Endometriosis - Treatment

Treatment

There is no perfect way of managing endometriosis. The three basic treatment approaches are:

• Watchful waiting (to relieve symptoms)
• Hormonal therapy (to reduce the size of endometrial implants)
• Surgery (to reduce endometrial implants, restore fertility, or possibly cure the condition)

The choice depends on a number of factors, including the woman's symptoms, her age, whether fertility is a factor, and the severity of the disease.

Watchful Waiting

Delaying treatment may be most appropriate for women with mild endometriosis or those who are approaching the age of menopause.

Women may also use lifestyle modifications, such as exercise and relaxation, to cope with their pain. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil) and naproxen (Aleve), or acetaminophen (Tylenol), can help provide some pain relief.

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Hormonal Therapy

Hormonal therapies are used to mimic states in which ovulation does not occur (such as pregnancy or menopause) or to directly block ovulation. Hormonal drugs include oral contraceptives (a first-line treatment), progestins, GnRH agonists, and (rarely) danazol. They can be very effective in relieving endometriosis symptoms, especially pain. Some of these drugs may also be used after surgery to help prevent recurrence of endometriosis. Downsides of these drugs include:

• None of these drugs can cure the problem. Symptoms recur in about half of patients within 5 years of treatment.
• They do not improve fertility rates and may delay conception.
• Side effects of some of these drugs can be distressing.
• Women who take GnRH agonists, danazol, or similar drugs should use non-hormonal barrier birth control methods (such as the diaphragm, cervical cap, or condoms) because these drugs can increase the risk for birth defects.

Surgery

Surgery is an option for women who:

• Have severe pain that does not respond to watchful waiting and medical treatment.
• Want to become pregnant and endometriosis is most likely the major contributor to infertility.

There are two basic surgical approaches for endometriosis: