Endometriosis

Treatment

Treatment depends on the how bad the symptoms are, the severity of the disease, the woman's desire to have children in the future, and her age.

Some women with mild disease and symptoms may just be monitored. It is important to maintain a regular schedule of examinations (every 6 to 12 months) to note any changes or to see if the disease has gotten worse.

Painkillers (analgesics) may be given to relieve pain.

Stopping the menstrual cycle creates a state resembling pregnancy (pseudopregnancy) and can help prevent the disease from getting worse. Pseudopregnancy can be created using oral contraceptives containing estrogen and progesterone. Women take the medicine consistently for 6 to 9 months. This type of therapy relieves most of the symptoms, but does not prevent scarring from the disease. Side effects include spotting of blood.

Hormonal therapy using progesterone medications are another effective treatment for endometriosis. Progesterone pills or injections can be used. However, side effects can be a problem for some women. The possible side effects include depression, weight gain, and spotting of blood.

Anti-gonadotropin drugs such as Synarel and Depo Lupron prevent the ovary from producing estrogen. Potential side effects of these drugs include menopausal symptoms (such as hot flashes), vaginal dryness, mood changes, and early loss of calcium from the bones.

Due to the effects on bone density, treatment of endometriosis with anti-gonadotropin drugs is usually limited to 6 months. Treatment can be extended up to 1 year if small doses of estrogen and progresterone are slowly given to reduce bone weakening and side effects.

Surgery (either laparoscopy or laparotomy) is usually only performed on women with severe endometriosis, including those with adhesions and infertility problems. The goal of surgery is to remove or destroy all of endometriosis-related tissue and adhesions, and restore the pelvic area to as close to normal as possible. In rare cases, nerve removal (neurectomy) may be performed during surgery to further relieve the pain associated with endometriosis.

Woman with severe symptoms or disease who do not want children in the future may have surgery to remove the uterus (hysterectomy), both ovaries, both fallopian tubes, and any remaining adhesions or endometriosis implants. Hormonal replacement therapy may be needed after removal of the ovaries.

Outlook (Prognosis)

How well surgery helps improve fertility depends on the severity of the endometriosis. Pregnancy rates after surgery in women previously considered to be infertile are approximately 75% for mild endometriosis, 50-60% for moderate cases, and 30-40% for severe cases.

Possible Complications

Infertility may result from endometriosis, but not in every patient -- especially if the endometriosis is mild. Endometriosis has been known to come back even after a hysterectomy. Other complications are rare. In a few cases endometriosis implants may cause blockages of the gastrointestinal or urinary tracts.

When to Contact a Medical Professional

Call for an appointment with your health care provider if symptoms of endometriosis occur, or if back pain or other symptoms come back after treatment of endometriosis.

Screening for endometriosis should be considered if your mother or sister has been diagnosed with endometriosis or if you are unable to become pregnant after trying for 1 year.

References

L Speroff, M Fitz. Clinical Gynecologic Endocrinology and Infertility. 7th ed. Lippincott Williams & Wilkins; 2004.

Hansen KA, Eyster KM. A review of current management of endometriosis in 2006: an evidence-based approach. S D Med. 2006 Apr;59(4):153-9.

Adamson GD, Pasta DJ. Surgical treatment of endometriosis-associated infertility: meta-analysis compared with survival analysis. Am J Obstet Gynecol. 1994 Dec;171(6):1488-504.