Deciding which treatment
Your gynaecologist will discuss the treatment options with you, and outline the risks and benefits of each.
When deciding which treatment is right for you, there are several things to consider.
- your age
- what your main symptoms are, such as pain or difficulty getting pregnant
- whether you want to become pregnant – some treatments may stop you getting pregnant
- how you feel about surgery
- whether you have tried any of the treatments before
Treatment may not be necessary if your symptoms are mild, you have no fertility problems, or you're nearing the menopause, when symptoms may get better without treatment.
Endometriosis sometimes gets better by itself, but it can get worse if it's not treated. One option is to keep an eye on symptoms and decide to have treatment if they get worse.
Support from self-help groups, such as Endometriosis UK, can be very useful if you're learning how to manage the condition.
These painkillers are available to buy from pharmacies and do not usually cause many side effects.
Tell your doctor if you have been taking painkillers for a few months and you're still in pain.
For more information, read about pain relief for endometriosis on the Endometriosis UK website.
The aim of hormone treatment is to limit or stop the production of oestrogen in your body, as oestrogen encourages endometriosis tissue to grow and shed.
Limiting oestrogen can reduce the amount of tissue in the body.
But hormone treatment has no effect on adhesions ("sticky" areas of tissue that can cause organs to fuse together) and cannot improve fertility.
Some of the main hormone-based treatments for endometriosis include:
- the combined oral contraceptive pill
- progestogens, including the intrauterine system (IUS), the contraceptive injection, the implant and progestogen pills
Evidence suggests these hormone treatments are equally effective at treating endometriosis, but they have different side effects.
You can discuss the different options and their side effects.
Most hormone treatments reduce your chance of pregnancy while using them, but not all of them are licensed as contraceptives.
None of the hormone treatments have a permanent effect on your fertility.
The combined oral contraceptive pill
The combined contraceptive pill contains the hormones oestrogen and progestogen.
They can help relieve milder symptoms, and can be used over long periods of time.
They stop eggs being released (ovulation) and make periods lighter and less painful.
These contraceptives can have side effects, but you can try different brands until you find one that suits you.
Your doctor may recommend taking 3 packs of the pill in a row without a break to minimise the bleeding and improve any symptoms related to the bleeding.
Progestogens are synthetic hormones that behave like the natural hormone progesterone.
They work by preventing the lining of your womb and any endometriosis tissue growing quickly.
But they can have side effects, such as:
- mood changes
- irregular bleeding
- weight gain
Progestogens used to treat endometriosis include:
Surgery can be used to remove or destroy areas of endometriosis tissue, which can help improve symptoms and fertility.
The kind of surgery you have will depend on where the tissue is.
The main options are:
- laparoscopy – the most commonly used technique
Any surgical procedure carries risks. It's important to discuss these with your surgeon before undergoing treatment.
During laparoscopy, also known as keyhole surgery, small cuts (incisions) are made in your tummy so the endometriosis tissue can be destroyed or cut out.
Large incisions are avoided because the surgeon uses an instrument called a laparoscope.
This is a small tube with a light source and a camera, which sends images of the inside of your tummy or pelvis to a television monitor.
During laparoscopy, fine instruments are used to apply heat, a laser, an electric current, or a beam of special gas to the patches of tissue to destroy or remove them.
Ovarian cysts, or endometriomas, which are formed as a result of endometriosis, can also be removed using this technique.
The procedure is carried out under general anaesthetic, so you'll be asleep and will not feel any pain as it's carried out.
Although this kind of surgery can relieve your symptoms and sometimes help improve fertility, problems can recur, especially if some endometriosis tissue is left behind.
You may need to take hormone treatment before and after surgery to help avoid this.
If keyhole surgery and other treatments have not worked and you have decided not to have any more children, removal of the womb (a hysterectomy) can be an option.
A hysterectomy is a major operation that will have a significant impact on your body.
Deciding to have a hysterectomy is a big decision you should discuss with your GP or gynaecologist.
Hysterectomies cannot be reversed and, though unlikely, endometriosis symptoms could return after the operation.
If the ovaries are left in place, the endometriosis is more likely to return.
If your ovaries are removed during a hysterectomy, the possibility of needing HRT afterwards should be discussed with you.
But it's not clear what course of HRT is best for women who have endometriosis.
For example, oestrogen-only HRT may cause your symptoms to return if any endometriosis patches remain after the operation.
This risk is reduced by the use of a combined course of HRT (oestrogen and progesterone), but can increase your risk of developing breast cancer.
But the risk of breast cancer is not significantly increased until you have reached the normal age for the menopause. Talk to your doctor about the best treatment for you.
Complications of surgery
All types of surgery carry a risk of complications.
If surgery is recommended for you, speak to your surgeon about the possible risks before agreeing to treatment.
Read about the complications of endometriosis for more information about the risks of surgery.
Gonadotrophin-releasing hormone (GnRH) analogues
GnRH analogues are synthetic hormones that bring on a temporary menopause by reducing the production of oestrogen.
They're sometimes given before surgery to help reduce the amount of endometrial tissue. You would normally take them for 3 months before your surgery.
GnRH analogues are not licensed as a form of contraception, so you should still use contraception while using them.
There's no evidence that traditional Chinese medicine or other Chinese herbal medicines or supplements can help treat endometriosis.