Treatment

Endometriosis can be well treated and managed.

Referral to a centre with the necessary expertise to offer all available treatments in a multi-disciplinary holistic context, including advanced laparoscopic surgery is strongly recommended. click here for Centres of Excellence

In New Zealand, women can choose to consult a gynaecologist specialising in endometriosis privately without referral from a GP.  Payment for this would be a personal expense or fully or partly covered through private health insurance.  

New Zealand women are fortunate in that some gynaecologists specialising in endometriosis also consult in public hospitals.   A letter of referral from your GP is required.

The most suitable treatment for you will depend on many factors, including:

• your age
• the severity of the symptoms
• the extent of endometriosis as seen at laparoscopy
• whether you plan to have children
• other health issues
• your preference

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Surgical Treatment

Laparoscopic excision of endometriosis is the preferred and latest treatment aiming to improve quality of life, restore normal anatomy and improve fertility:

The objectives of surgery are to

• diagnose the presence of endometriosis
• remove or re-sect (excise or cut out) endometriosis lesions, nodules, cysts
• remove an endometrioma (chocolate cyst) from the ovary
• remove adhesions

Laparoscopy is preferred to an open operation through a larger incision on the bikini line (laparotomy) because:

• it reduces the risk of adhesions
• the laparoscope magnifies the endometriosis
• incisions are smaller, less painful and heal more quickly and are not as obvious
• recovery time is quicker

Laparoscopy for endometriosis is performed under general anaesthetic, often as a day hospital procedure.  It may be necessary to have an overnight or longer stay in hospital depending on the severity of endometriosis, the organs involved, other factors and the post-op recovery.   Sometimes another surgeon such as a colo-rectal surgeon may assist if the bowel is significantly involved for example.

A surgeon may undertake the surgery as a two-stage procedure for a variety of reasons which should be discussed with you. Sometimes the ovaries are sutured out of the way at the time of surgery to allow the pelvic side walls to heal if there has been a lot of endometriosis. When the sutures dissolve, the ovaries usually return spontaneously but surgeons often like to check this has happened particularly if fertility is still important to you.

More extensive surgery for severe endometriosis may be necessary. A hysterectomy on its own does not cure endometriosis.

It is important to discuss the benefits and risks of surgery. Smoking, diabetes and obesity and other medical problems cause greater risks and complications at surgery.

Medical Treatment

Drug therapy may be used in the management of endometriosis.

The contraceptive pill is often a first line treatment particularly for young women and girls presenting with symptoms suspicious of endometriosis.  It is sometimes recommended to take the pills continually for several months to stop periods.

Hormonal therapies aim to reduce the endometriosis by suppressing oestrogen production.  They can be effective in treating the pain particularly in less severe endometriosis. They may be used on their own or in combination with surgical treatment.  These hormonal treatments have possible side effects and some women find their endometriosis symptoms return after treatment stops.

Unfortunately there is no evidence that medical treatment improves fertility outcomes.

Anti-inflammatory medication may be used to reduce pain and inflammation.

Endometriosis New Zealand has information that explains how these drugs work and what the side effects may be.

To find out about surgical techniques and medical treatments best suited to you, talk to your GP or consult a specialist gynaecologist.  

ENZ has current and professionally produced resources which can help. 

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