There are different ways of managing the symptoms and the disease. The type of treatment you choose should be decided upon in partnership with your consultant. The decision will depend on your individual circumstances including your age, the severity of your symptoms, your desire to have children, the severity of the disease, previous treatment, your priorities – pain relief or fertility, side effects of drugs, risks and intended duration of treatment.
Types of treatment include:
- Hormone treatment
- Pain management
- Complementary therapies
- Emotional support
You should be as informed as you can about possible treatments for endometriosis, so you can choose a route that is right for you. This may include several types of treatment, such as hormone treatment (e.g. GnRh analogues such as Zoladex) followed by surgery. Many women also use complementary therapies for relief. Endometriosis affects women differently and therefore treatment options that work for others may not necessarily be right for you; it can take time to work out the right treatment. Working with your consultant, GP and hospital team and being honest about what you want to achieve (e.g. is pain relief or fertility the main priority) will be very helpful.
Surgical treatment of endometriosis involves removing or destroying the endometriosis tissue in an attempt to ease symptoms such as persistent pelvic pain, painful intercourse and painful periods, and increase the chance of pregnancy if infertility is an issue. Surgery can either be conservative or radical (removal of the uterus and fallopian tubes with or without both ovaries).
Incomplete removal may result in the endometriosis recurring and the symptoms persisting. In case of an endometriotic (Chocolate)ovarian cyst (also called endometrioma), the surgical approach associated with less recurrence is the drainage and excision of the cyst. Conservative surgery is associated with 20-40% risk of recurrence. The risk of recurrence after hysterectomy only is 15-25% whilest removal of both ovaries reduces the risk to 0-4%.
Laparoscopic (keyhole) treatment of pelvic endometriosis is generally the preferred approach as recovery is quicker. Often the management of advanced endometriosis requires a multidisciplinary approach including a colorectal surgeon and an urologist.