Endometriosis - Treatment

Treatment

There is no perfect way of managing endometriosis. There are basically three treatment approaches:

• Watchful waiting (to relieve symptoms)
• Hormonal therapy (to reduce endometrial implants)
• Surgery (to reduce endometrial implants, restore fertility, or possibly cure the condition)

The choice depends on a number of factors including the woman's symptoms, her age, whether fertility is a factor, and the severity of the disease.

Watchful Waiting

In general, watchful waiting is a good initial choice for:

• Women with mild pain who, if fertile, do not wish to become pregnant. If women with mild endometriosis wish to become pregnant, the doctor may recommend unprotected sex for 6 months to year. If pregnancy does not occur, then treatment may be started.
• Women approaching menopause.

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Some experts believe that early diagnosis and treatment in young women without symptoms might prevent some cases of infertility later on. Unfortunately, however, some treatments for endometriosis may actually trigger symptoms in those who do not yet experience them.

Hormonal Therapy

Hormone therapies are used to mimic states in which ovulation does not occur (such as pregnancy or menopause) or to directly block ovulation. Hormonal drugs include oral contraceptives, progestins, GnRH agonists, and danazol. They can be very effective in relieving endometriosis symptoms. Some of these drugs may also be used after surgery to help prevent recurrence of endometriosis. There is also some evidence that GnRH agonists and danazol may improve immune factors associated with endometriosis. But there are downsides:

• None of these drugs can cure the problem. Symptoms recur in about half of patients within 5 years of treatment.
• They do not improve fertility rates and may delay conception in women who use them.
• Side effects of these drugs can be distressing. There is a high dropout rate with the use of nearly all these hormonal treatments.
• Women who take GnRH agonists, danazol, or similar drugs should use non-hormonal birth control methods (such as the diaphragm, cervical cap, or condoms) because these drugs can increase the risk for birth defects.