Management and Treatment
There are three kinds of treatments for endometriosis:
- Medical treatments (medications)
- Surgical treatments (involving an operation)
- Complementary treatments (physiotherapy, psychology, complementary medicine, etc.)
These can be divided into hormonal and non-hormonal treatments. Hormonal treatments include the oral contraceptive pill and progestogens (one of the two main female hormones) in a variety of forms.
You should discuss the differences in the treatments with your doctor before starting a treatment. There are advantages and disadvantages to all the types of treatments and you may need to have several treatments of different types before finding the right combination for you. Hormones can be given in an injection for three months, given continuously in a rod inserted under the skin, or released from an intrauterine system (like an IUD).
There are a number of other hormonal treatments that can be used for short periods only because of their side effects if used long term. These are powerful medications and can have significant side effects.
Non-hormonal medications include:
- pain-relieving medications such as paracetamol
- non-steroidal anti-inflammatories
- strong pain relievers.
These medications are designed to relieve the pain that can be associated with endometriosis, though they are not intended to reduce the amount of endometriosis present. They may be used as a sole treatment or in combination with other treatments.
Surgical treatments for endometriosis include laparoscopy or laparotomy. A laparotomy is where the abdomen is opened through a large incision either through a bikini line cut, or occasionally through a lengthwise cut from the umbilicus (navel or belly button) down to the pubic area.
Surgery for endometriosis is usually performed by laparoscopy because it causes less scarring, less pain, less time in hospital, better visualises the areas where endometriosis can grow and small bleeding points can be more easily seen. Sometimes the disease is so severe that a laparotomy is required. Usually your doctor will inform you of the chances of this prior to your surgery.
Very occasionally, a laparotomy is required to complete surgery started by laparoscopy or to deal with a complication that can arise during surgery.
You should discuss the possible complications and the likelihood of them occurring if you decide to have surgery. Your doctor will explain specific risks for you based on your symptoms and signs and will ask you to complete a consent form for your surgery.
Using allied health professionals such as physiotherapists, acupuncturists, herbalists, nutritionists, homeopaths and psychologists can be very helpful for people with endometriosis. You should discuss these treatments with your doctor before commencing them, or if you are on any of these treatments and are having surgery, then it is also important to tell your doctor as some treatments can interfere with surgery.
Your doctor may ask you to see a physiotherapist if you have problems with your bladder and bowel, or if they think that there are muscle problems contributing to your symptoms. Physiotherapists that deal with this area are highly specialised in this area and are used to dealing with these problems. Ask your doctor if they know a physiotherapist in your local area.
A clinical psychologist is a very useful person to consult if you have chronic pain. If you are referred to the psychologist, it is not because your doctor thinks “it is all in your head’, but rather that the traditional methods of dealing with your symptoms have been of limited help to control your pain.
There are two aspects of pain, the stimulus (or cause) of the pain – such as endometriosis and the perception (or processing) of the pain, which occurs in the brain.
Removing the endometriosis (stimulus) by surgery or trying to shrink it with medication may completely remove the symptoms. However, if the pain is still present it does not always mean that the endometriosis has returned. There can be a problem with the perception (processing) of the information leading to pain, where the endometriosis may no longer be present though the symptoms may still persist.
While there are medical and pharmacological treatments which may provide some relief, it is often only temporary, so it is useful for the individual with a chronic pain condition to learn some strategies that help them to help themselves. A Clinical Psychologist who specialises in pain management can help by teaching specific strategies that have been found to be helpful in coping with chronic pain, as well as teaching strategies to manage associated problems such as impact on relationships, stress, anxiety, depression and mood swings.
What is the best treatment for endometriosis?
There is no ‘best treatment’, since treatments will work differently for each individual with endometriosis. You should be aware of the different kinds of treatments, and their possible effects and side effects or complications. A combination of treatments can be used to assist relieve the symptoms associated with endometriosis.
What can I expect from treatment?
Most treatments for endometriosis will not eradicate pain. This is because even without endometriosis being present, some people will experience pain with their periods, in between periods or at other times. It should also be remembered that the presence of endometriosis is not always the cause for pain or infertility and there may be other causes present.
Treatments are likely to reduce symptoms by 50-70% for most patients. Some individuals will have no relief from any treatment. Symptom control and other investigations may then be necessary. If you have surgery for your endometriosis, there is the possibility of recurrence of approximately 35%. The time interval may be short or very long. There is no way of predicting who will respond to treatment or in whom it will return. For patients with very severe endometriosis (stage 4), the chance of recurrence is higher at about 70%, though many patients are able to have good quality of life and become pregnant following treatment.
What are the risks of treatment?
Medical treatments can be associated with side effects such as spot bleeding, break-through bleeding, bloating, nausea, weight gain, and depression. Skin changes (oily or spotty skin) may occur as can elevation in blood pressure.
For surgery, there are risks associated with the area being operated in, like damage to other organs such as the bladder, bowel, ureters (the tubes that lead from the kidneys to the bladder) or the large blood vessels. Damage to other organs would require repair usually by further surgery that may be done by laparoscopy or may require a laparotomy (large cut in the abdomen) to complete.
There are no known complications from seeing a psychologist or a physiotherapist. There can be side effects and complications from acupuncture, herbalism and other complementary medicines. You should ask your health care professional for risks associated with a treatment or procedure prior to commencing that treatment or having a procedure.
Medical information disclaimer
Endometriosis Australia’s information about the diseases, treatments and general matters has been written and edited by Endometriosis Australia’s volunteers. Endometriosis Australia makes every effort to ensure the information provided is as up-to-date and accurate as possible, however does not accept liability for misinterpreted or incorrect information.
It is also not the intention of Endometriosis Australia to recommend any particular form of treatment. At all times you need to discuss the information you find on this website, or any other source, with your doctors or health team, given your unique situation and status.