Endometriosis is a complex disease with various manifestations, affecting all aspects of one’s life. Symptoms are different in patients and the pain does not correlate with the stage. Treatment methods of endometriosis are medical therapy, which reduces symptoms during administration, and surgical therapy, which is divided into ablation (burning of tissue) and excision (removal of tissue). Multiple long-term cohort studies show that out of all treatment methods, excision has a low recurrence rate and, in some cases, can cure the disease.
Medical Treatment
Based on symptoms, disease location and patients personal circumstances, medical therapy can be divided into painkillers, birth-control pills or hormonal medication that suppress ovulation and stop the period. Each treatment method has its own advantages and disadvantages, hence why it is important for patients to see an endometriosis specialist.
Painkillers
As a first treatment method in patients with a low to moderate period pain, painkillers might be recommended. Some of these painkillers can be bought over the counter, others are only available on prescription, particularly if taken in higher doses. In patients with more severe pain, drugs known as opioids are sometimes used too. These drugs are only allowed to be used if prescribed by a doctor. Some of these painkillers can be bought over the counter, others are only available on prescription, particularly if taken in higher doses. In patients with more severe pain, drugs known as opioids are sometimes used too. These drugs are only available on prescription.
Birth-control
Birth-control pills are often used to relieve endometriosis-related pain by stopping menstruation. They can be either mini-pill or combined both oestrogen and progesterone. In the case of endometriosis, the effectiveness of oral contraceptives is limited only to the relief of symptoms, however, there are few studies that demonstrate this. Combined birth-control might be recommended for adolescent patients suffering from menstrual pain.
Progestins
Progestin is available as intrauterine devices, implants, injections (Depo-provera) or pills. Drugs containing the hormone progestin are also used to relieve pain in endometriosis. As with birth-control pills there are few studies that show the effectiveness of progesterone in treating endometriosis symptoms.
GnRH analogues (agonists)
Hormone drugs known as GnRH (gonadotropin-releasing hormone) analogues or GnRH agonists are also used to relieve endometriosis symptoms, however they have stronger side effects than the pill.
There are several types of GnRH that are similar but have different forms: daily, monthly or quarterly injections. Endometriosis is considered an oestrogen-dependent disease originating from various sources and as a result, suppression of ovarian oestrogen by administration of GnRH is considered an effective method of treatment of the disease. Their effectiveness has not been compared directly with surgical treatment, but only in placebo studies or in comparative studies with different hormonal therapies.
Surgical Treatment
Endometriosis can be treated surgically either using laparoscopy or robotic surgery. The best technique for endometriosis is excision surgery. However, other types of surgery are also used, despite the fact that they do not treat the disease or that they have a higher recurrence rate. However, other types of surgery are also used, despite the fact that they do not treat the disease or that they have a higher recurrence rate. The purpose of endometriosis surgery is to remove all visible endometriosis tissue by excision or ablation, adhesion removal and restoration of normal anatomy.
Ablation
Ablation known as coagulation, vaporisation or fulguration is a technique that uses different types of ultrasonic and laser energy to destroy/vaporise endometriotic tissues. One of the disadvantages of this procedure is that the surgeon has no way of knowing if the disease is completely destroyed. Ablation leaves deep endometriotic tissue behind, leading to a high recurrence rate and potential complications in future surgeries. Also, ablation cannot be used on implants that lie over vital organs such as the bowel and large blood vessels, as there is a risk of damaging them, so active disease may remain in the pelvis and continue to cause pain.
Excision
Excision removes endometriosis tissues from the surrounding tissue using various surgical instruments such as scissors or electrosurgery. This method does not destroy tissue, as such a histopathological diagnosis can be obtained. Excision can be used both in the case of superficial lesions and in the case of deep lesions or endometriotic nodules that infiltrate different organs. Excision also allows the surgeon to separate the endometriosis lesions from the surrounding tissue, ensuring that the entire implant is completely removed.