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Treatment

Treatment of endometriosis should be individualised due to the complexity and severity of the disease. Factors such as age, symptoms, severity of symptoms, previous treatment history, fertility plan, ovarian reserve, location of endometriosis, response to hormonal treatment should be taken into account. Talking with endometriosis specialists will help find a solution suitable for you.

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HORMONAL TREATMENTS

Hormonal treatments are used to manage endometriosis by suppressing estrogen levels. Long-term usage of medical treatment can reduce endometriosis-related pain symptoms.

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There are several types of medications that act by shrinking the lining of the uterus and the endometriotic lesions:

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  • Progestins/progesterone

  • Oral contraceptive pills

  • GnRH-analogues

  • LNG-IUS

 

Unfortunately, hormonal therapy has various degree of side effect. Doctors need to balance the benefit and risk based on your personal history and condition before deciding to prescribe hormonal medication.

 

SURGERY

Laparoscopic surgery is the only definitive way to diagnose endometriosis, and in most cases the disease can be diagnosed and treated in the same procedure. Laparotomy is seldom used in endometriosis these days.

 

The success of surgery is, however, surgeon dependent, so do try to find someone who is experienced in the surgical removal of endometriosis.

 

Endometriosis surgery can be complex and difficult, and surgeons need specialized skills and expertise to perform these operations. Many gynecologists have the expertise to treat minimal endometriosis. However, experienced specialist surgeons are needed for more severe endometriosis, and only a limited number of gynecologists have the expertise to treat very severe endometriosis.

 

SURGICAL TECHNIQUES 

Endometrial implants can be treated using two techniques:

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  • Excision

  • Coagulation

 

Excision removes endometrial implants by cutting them away from the surrounding tissue with scissors, a very fine heat gun or a laser beam.

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The technique does not damage the implants, so the gynecologist is able to send a biopsy of the excised tissue to the pathologist to confirm that it is endometriosis and not cancer or another condition. Excision allows the gynecologist to separate the implants from the surrounding tissue, thus ensuring that the entire implant is removed and no endometrial tissue is left.

 

Coagulation destroys implants by burning them with a fine heat gun or vaporizing them with a laser beam.

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When coagulating implants, care must be taken to ensure that the entire implant is destroyed, so it cannot regrow.  Care must also be taken to ensure that only the implant is destroyed, and no underlying tissue, such as the bowel, bladder or ureter, is damaged. The possibility of accidentally damaging the underlying tissue means that most gynecologists are wary of using coagulation on implants that lie over vital organs, such as the bowel and large blood vessels.

 

WHICH TECHNIQUE?

Of the two techniques, excision is more effective, requires more skill, and is more time consuming. The skill and time required means that it is not used by all gynecologists. If your gynecologist does not have the skill to excise all your endometriotic implants, ask to be referred to a gynecologist who specializes in endometriosis surgery and is skilled in excision.

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