Treatment of endometriosis

Treatment - Surgical, Medical

Until the cause of endometriosis is determined, no particular treatment will provide a guaranteed cure.

A multi-disciplinary holistic approach is considered best practice treatment, which can include surgical, medical and management options. In recent times gynaecologists specialising in endometriosis are favouring surgical resection of disease as the gold standard treatment sometimes combined with medical therapy. A referral to a gynaecologist who has a special understanding and skill in treating pelvic pain and endometriosis is recommended.

Choosing the most suitable treatment will depend on many factors including:

• your age

• the severity of your symptoms

• whether you plan to have children

• the extent of endometriosis

• your preference

All treatment options should be explored so that a long term individualised treatment plan can be arranged. Unfortunately endometriosis is known to recur and repeat treatment procedures are sometimes necessary.

In New Zealand, you can access an appointment with a gynaecologist by getting your GP to refer you to the DHB in your area.  If you have private health insurance you can refer yourself to a specialist gynaecologist by directly making an appointment.  However, a letter of referral from your GP is recommended.

Surgical Treatment 

Laparoscopic surgery is the only definitive way to diagnose endometriosis which is usually removedat the same time. A laparoscopy is key hole surgery where a laparoscope is inserted through a small incision at the base of the navel so the internal organs can be seen.

The extent of the disease is generally noted at this time as mild, moderate or severe, or stage (grade) I - IV. The success of surgery depends greatly on the skill of the surgeon and the thoroughness of the surgery. The aim is to remove all endometriosis lesions, cysts, and adhesions and restore normal anatomy. As with all surgery there is an element of risk which should be discussed with you and of course your consent must be in written form.  Sometimes it can take weeks or even months to feel the benefits of surgery. Give yourself that healing time and work with your doctor to ensure the best outcomes.

Hysterectomy
This procedure removes the uterus and cervix and is sometimes recommended in severe cases of long-standing painful and extensive endometriosis or adenomyosis. Removal of one or both ovaries (oophorectomy) may be considered at the same time if they have been damaged with endometrioma but this can have long term consequences. If both ovaries are removed, symptoms of menopause will usually be experienced immediately or very soon after surgery which can be quite extreme in a surgically induced menopause. Hormone Replacement Therapy (HRT) is usually recommended and will be dependent on factors such as age, medical history and personal choice. 

While the symptoms of endometriosis are often eliminated or helped by hysterectomy, it does not ‘cure’ endometriosis.  If a hysterectomy is performed, it is essential that the endometriosis is removed as well to help prevent the symptoms continuing. If radical surgery is recommended, gather all the medical facts and thoroughly explore your personal feelings.  Discuss the different types of hysterectomy with a specialist and what surgical procedure would be best suited to you.

Sometimes symptoms persist even after major surgery and will require thorough review to find the cause.  
 

Medical Treatment

Medications may be used in the management of endometriosis. Here’s some commonly used medications:

• Oral contraceptives (the pill) are often prescribed for you to try first if it’s appropriate. The pill can be used effectively to relieve symptoms and regulate periods. The pill can also mask the symptoms of endometriosis and is not a diagnosis.  It’s important to work with your doctor to find the pill that is best suited to you. Depo Provera may also be offered (the injections).
• Hormonal medications aim to reduce the growth of endometriosis by suppressing oestrogen production. Sometimes these drugs are used in conjunction with surgery to ‘dampen down’ active endometriosis. Hormonal medications can have significant side effects with questionable long term benefits. Therefore it is important to understand how they work so you can make informed choices. Some of these medications include:

Injections like Zoladex (GnRH)

Pills like Provera

Intrauterine device or system (IUS) is often used to treat heavy bleeding, can lessen the
symptoms of endometriosis and reduce the likelihood of recurrence of endometriosis.
It can be left in place for us to five years giving long term relief.

• Many pain medications are available without prescription and advice should be sought from a pharmacist to ensure the brand you are buying is going to give you the best relief for your type of pain. Sometimes combinations of drugs (e.g. an anti-inflammatory and a pain killer taken together) can be very effective but it is crucial that you seek expert advice from your doctor or specialist.
• Natural painkillers such as magnesium can relieve pain. Follow the guidance of a medical herbalist or natural health practitioner.

Unfortunately there is no evidence that medical treatment for endometriosis improves fertility outcomes but they can improve symptoms.

More specific information on medications commonly used and the side effects can be found in the book “Endometriosis and Pelvic Pain” or contact us. It’s important to ask your doctors about all medications prescribed.

Contact ENZ for more information on the treatment and management of endometriosis