Treatment of Endometriosis

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Treatment for endometriosis is aimed at easing the symptoms so that the condition does not interfere with your daily life. There is no known cure for endometriosis.

Not treating at all is an option if the symptoms are mild and there are no problems with subfertility of infertility. In about a third of cases, endometriosis gets better by itself without treatment. It is also possible to keep an eye on the symptoms and decide to have treatment if they get worse.

Drug treatments

Pain killers:

Non-steroidal anti inflammatory (NSAIDS) are usually the preferred treatment, as they act against the inflammation caused by endometriosis as well as helping ease pain and discomfort. Examples are ibuprofen and naproxen.
Paracetamol is sometimes used as an alternative. It is not usually as effective as NSAIDS, but may be used if NSAIDS cause any side effects
Codeine is a stronger pain killer that is sometimes combined with paracetamol or used alone if other pain killers are not suitable. Constipation is a common side-effect

Hormone treatments:

Hormone treatments aim to stop egg release (ovulation). This encourages the endometrial tissue to shrink and this helps to reduce the symptoms. In some cases, they may eventually disappear. In effect the treatment stops your periods. There are four broad types of hormone-based treatment:

Progestogens: these drugs stop egg release and help to shrink endometrial tissue. They sometimes have unpleasant side effects such as bloating, mood changes, irregular bleeding and weight gain. Drug names include medroxyprogesterone acetate, dydrogesterone, and norethisterone.
Antiprogestogens: these drugs create an effect similar to after the menopause. They can have unpleasant side effects including weight gain, acne, mood changes and the development of masculine features (hair growth and deepening voice). Drug names include danazol and gestrinone; gestrinone is known to have fewer unpleasant side effects
Combined oral contraceptive pill: Although not officially licensed for the treatment of endometriosis, it can help to relieve symptoms and can be taken indefinitely
Gonadotrophin-releasing hormone (GnRH) analogues: this is a group of drugs that create an effect similar to after the menopause. They often have unpleasant side effects similar to the menopause such as hot flushes, difficulty sleeping, vaginal dryness, low libido, and headaches and reduced bone mineral density (â€˜thinning' bones). For this reason they can only be used for relatively short periods of time (6 months). Drug names include buserelin, goserelin, nafarelin, leuprorelin, and triptorelin.

Surgery

Surgery can be used to remove areas of endometrial tissue and this can help with the symptoms. This kind of surgery will depend on where the tissue is. Often it is carried out as â€˜keyholeâ€™ surgery during a laparoscopy and may include the use of laser surgery techniques. This type of surgery is sometimes called â€˜conservativeâ€™ surgery as it has a smaller impact on your body and the operations are generally minor.

If other treatments have not worked and if you have decided not to have any more children, then a hysterectomy (removal of the womb) is an option. Sometimes this includes removal of the ovaries too (Oophorectomy). Generally, this is considered to be a â€˜last resortâ€™ treatment and there is evidence that, even after this operation, endometriosis can come back. Hysterectomy and Oophorectomy are sometimes called â€˜radicalâ€™ surgery as they are major operations that will have a significant impact on your body.

Support from self-help groups can be very helpful if you are learning to manage endometriosis.