treatment

Treatment needs to be planned on an individual basis and tailored to each woman’s needs. Some patients are not able to have surgery or won’t want surgery while others will not tolerate various drug therapies. In some patients the treatment will be aimed at decreasing pain.

Cure Rates

  • Surgical treatment 70%
  • Drug treatment 40%
  • No treatment 20%

Drug Therapy

  • Side effects should be discussed prior to any drug therapy
  • Drug therapy is more effective in superficial or minor endometriosis rather than deep invasive endometriosis
  • It is often used prior to surgery and after surgery as it may make the surgery easier and more effective

Drugs

a) GnRH analogues reduce the production of oestrogen from the ovaries and create an artificial menopause. This has the same effects as the menopause (hot flushes, dry vagina, irritability, mild headaches). It also causes calcium loss from the bones (osteoporosis) so should only be used for about six months.
b) Progestogens act as anti-oestrogens and may cause weight gain, tiredness and depression. Provera and Primolut N are used in tablet form and Depo-provera can be sued as a 3-monthly injection.
c) Mirena (Intrauterine continuous release hormone device) used to treat heavy menstrual bleeding and pain. Also a form of contraception.
d) The Oral Contraceptive Pill contains oestrogen and it can be helpful when used continuously to stop periods and control symptoms.

Surgical Therapy

It is very important that any surgery is performed by a surgeon with special knowledge and skills in this type of procedure and that all of the endometriosis is treated properly.

In some cases of mild, superficial endometriosis the areas can be burnt off with diathermy (electro surgery). More severe forms of endometriosis must be removed. These include larger nodules of endometriosis that have attached themselves to other organs and tissues, or endometiomas of the ovary. This type of surgery is usually done Laparoscopically.

Hysterectomy and removal of the ovaries is occasionally required in cases of severe uncontrolled endometriosis. This operation is best performed through the laparoscope so that the whole pelvic cavity can be inspected properly and all endometriosis removed at the same time. Hysterectomy without removing the ovaries can be an option is some women but about a third of these women will later have to have the ovaries removed.

Laparoscopy

The only sure way to diagnose endometriosis is to see it through a laparoscope. A laparoscopy is a minor, relatively safe operation performed under anaesthesia in a hospital. A telescope with a camera attached is inserted into the abdomen through a small cut in the navel. The internal organs are inspected for signs of disease.

Treatment can be performed at the time of diagnosis if the disease is only mild to moderate. if the disease is severe, treatment may need to be planned at a later date allowing more time for unhurried laparoscopic surgery.

Al gynaecologists perform laparoscopies but not all gynaecologists are trained to diagnose all types of endometriosis and treat it expertly via the laparoscopic method. Some doctors believe that an open operation (laparotomy) is a more effective way of dealing with endometriosis but this is not correct.

Laparoscopy allows better vision because it gets closer to the area and can magnify it, making th surgery much more precise. It does require more specialised training but gives better results in terms of:
· Cure rates
· Smaller cut, less pain, less scarring
· Day surgery as opposed to prolonged hospital stay
· Less time of work

Summary

Endometriosis is a common and serious condition that deserves proper diagnosis and expert treatment that is tailored to the individual woman’s needs.