Treatment of Endometriosis

Medical Therapy

The goal of medical therapy for endometriosis is the control of symptoms, particularly pain. None of these therapies results in a cure; medical therapies suppress endometrial implants but do not destroy them. In women who initially receive relief from medical therapy, 5-15% have a recurrence of symptoms within 1 year. By 5 years, 40-50% of women have symptoms that no longer respond to medical therapy.2

  • Initial Therapy

    • Analgesics – Although there is a lack of strong scientific evidence for their use in endometriosis, most physicians will include a trial of non-steroidal anti-inflammatory drugs (NSAIDs, e.g. ibuprofen) in patients with pelvic pain
  • Combination Oral Contraceptives (Birth Control Pills) – Oral contraceptive pills have been shown to reduce pelvic pain in women with endometriosis.7 OCPs may also slow or stop the progression of disease (the formation of new endometrial implants).
  • Second Line Therapy: Women are typically given a 3 to 6 month trial of initial therapy. If analgesics and oral contraceptive pills are unable to control symptoms, alternate medications can be tried.
    • GnRH agonists – GnRH (Gonadotropin releasing hormone) agonists are synthetic hormones that decrease the circulating levels of female hormones, including estrogen. This results in a menopause-like state that may be accompanied by hot flashes and mood swings. GnRH agonists decrease the size of endometrial implants and often result in relief of pelvic pain.
    • Danazol – Danazol is derived from a synthetic form of testosterone. It has been approved by for the treatment of endometriosis since the 1970s, and was once the mainstay of medical therapy. While it is effective, androgenic (masculinizing) side effects, including decreased breast size and excess hair growth, have made it a less popular choice more recently.
    • Progestins – Progestins mimic the action of progesterone, the ‘pregnancy hormone’. Progestins cause endometrial implants to atrophy (shrink), and often result in decreased pelvic pain. However, some women are unable to tolerate the side effects, which include excessive weight gain and depression.

Surgical Therapy

 Surgical therapy is considered when:

  • symptoms are unrelieved by a trial of medical therapy
  • symptoms are severe or incapacitating
  • acute problems including bowel or urinary obstruction are present

Conservative Surgical Therapy – Conservative surgery involves the ablation (destruction) or removal of endometrial implants while leaving the uterus and ovaries intact. Surgeons may also remove adhesions, fibrous bands of scar tissue that can cause pain or complications including bowel obstruction. Conservative surgery is typically performed as a laparoscopic procedure, utilizing a special camera and instruments inserted through small incisions in the skin.

Definitive Surgical Therapy – Definitive surgical therapy involves removal of the uterus, ovaries, fallopian tubes and all visualized endometrial implants. Definitive surgery is reserved for women with advanced disease, particularly those with recurrent endometriosis after conservative surgery.

Treatment of Endometriosis Associated With Infertility

30-45% of women with infertility have evidence of endometriosis.2  These women are not candidates for medical therapy if they are attempting to conceive (become pregnant) naturally, because the medications used to treat endometriosis stop ovulation from occurring. Conservative surgical therapy may be appropriate in certain settings. For women considering in vitro fertilization (IVF), pretreatment with GnRH agonists may increase the chances for a successful pregnancy.2

Prevention of Endometriosis

There is no known way of preventing endometriosis. Medical treatment early in the course of the disease may stop the disease from progressing.