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If you are suffering from endometriosis-associated symptoms then you probably should be treated. Treatment approaches ought to be tailored to your specific situation. Treatment breaks down into medical treatment and surgical treatment. All treatments should take into consideration whether you are currently trying to become pregnant or not.

As endometriosis proceeds individually you and your attending physician will plan your treatment based on your prevailing symptoms, symptom severity, disease location and extent. Important factors for the choice of your treatment are your age, a potentially present wish to have children, your symptoms or contraindications for specific medications.

As endometriosis comes with a variety of symptoms from pelvic pain, pain during bowel movement or opening, pain during passing urine to in rare cases difficulties while breathing etc. You as well as other patients may present with a variety of symptoms relating to your medical condition which you will address with your attending physician in detail to work on improvement of those.

Algorithm for management of endometriosis-associated pain

Medical Treatment

Your doctor may decide with you to assume that you may have endometriosis and treat it medically without surgical proof. This is known as empirical treatment and is frequently done. If your symptoms stop or at least become much better it may indicate that endometriosis is present and you are correctly treated. Endometriosis is a disease driven by estrogen, the central female hormone. As such, most medical therapies are hormone based. However, in most circumstances, hormones should not be given if you are trying for a baby.

Medical therapy also encompasses specific pain medication and can often be a combination of drugs. If you do not get better, it does not rule out endometriosis, though, and your doctor might change the medication, discuss the surgical approach or refer you to a specialist in a different field. In general, your doctor should discuss the various options with you so that you can make an informed decision which approach to takeRead more...

Surgical Treatment

Surgical treatment, which almost always means laparoscopic (key hole) surgery and not open surgery (laparotomy). This approach has the benefit of confirming or ruling out endometriosis. If you are having surgery, ideally your endometriosis should be treated at the same time. This can be done by removing, burning or evaporation the lesions. It is important to point out that endometriosis treatment, especially surgery, should be performed in a centre with vast experience in the field. This is particularly true for endometriosis involving other organs such as the bowel, bladder and ureters as a multi-disciplinary approach involving bowel surgeons and/or urologist may be necessary. However, surgery is an invasive procedure and not entirely free of risks. Read more...

Fertility Treatment

While endometriosis is known to impair fertility, the underlying mechanisms are still not thoroughly understood. In couples presenting with infertility endometriosis though is not assumed to be the only cause. Subfertility is likely to be partially dependent on the extent of the disease as well as other factors so that couples which present with problems in conceiving undergo a detailed evaluation of contributing factors.

As no medical treatment can improve fertility in endometriosis patients, treatment options are narrowed down to surgical approaches. In women wishing to conceive fertility-sparing surgery of endometriosis should be intended. Removal of endometriotic lesions likely improves the pregnancy rate in mild or moderate endometriosis whereas in severe disease in vitro fertilization (IVF) may be the treatment of choice. In rare cases and on individual basis medical treatment might be discussed prior to fertility treatment. Read more...