There are many treatments for endometriosis and the right one depends on the particular case, associated symptoms and desire for pregnancy. Consult your obstetrician-gynecologist or a fertility specialist, if you have endometriosis or have symptoms suspicious for endometriosis.
The treatment can be observation, medical or surgical depending on many variables and individual circumstances. There is no one best treatment because each approach has its own risks, benefits and success rates.
Treatments for Pain
Treatments for pain include pain medications, hormone treatment, exercise, meditation and relaxation techniques, acupuncture and sometimes surgery. Pain medications and hormone treatments are usually a good place to start, while surgery is often the last resort when all other treatments have been ineffective. Exercise and relaxation techniques are recommended for all women with pelvic pain and certainly for those with known or suspected endometriosis.
The most common pain medications are acetaminophen (Tylenol) or non-steroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen (Motrin, Advil, etc.) or naproxen (Aleve, Naprosyn, etc.). These drugs often give some pain relief and may be taken along with hormonal treatment as combination therapy. Pain that requires higher dose pain medications or opioids (such as narcotics), is a strong indication that hormone treatment or surgery is required as soon as possible.
Endometrial tissue, both the normal tissue in the womb and the abnormal tissue of endometriosis, needs estrogen to grow. Hormone treatments reduce the amount of estrogen that reaches any patches of endometriosis you may have. These patches are then starved of estrogen and may gradually shrink.
Among the most common treatments are hormonal birth control pills, patch and the vaginal ring. A progestin-containing intrauterine device (IUD) can also be very effective in treating pelvic pain.
The process of producing estrogen starts in the brain, where gonadotropin-releasing hormone (GnRH) is made. GnRH causes the pituitary gland to produce other hormones called gonadotropins, which are released into the bloodstream and eventually reach the ovaries, where estrogen is then produced and released into the bloodstream.
Several different medications exist that block different parts of this process. But the end result of all of them is to reduce the amount of estrogen that is made or block its action on endometrial tissue. The variety of medications insures that if there are problems with side effects from one, there’s another that can be tried.
Pain often returns when hormonal treatments are stopped so it may be necessary to continue the treatment for an extended period of time or consider alternative options such as surgery.
If neither pain medications nor hormonal treatments are effective in reducing pain, surgery may be required. The goal of surgery is to remove endometriotic lesions, remove any endometriosis cysts (endometriomas), remove scar tissue and restore normal anatomy. The goal is to remove patches of endometriosis without harming the healthy tissue around it. This will provide a long-term cure for pain in up to 80% of all women.
Laparoscopy is the preferred way to remove endometriosis and recurrence rates of pain are approximately 10-20% per year. The need to do a second surgery is 20-40% in 2-5 years following the initial surgery.
More extensive surgery is frowned on, though it may be needed in a small percentage of the time. This refers to removal of the uterus in someone who completed their family and can be effective in relieving pain up to 90% of the time. The key to avoid recurrence is also o remove any endometriotic lesions at the time of hysterectomy (removal of uterus). If someone desires pregnancy and is in her reproductive years laparoscopic treatment of endometriosis is always preferred over hysterectomy.
Treatments of Endometriosis for Infertility
Surgery and in vitro fertilization (IVF) are the two methods used to overcome infertility problems caused by endometriosis.
Surgery has been shown to improve the odds of conception for women with mild to severe endometriosis (30%). Once again, the key is to remove only patches of abnormal endometrial tissue without harming the healthy tissue that surrounds it.
In moderate or severe cases, surgical treatment significantly improves the chances of pregnancy (40%). In severe cases, attention should be paid to minimizing any damage to the ovaries and preserving as much ovarian tissue as possible.
If the surgery is unsuccessful at restoring fertility, IVF is probably the best bet. Performing a second surgery is generally frowned upon unless symptoms of pain prevent undergoing IVF. There is new information that IVF treatment may even be better than surgery if the goal of the treatment is achieving pregnancy rather than treating pain.
Medical treatment of endometriosis does not improve outcome unless suppressive therapy is used in preparation for IVF. Leuprolide (Lupron) has been used to suppress ovarian activity, endometriotic lesions and inflammation prior to IVF treatment and has been shown to improve pregnancy rates. The drawback is the waiting time which is sometimes six months before starting IVF and some suggest waiting is not good when severe endometriosis is present and ovarian reserve is declining.
IVF Treatment for Endometriosis related Infertility
Fertilizing the eggs in the laboratory environment versus the pelvic cavity (natural conception) is probably one of the most important benefits of IVF treatment for endometriosis. The laboratory environment may be a better option because endometriosis causes inflammation in the pelvis and can create a hostile environment for the sperm, eggs and the developing embryo. During the IVF treatment, multiple embryos can be created and the best one can be selected for transfer into the uterus and remaining embryos can be frozen for later use.
If endometriosis is more advanced, the pregnancy rates are lower which is due to low egg reserve. Therefore, if endometriosis is suspected or diagnosed already and pregnancy is desired, it would be important to understand the importance of time as egg reserve may be declining rapidly
If the diagnosis can be made early and treatment started soon, the overall success rates of IVF for women with endometriosis can be favorable and as high as 40% per IVF cycle or attempt including all age groups.
Consult with a fertility specialist if you have the symptoms or the diagnosis of endometriosis already and considering having a baby in the future because you may be at risk for infertility or declining egg reserve.