How can endometriosis be treated?
Medical treatment takes account of the dependence of endometriosis on sex hormones by reducing oestrogen levels or by creating a largely progestogenic or androgenic (Q 2.9) environment. It is not yet clear whether treatments designed to reduce menstrual flow exert their benefit by reducing the activity of the endometriotic deposits or by suppressing retrograde menstruation ( 6) and hence deposition of endometrial cells.
- Reducing menstrual flow by the combined oral contraceptive pill or with the LNG-IUS (Mirena) for example may be beneficial.
- Progestogens (Q33.10) or danazol can be prescribed daily for several months to suppress the menstrual cycle.
- Endometriosis tends to disappear after the menopause. A relatively new set of drugs called gonadotrophin releasing hormone analogues (GnRH –gonadotrophins) provide a temporary menopause like state and they have proven value in the treatment of endometriosis. They should usually be used for a maximum of six months at a time as there is concern that prolonged suppression of oestrogens may have an adverse effect on the bones and arteries. In some circumstances it may be appropriate to continue GnRH analogues in combination with add-back HRT therapy (Q 27.27).
- Exercise is associated with a reduction of oestrogen and sometimes helps.
- It is acceptable to provide a trial of medical treatment for presumed endometriosis without performing a diagnostic laparoscopy first (laparoscopy).
- Some gynaecologists treat endometriosis by laser or diathermy during laparoscopy. Studies are currently underway to compare the relative merits of GnRH analogues and laser therapy. Almost invariably, removing the ovaries will cure endometriosis and this may be the operation of choice combined with hysterectomy (hysterectomy) once your family has been completed.
- The relationship between endometriosis and pelvic pain is open to debate. It is a common observation that the severity of symptoms and the severity of the endometriosis do not correlate. Some with severe pain have just a few tiny spots of endometriosis whilst others with severe endometriosis may be symptom free. In a series of 33 patients having a second laparoscopy for persistent pelvic pain after laser therapy, more than half had no evidence of residual endometriosis. We should therefore be cautious in assuming that when endometriosis is discovered that it is necessarily the cause of pain. Failure of symptoms to respond to treatment may suggest that the endometriosis is not the cause of the pain rather than that the treatment of the endometriosis is not effective.
Guideline for treatment - ESHRE
Related Medical Abstracts - Click on the paper title:-
- Treatment strategies for endometriosis.(2008-01)
- Management of the pain associated with endometriosis: an update of the painful problems. (2006-01)
- Recurrence rate of endometriomas following a laparoscopic cystectomy. (2006-02)
- The role of the levonorgestrel-releasing intrauterine device in the management of symptomatic endometriosis. (2005-01)
- Comparison of a levonorgestrel-releasing intrauterine device versus expectant management after conservative surgery for symptomatic endometriosis: a pilot study. (0301-01)
- Modern combined oral contraceptives for pain associated with endometriosis. (2002-02)
- Use of a levonorgestrel-releasing intrauterine device in the treatment of rectovaginal endometriosis (2001)
- Post-operative GnRH analogue treatment after conservative surgery for symptomatic endometriosis stage III-IV: a randomized controlled trial. (2001-02)
- Long-term use of gonadotropin-releasing hormone analogs and hormone replacement therapy in the management of endometriosis: A randomized trial with a 6-year follow-up (2000).
- A gonadotrophin-releasing hormone agonist compared with expectant management after conservative surgery for symptomatic endometriosis. (1999)
- Low-dose danazol after combined surgical and medical therapy reduces the incidence of pelvic pain in women with moderate and severe endometriosis. (1999)
- Add-back therapy and gonadotropin-releasing hormone agonists in the treatment of patients with endometriosis: Can a consensus be reached? (1999)
- Randomized clinical trial of two laparoscopic treatments of endometriomas: cystectomy versus drainage and coagulation. (1998-02)
- Effectiveness of tibolone on hypoestrogenic symptoms induced by goserelin treatment in patients with endometriosis (1997).
