The aim of treatment in endometriosis is to ease the symptoms you are having so that the condition does not interfere with your daily life. This can be done in a number of ways including through pain medication, hormone treatment, or surgery.
Pain medication
Sometimes pain killers like NSAIDs (nonsteroidal anti-inflammatory drugs) may be used to relieve pain since they can act against the inflammation caused by endometriosis. These drugs do not treat any other symptoms of endometriosis, but they can make the pain more tolerable for some patients.
What is hormone therapy?
Hormonal treatment also may be used to ease the pain and discomfort resulting from endometriosis. The hormones, by limiting or stopping the production of estrogen in your body, also may help slow the growth of the endometriosis tissue and prevent the growth of new scar tissue (adhesions) formation, but will not make them go away. There are four broad types of hormone-based treatment
• Oral contraceptives
• Gonadotropin-releasing hormone (GnRH)
• Progestin
• Danazol
As with most medications, there are some side effects linked to hormonal treatment. In addition, hormonal treatment helps only with the pain resulting from mild to moderate disease and does not treat infertility or adhesions resulting from endometriosis. The presence of an endometrioma is also not affected by medical therapy and often requires surgery.
What surgical treatments are available?
There are two primary surgical treatments for endometriosis: hysterectomy, or removal of the uterus is the treatment of choice for women who are past childbearing years, and laparoscopic removal of endometriosis implants or adhesions is the treatment of choice for women who wish to preserve fertility or do not wish to have a hysterectomy.
Patients who have completed childbearing may decide on hysterectomy, thereby removing the source of endometriosis. Note that estrogen production from the ovaries allows endometriosis to grow. Removal of the uterus alone may not completely control endometriosis or the pain associated with it if an ovary is left in place due to continued production of estrogen from the ovary. Most patients undergoing hysterectomy, however, will have significant pain relief after hysterectomy, especially if the most severe pain is with menstrual cycles. For more information on laparoscopic hysterectomy with the Women’s Surgery Center, please refer to our detailed explanation of laparoscopic hysterectomy.
The Women’s Surgery Center is able to treat even the most advanced cases of endometriosis using tiny incisions through the use of advanced laparoscopic surgery with retroperitoneal dissection. Laparoscopic surgical removal of endometriosis is helpful in treating pain and infertility, as well as in the removal of scar tissue. It also temporarily prevents further spread of the disease.
Most advanced cases of endometriosis involve the bladder, bowel, and ureters (for more information on pelvic anatomy, please see Learning Center: Anatomy). The disease spreads throughout the pelvis, and can make removal of the implants very difficult without injury to these structures. The approach used by the Women’s Surgery Center identifies the anatomy completely, thereby allowing for removal of endometriosis without injury to bowel, bladder, ureters, large vessels, and avoids removal of the uterus, tubes, and ovaries in the vast majority of cases for those patients wanting to become pregnant.
Removal of implants controls pain in many patients, and is often performed at the time of initial evaluation of pelvic pain. Masses identified to the ovary are often due to endometriomas, and most infertility patients require them to be removed before undergoing fertility treatments.
The Women’s Surgery Center performs advanced laparoscopic surgery for endometriosis using three to four tiny (1/4 inch) incisions. Removal of endometriomas may require one incision to be slightly larger (3/4 inch) to remove the mass.
Using advanced laparoscopic surgery, the important anatomical structures of the pelvis are completely identified, and implants of endometriosis are dissected away from these structures safely. Implants on the ureter (tube that drains urine from the kidney to the bladder) are actually on the peritoneal lining covering the ureter, and can be removed once the ureter is identified and then dissected away from the peritoneal lining.
Endometriosis involving the bladder, uterus, and on the lining of the pelvis and abdomen can be removed in the same way. Some patients may have extensive endometriosis between the rectum and the back wall of the uterus. Once the rectum is dissected safely away from the uterus, the endometriosis can then be removed.
What are the advantages to surgical treatment by the Women’s Surgery Center?
The Women’s Surgery Center uses the smallest possible incisions to perform laparoscopic surgery, and with our advanced laparoscopic techniques, endometriosis can be removed safely and completely. Advanced laparoscopic surgery with retroperitoneal dissection allows almost all cases of endometriosis to be treated, and avoids major open surgery with large incisions.
Most patients are discharged from the hospital the same day, and pain control and recovery is far better than with open procedures. Most patients are back to work and normal activities within 2 weeks.
What are the possible risks?
In some cases, extreme endometriosis involving the rectum and bladder cannot be removed laparoscopically, and open procedures may be necessary. This is only done to remove all endometriosis and to avoid major injury to the bowel. The Women’s Surgery Center has the lowest conversion rates, the number of times surgeries begun laparoscopically have to be completed as open surgeries, in the published literature. Less than 1% of our surgeries have to be converted to open surgery during the surgical procedure. Learn more about surgical complications.
Advanced Laparoscopic Surgery with Retroperitoneal Dissection for the Treatment of Endometriosis
| Indications | All patients with pelvic pain/endometriosisr |
| Discharge Home | 24 hours or less |
| Recovery Time | 5 days to 2 weeks |
| Incision Size | 3 - 4 1/4 inch incisions with 3/4 inch incision as needed |
| Pain Tolerance | Very good to excellent |
| Blood control | Excellent |
| Procedure Time | 20 – 30 minutes, up to 90 minutes in advanced cases requiring hysterectomy |
| Conversion to Open | Rare, indicated for extensive disease involving rectum |