Treatment of Endometriosis

When you are diagnosed with endometriosis, the future can seem bleak. There is too much myth and misinformation around, with websites, books and even doctors saying that endometriosis can not be cured. That is not true.

Endometriosis is painful, frustrating and difficult to deal with-but you do not have to suffer in silence. There are treatments to ease discomfort and prevent the progress of the disease and in expert surgical hands the areas of endometriosis can be cut out and the condition can be considered as cured.

Why was endometriosis described as incurable?

It’s true to say that endometriosis is tricky and challenging to treat. Inadequate surgery in inexpert hands can mean that endometriosis is not properly removed and recurs rapidly. This is especially true if the patches have been burned away, ablated or lasered (as opposed to excised or cut away).

However, better techniques have changed things. Mr Khazali has operated on many women who now live free from the pain of endometriosis. Sometimes patches recur and symptoms can return, however, this is the exception, not the rule, and repeat surgery can usually resolve this issue.

What is the best treatment for endometriosis?

The right treatment will depend on your symptoms, the extent of your disease and whether any of the vital pelvic structures such as the bladder, bowel and the ureters (tubes that take urine from the kidneys to the bladder) are affected. Sometimes, no treatment is necessary and it is better to simply monitor your endometriosis.

Medication and surgery can both help. The best treatment for your individual needs can be decided after a detailed discussion, considering your preferences and whether you plan any future pregnancies.

Consulting with a gynaecological surgeon with a special interest and skills in the management of endometriosis can help plan the pathway to controlling your endometriosis, instead of it controlling you.

The treatments can include:

Painkillers: Pain can be excruciating in endometriosis. Simple analgesics like paracetamol, anti-inflammatories such as ibuprofen and stronger painkillers including codeine can all help. When the endometriosis has caused nerve sensitivity or damage, other treatments may become necessary such as pregabalin or gabapentin.

Hormonal Treatments: These can be useful to treat milder disease. By preventing periods, endometriosis patches stop bleeding and the pain is eased. They’re not a cure and the condition will continue when medication is stopped. The hormones won’t have an effect on adhesions and fertility, although they should prevent problems getting worse. Options include the Oral Contraceptive Pill, the IUS or Mirena Coil and contraceptive implants or injections.

Gonadotrophin-releasing hormone (GnRH) analogues are synthetic hormones that cause a sort of temporary menopause. They can only be used for a short time, usually a maximum of six months and symptoms may return afterwards. Mr Khazali sometimes uses these prior to big procedures or for testing if surgery will be helpful. They’re usually taken as monthly injections and may give you the flushes, vaginal dryness and mood swings of menopause. These side effects can be alleviated by other medications and are usually well tolerated.

Surgery for endometriosis

Surgery is an excellent way of treating endometriosis, physically removing the patches to provide relief and often cure the condition. The surgery is almost always through keyhole surgery (more than 99% of the time).

Keyhole or open?

Laparoscopic surgery is a far superior method of treating endometriosis than laparotomy or open surgery. Not only are there smaller scars, rapid recovery time and shorter hospital stay, but also it is a more precise way of removing the areas of endometriosis.

Laparoscopy gives a much better view, a magnified image and greater access to deep pelvic structures. You would think that a big hole gives a surgeon better access, but in fact, the opposite is true.

The results of surgery are much better if the endometriosis is excised or cut away. This can be efficiently done by the right surgeon through the laparoscope. Alternatives include burning, ablating or lasering the areas. However, despite the high-tech sounding names, these older techniques are less effective, lead to incomplete treatment and all too often the endometriosis comes back. There are some exceptions to this rule, such as very superficial endometriosis.

The problem is that endometriosis can be like an iceberg. A tiny patch on the surface that deeply infiltrates underneath. By burning away the top, we’re simply not getting to the heart of the problem and the disease will recur.

Which surgeon?

he key message is to see a specialist gynaecological surgeon with expertise and interest in treating endometriosis. They should have skills and experience in laparoscopic surgery and the excision of endometriosis lesions.

Click for our pages on endometriosis and laparoscopic surgery for endometriosis to find out more.