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Endometriosis can be difficult to treat. The aim of treatment is to ease theÂ symptoms so that the condition does not interfere with your daily life.
Therefore, treatment will be given to relieve pain, slow the growth of endometriosis,Â improveÂ fertility or prevent the disease from coming back.Â The options areÂ pain medication,Â hormone treatment and surgery.
Deciding which treatment
Your gynaecologistÂ will discuss the treatment options with you and outline the risks and benefits of each.
In deciding which treatment is right for you, you may wish to consider:
- your age
- whether your main symptom is pain or difficulty getting pregnant
- whether you want to become pregnant (some treatments may stop you getting pregnant)
- how you feel about surgery
- whether you have tried any of the treatments before
Treatment may not be necessary if your symptoms are mild and you have no fertility problems. In about one-third of cases, endometriosis gets better by itself without treatment.
It is possible to keep an eye on symptoms and decide to have treatment if they get worse. Support from self-help groups can be veryÂ useful if you are learning to manage endometriosis.
Non-steroidal anti-inflammatories (NSAIDs), such as ibuprofen and naproxen, are usually the preferred treatment as they act against the inflammation (swelling) caused by endometriosis, as well as helping to ease pain and discomfort. It is best to take NSAIDs the day before (or several days before) you expect the period pain.
Paracetamol can be used to treat mild pain. It is not usually as effective as NSAIDs, but may be used if NSAIDs cause any side effects, such as nausea, vomiting and diarrhoea.
Codeine is a stronger painkiller that is sometimes combined with paracetamol or used alone if other painkillers are not suitable. However, constipation is a common side effect, which may aggravate the symptoms of endometriosis.
For more information, read the Endometriosis UK factsheet on pain management for endometriosis.
Hormone treatments aim to limit or stop the production of oestrogen in your body. This is becauseÂ oestrogenÂ encourages endometriosis to grow and shed. Without exposure to oestrogen, the endometriosis tissue can be reduced,Â which helps to ease your symptoms. However, hormone treatmentÂ has no effect onÂ adhesions ('sticky' areas of endometriosis, which can cause organs to fuse together, seeÂ Complications of endometriosis for more information) and cannot improve fertility.
Hormone treatments stop the production of oestrogen by putting you in either an artificial state of pregnancy or an artificial state of menopause, which stops your periods.
Once your periods have stopped, the endometriosis is no longer aggravated. However, it is important to note thatÂ most ofÂ these treatments are not contraceptives.
There are four broad types of hormone-based treatment:
- the combined oral contraceptive pill
- gonadotrophin-releasing hormone (GnRH) analogues
ProgestogensÂ are synthetic hormones that behave like the natural hormone progesterone.Â TheyÂ stop eggs from beingÂ released (ovulation), which can help to shrink endometriosis tissue. However, they can have side effects such as bloating, mood changes, irregular bleeding and weight gain.
Drug names include medroxyprogesterone acetate, dydrogesterone and norethisterone.
The Mirena intrauterine system, a T-shaped contraceptive device that fits into the womb and releases progestogen, has been successfully used for the treatment of endometriosis (seeÂ Health A-Z: intrauterine system for more information).
Also known as testosterone derivatives, antiprogestogensÂ are synthetic hormones that bring onÂ an artificial menopauseÂ by decreasing the production of oestrogen and progesterone. Side effects can include weight gain, acne, mood changes and the development of masculine features (hair growth and deepening voice).
Drug names include danazol and gestrinone. Gestrinone has fewer unpleasant side effects.
The combined oral contraceptive pill
The combined contraceptiveÂ pill contains the hormones oestrogen and progestogen. Although it is not officially licensed for the treatment of endometriosis,Â the pillÂ can help relieve milder symptoms and can be taken over long periods of time. It stops the function of the ovaries, which in turn stops the menstrual cycle.
The pill can have side effects, but you canÂ try different brands until you find one that suits you.
For more information, see Health A-Z: the pill.
Gonadotrophin-releasing hormone (GnRH) analogues
Like antiprogestogens, GnRH analogues are synthetic hormones that cause an artificial menopause. They are taken as a nasal spray, implant or injection and work in a similar way to gonadotrophin-releasing hormone (a natural female hormone).
When you take GnRH analogues continuously for over two weeks, the production of oestrogen is stopped. They often have side effects such as hot flushes, vaginal dryness and low libido, so they are recommended alongside HRT (hormone replacement therapy), which is usually used to reduce the symptoms of menopause.
Drug names include buserelin, goserelin, nafarelin, leuprorelin and triptorelin.
Surgery can be used to remove or destroy areas of endometriosis tissue, which can help improve symptoms and fertility. The kind of surgery you have will depend on where the tissue is.Â The options are:
- laparoscopic surgery (the most commonly used and least invasive technique)
AnyÂ surgical procedure carries risks.Â DiscussÂ them withÂ your surgeon.
During a laparoscopy (a surgical procedure to gain access to the inside of your pelvis), endometriosis tissue can beÂ destroyed or cut out using delicate instruments that are inserted into the body. This is also known as keyhole surgery.
Laparoscopy is now commonly used to diagnose and treat endometriosis. All grades of endometriosis can be successfully treated with this minimally invasive technique (where only small cuts are needed to insert the instruments). Heat, a laser or an electric current may be applied to destroy the patches of tissue.
Endometriomas (ovarian cysts formed as a result of endometriosis) can also be easily treated using this technique, whichÂ can be used alongside medication such as GnRH analogues.
Although this kind of surgery can relieve your symptoms, they can sometimes recur, especially if some endometriosis tissue is left behind at the time of surgery.
This is major surgery that is used if your endometriosis is severe and extensive.Â Recovery time is longer than that for keyhole surgery. The surgeon makes a wide cut around your bikini line and opens up the area to access the affected organs and remove the endometriosis tissue.
If keyhole surgery and other treatments have not worked and you have decided not to have any more children, a hysterectomy (removal of the womb) can be an option (see Health A-Z: hysterectomy). However, this is rarely required.
A hysterectomy is a major operation that will have a significant impact on your body. Deciding to have a hysterectomy is a big decision, which you should discuss with your GP or gynaecologist. Hysterectomies cannot be reversed and there is no guarantee that the endometriosis will not return after the operation.
If the ovaries are left in place, the endometriosis is more likely to return.view information about Endometriosis on www.nhs.co.uk »
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