- Progestins for symptomatic endometriosis: A critical analysis of the evidence (1997)Treatment of endometriosis with the antiprogesterone mifepristone (RU486) (1996-01).
- Prognostic application of magnetic resonance imaging in patients with endometriomas treated with gonadotrophin-releasing hormone analogue (1996-02).
- The need for add-back with gonadotrophin-releasing hormone agonist therapy (1996-03).
- Laparoscopy versus laparotomy in conservative surgical treatment for severe endometriosis (1996-04).
- Comparison of the gonadotropin-releasing hormone agonist goserelin acetate alone versus goserelin combined with estrogen-progestogen add-back therapy in the treatment of endometriosis (1995).
- Gonadotropin-releasing hormone analogue (goserelin) plus hormone replacement therapy for the treatment of endometriosis: A randomised controlled trial (1995).
- A multicentre comparative study of gestrinone and danazol in the treatment of endometriosis (1995)
- Endoscopic versus laparotomy management of endometriomas (1994)
-
Very low dose danazol for
relief of endometriosis-associated pelvic pain: a pilot study (1994)
Please click on the required question.
- 1 Pelvic Pain. Is this a common problem?
- 2 What are the common causes of pelvic pain in women?
- 3 What are the more common gynaecological causes of pelvic pain?
- 4 What are the more common non-gynaecological causes of pelvic pain?
- 5 What are primary and secondary dysmenorrhoea - painful periods?
- 6 What is retrograde menstruation?
- 7 How can dysmenorrhoea - painful periods be treated?
- 8 What are ovarian cysts?
- 9 How do ovarian cysts cause pain?
- 10 How are ovarian cysts diagnosed?
- 11 How are ovarian cysts treated?
- 12 I think I may be pregnant and I have some pelvic pain. What should I do?
- 13 What is pelvic inflammatory disease and how can it be treated?
FIBROIDS
- 14 What are fibroids?
- 15 I have fibroids. What difficulties might they cause for me?
- 16 How are fibroids diagnosed?
- 17 How could my fibroids be treated?
ENDOMETRIOSIS
- 18 What is endometriosis?
- 19 How prevalent is endometriosis?
- 20 What causes endometriosis?
- 21 How can my endometriosis be treated?
- 22 How can my doctor determine the cause of my pelvic pain?
- 23 What investigations might be recommended by my gynaecologist to investigate my pelvic pain?
- 24 What is laparoscopy?
- 25 What are pelvic adhesions?
- 26 I have chronic pelvic pain. Could this be related to adhesions?
- 27 What is uterine retroversion (retroverted uterus)
- 28 Does a retroverted uterus cause symptoms?
- 29 How is a retroverted uterus treated?
- 30 What is pelvic congestion?
- 31 What causes pain associated with sexual intercourse (dyspareunia)
- 32 How can painful sexual intercourse (dyspareunia) be treated?
- 33 What is a pelvic mass?
IRRITABLE BOWEL SYNDROME - IBS
- 34 What is irritable bowel syndrome?
- 35 How can we find out if I have irritable bowel syndrome?
- 36 Is irritable bowel syndrome (IBS) a common condition?
- 37 What causes IBS?
- 38 What is the pain associated with IBS like?
- 39 Can IBS be mistaken for gynaecological problems?
- 40 How can my IBS be treated?
- 41 What other treatments are available for IBS?
- 42 What can be done to reduce the amount of bowel gas(flatus)
- 43 What is constipation?
- 44 What causes constipation?
- 45 How can constipation be treated?
- 46 How could we summarise the treatments that are available for my pelvic pain?
- 47 Where can I obtain more information?
- 48 Support Groups.
Thank you for choosing to visit us.
This is the personal website of David A Viniker MD FRCOG, Consultant Obstetrician and Gynaecologist at Whipps Cross University Hospital, London - Specialist Interests - Reproductive Medicine including Infertility, PCOS, PMS, Menopause and HRT.
I do hope that you find the answers to your women's health questions in the patient information and medical advice provided.
