Treating Endometriosis

NHS

There's no cure for endometriosis and it can be difficult to treat. Treatment aims to ease symptoms so the condition does not interfere with your daily life. Treatment can be given to:

  • relieve pain
  • remove endometriosis tissue
  • improve fertility
  • reduce the chance of the condition returning

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. These include:

  • your age
  • what your main symptoms are, such as pain or difficulty getting pregnant
  • whether you might want to become pregnant in the future – 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.

Pain medication

Anti-inflammatories (NSAIDs), such as ibuprofen or paracetamol, may be tried to see if they help reduce your pain. They can be used together for more severe pain. These painkillers are available to buy from pharmacies. Tell your doctor if you have been taking painkillers for a few months and you're still in pain.

Hormone treatment

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 shrink endometriosis tissue in the body and reduce pain from endometriosis.

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), contraceptive injection, contraceptive implant and progestogen-only pill

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 with your doctor.

The combined contraceptive pill contains the hormones oestrogen and progestogen. It can help relieve symptoms and can be used over long periods of time.

Progestogens are synthetic hormones that behave like the natural hormone progesterone. They work by preventing the lining of your womb and any endometriosis tissue from growing quickly.

Surgery

Surgery can be used to remove or destroy areas of endometriosis tissue, which can help improve symptoms. The kind of surgery you have will depend on where the endometriosis is and how much of it there is.

Some of the options are:

  • laparoscopy – the most commonly used technique
  • hysterectomy

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.

If keyhole surgery and other treatments have not worked and you do not want to try to get pregnant, removal of the womb (a hysterectomy) might be an option. Deciding to have a hysterectomy is a big decision you should discuss with your GP or gynaecologist.

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