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:-

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This is the personal website of David A Viniker MD FRCOG, retired Consultant Obstetrician and Gynaecologist - 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.

I do hope that you find the answers to your women's health questions in the patient information and medical advice provided.

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