occur (such as pregnancy or menopause) or to directly block ovulation. Hormonal drugs include oral contraceptives (a first-line treatment), progestins, GnRH agonists, and (rarely) danazol. They can be very effective in relieving endometriosis symptoms, especially pain. Some of these drugs may also be used after surgery to help prevent recurrence of endometriosis. Downsides of these drugs include:
- None of these drugs can cure the problem. Symptoms recur in about half of patients within 5 years of treatment.
- They do not improve fertility rates and may delay conception.
- Side effects of some of these drugs can be distressing.
- Women who take GnRH agonists, danazol, or similar drugs should use non-hormonal barrier 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 women who:
- Have severe pain that does not respond to watchful waiting and medical treatment.
- Want to become pregnant and endometriosis is most likely the major contributor to infertility.
There are two basic surgical approaches for endometriosis:
- Conservative Surgery (Laparoscopy or Laparotomy). Conservative surgery uses minimally invasive laparoscopy, or sometimes laparotomy (conventional “open” surgery through normal incision), to remove the endometriosis implants without removing any normal tissue or reproductive organs. It is a good option for women who wish to become pregnant or who cannot tolerate hormone therapy. Endometriosis often recurs after conservative surgery, however. The risk for recurrence or residual pain after any procedure increases with the severity of the condition, particularly if endometriosis has affected areas outside the uterus.
- Radical Surgery (Hysterectomy). Hysterectomy offers the best option for either a cure or more significant control of the problem. Younger patients can often have only a hysterectomy while leaving one or both of their ovaries intact. However, if endometriosis has developed outside the uterus then even this procedure is not curative. Removing only the uterus with hysterectomy has the same risk for recurrence as conservative surgery. Removing both ovaries (bilateral oophorectomy) along with the uterus is the only potential cure for endometriosis.
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Click the icon to see an illustrated series detailing hysterectomy. |
In choosing between hysterectomy (with or without removal of the ovaries) and conservative surgeries, age and the desire for children are important factors.
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Review Date: 07/26/2010
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine,
Harvard Medical School; Physician, Massachusetts General Hospital.
Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M.,
Inc.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org)
