There is no cure forendometriosis and it can be difficult to treat. Treatmentaims to ease symptoms so the condition doesn't interfere with your daily life.
Treatment will be given to:
Your gynaecologist will discuss the treatment options with you and outline the risks and benefits of each.
When deciding which treatment is right for you, there are several things toconsider, including:
Treatment may not be necessary if your symptoms are mild, you have no fertility problems, or if you're nearing the Testosterone deficiency (hypogonadism) , when symptoms may get better without treatment.
Endometriosis gets better by itself without treatment in about 3 in every 10 cases, but it becomes worse without treatment in about 4 in every 10 cases. One course of action is to keep an eye on symptoms and decide to have treatment if they get worse.
Support from self-help groups, suchas Endometriosis SHE Trust UK and Endometriosis UK ,can be very useful if you're learning how to manage the condition.
Non-steroidal anti-inflammatories (NSAIDs) , such as ibuprofen and naproxen,are usually the preferred painkiller used to treat the pain associated with endometriosis.
This is because they act against the swelling(inflammation) caused by the condition, which may help ease pain and discomfort. It's best to take NSAIDs the day before or several days beforeyou expect the period pain.
Paracetamol can be used to treat mild pain. It's not usually as effective as NSAIDs, but may be used ifthese types of drugscause any side effects, such as nausea, vomiting and diarrhoea .
Codeineis a stronger painkiller that's sometimes combined with paracetamol or used alone if other painkillers aren't suitable. However, constipation is a common side effect, which may aggravate the symptoms of endometriosis.
For more information, read theEndometriosis UK factsheet on painrelief for endometriosis .
The aim of hormone treatment is to limit or stop the production of oestrogen in your body. This is because oestrogen encourages endometriosis tissue to grow and shed. Without exposure to oestrogen, the endometriosis tissue can be reduced, which helps ease the symptoms.
However, hormone treatment has no effect on adhesions "sticky" areas of tissue that can cause organs to fuse togetherand can't improve fertility.
Although most hormone treatments reduce your chance of pregnancy while using them, only the contraceptive pill or patch and LNG-IUS are licensed to be used as contraceptives.
Progestogens and antiprogestogens are used less commonly these daysas they often cause unpleasant side effects.
The combined contraceptive pill and contraceptive patch contain the hormones oestrogen and progestogen.They can help relieve milder symptoms and can beused over long periods of time. They stop eggs being released (ovulation) and make periods lighter and less painful.
These contraceptives can have side effects, but you can try different brands until you find one that suits you. Your doctor may recommend taking three packs of the pill in a row without a break to minimise the bleeding and improve any symptoms related to the bleeding.
The Mirenalevonorgestrel-releasing intrauterine system (LNG-IUS) is a T-shaped contraceptive device that fits into the womb. It releases a type of progestogen hormone called levonorgestrel.
This hormoneprevents the lining of your womb growing quickly, which canhelp reduce pain and greatly reduces or even stops periods.
The device is put intothe womb by a doctor or nurse. Once in place, it can remain effective for up to five years.
Possible side effects of using LNG-IUS include irregular bleeding that may last more than six months, breast tenderness and acne .
Learn more about the IUS .
GnRH analogues are synthetic hormones that bring on a temporary artificial menopause by reducing the production of oestrogen. They're usually taken as a nasal spray or injection.
Menopause-like side effects of GnRH analogues include hot flushes, vaginal dryness and low libido . Sometimeslow doses of hormone replacement therapy (HRT) may be recommended in addition to GnRH analogues to prevent these side effects.
They're only prescribed on a short-term basis (normally a maximum of six months at a time) and your symptoms may return after treatment is stopped.
GnRH analogues aren't licensed as a form of contraception, so you should still use contraception in the first month while taking them until they take full effect.
Examples of GnRH analogues include:
Progestogens, such asnorethisterone,are synthetic hormones that behave like the natural hormone progesterone. Theywork by preventing the lining of your womb andany endometriosis tissue growing quickly.
However, they have side effects such as:
Progestogens areusually taken daily in tablet form from days 5 to 26 of your menstrual cycle, counting the first day of your period as day one.
Progestogen tabletsaren't an effective form of contraception,so you'll still need to use contraception while taking them if you don't want to get pregnant.
Also known as testosterone derivatives, antiprogestogens are synthetic hormones that work in a similar way to GnRH analogues. They bring on a temporary artificial menopause by decreasing the production of oestrogen.
Side effects ofantiprogestogenscan include:
These side effects are often severe and alternative medications are more effective. This means antiprogestogens are usually only prescribed as a last resort if other medications haven't worked.
Like GnRH analogues, antiprogestogens are usually only prescribed for a maximum of six months at a time. Examples of antiprogestogens include danazol and gestrinone.
Surgery can be used to remove or destroy areas of endometriosis tissue, which can help improve symptoms and fertility. The kind of surgery you have will depend on where the tissue is. The options are:
Any surgical procedure carries risks. It's important to discuss these with your surgeon before undergoing treatment.
Laparoscopy, also known as keyhole surgery, is a common procedure used to treat endometriosis. Small cuts (incisions) are made in your tummy so theendometriosis tissue can be destroyed or cut out.
Large incisions can be avoided because the surgeon uses an instrument called a laparoscope. This is a small tubewith a light source and a camera, which relays images of the inside of your tummy or pelvis to a television monitor.
During laparoscopy, fine instruments are used to apply heat, a laser, an electric current (diathermy) or a beam of special helium gas to the patches of tissue to destroy or remove them.
The procedureis carried out under general anaesthetic , so you'll beasleep and won't feel any pain as it's carried out.
Ovarian cysts ,or endometriomas, which are formed as a result of endometriosis, can also be removed using this technique.
Although this kind of surgery can relieve your symptoms and has been shown to improve fertility, problems can sometimes recur, especially if some endometriosis tissue is left behind.
A laparotomy is a moreinvasiveoperation used if your endometriosis is severe and extensive, or if some of your organshave fusedtogether.
During the procedure, the surgeon makes a wide cut along the bikini line and opens up the area to access the affected organs and remove the endometriosis tissue.
Recovery time for this type of surgery is longer than for keyhole surgery.
If keyhole surgery and other treatments haven't worked and you've decided not to have any more children, a hysterectomy (removal of the womb) can be an option. However, this is rarely required.
A hysterectomy is a major operation that will have a significant impact on your body. Deciding to have a hysterectomy is a big decision that you should discuss with your GP or gynaecologist.
Hysterectomies can't be reversed and, though unlikely, there's no guarantee the endometriosis symptoms won't return after the operation. If the ovaries are left in place, the endometriosis is more likely to return.
If your ovaries are removed during a hysterectomy, the possibility of needing HRT afterwards should be discussed with you. However, it'snot clear what course of HRT is best for women who have endometriosis.
For example, oestrogen-only HRT may cause your symptoms to return if any endometriosis patches remain after the operation. This risk is reduced by the use of a combined course of HRT (oestrogen and progesterone), but this can increase your risk of developing breast cancer .
However, the risk of breast cancer isn't significantly increased until you've reached the normal age for the menopause. Talk to your doctor about the best treatment for you.
Endometriosis is a common condition where small pieces of the womb lining (the endometrium) are found outside the womb.
The exact cause of endometriosis is unknown, but there are several theories.
Endometriosis can be difficult to treat. The aim of treatment is to ease the symptoms.