Several factors require consideration when deciding on the appropriate treatment approach for women affected by endometriosis.
Decisions about therapy should be based on the woman’s symptoms, as well as her desires with regard to having children.
Endometriosis cannot be cured and treatment is therefore aimed at slowing the growth of endometriosis tissue, relieving pain and improving fertility.
Treatment does not always work, but in the majority of cases, it provides significant relief form pelvic pain as well as helping women to achieve pregnancy.
The main problem associated with endometriosis is not being able to get pregnant (infertility) or difficulty getting pregnant (subfertility).
This is because the condition can cause damage to the fallopian tubes or ovaries. However, as many as 70% of women who suffer from a mild to moderate form of this condition do manage to achieve a pregnancy without being treated.
Medication cannot improve fertility but surgical removal of the endometriosis tissue can help.
Women with endometriosis sometimes use in vitro fertilisation (IVF) as a way of achieving a pregnancy, although the chances of conceiving using this technique are lowered in this patient group.
The aim of surgery is to remove endometriosis tissue to help improve any symptoms the woman is experiencing, as well as improving their fertility.
The type of surgery chosen depends on where the endometriosis tissue is growing, but the procedures available include laparoscopy, laparotomy and hysterectomy.
As with any surgery, the associated risks should be thoroughly discussed with the patient.
Studies suggest that the reason endometriosis may recur after surgery or medical intervention is that the underlying process that causes the condition does not necessarily cease afterwards.
The recurrence rate five years following surgery is between 20% and 40%, providing menopause has not been reached and hysterectomy has not been performed.
Women who have undergone treatment for this condition need to attend periodic examinations so they can be monitored using sonography.
Reviewed by Sally Robertson, BSc