It is crucial that your endometriosis treatment is tailored to your own specific circumstances and that you see a specialist in endometriosis who can advise you on this. Your treatment will depend upon your age, desire for a diagnosis, fertility requirements and pain symptoms.
Do not just accept the first treatment
offered without understanding why
it is being offered in your situation. A
consultation for complex endometriosis
will take at least 45 minutes.
There is no absolute cure for
endometriosis and it tends to be an
issue that remains with you for most of
your fertile years.
Both medical and surgical treatments
give a measure of relief from
pain depending on the type of
endometriosis you have. The amount of
pain relief can vary greatly depending
on many factors. Pain can recur after
stopping medical treatments or at a
later date after surgery.
If you are not keen to have a diagnostic
laparoscopy (keyhole surgery) to
confirm that you have endometriosis,
then it may be reasonable to try
medical treatments first and then
consider a diagnostic laparoscopy later
if the medical treatments do not work.
All of the hormonal treatments have
been shown to be equally effective as
each other at relieving pain but none
of them improve fertility. The choice of
drug treatment is decided by your age,
requirement for birth control and the
potential side effects of the drugs.
Some women may decide to proceed
directly to a diagnostic laparoscopy
because they wish to be certain if
they do have endometriosis. Knowing
the cause of the problem helps them
psychologically to deal with it.
Surgical treatment requires the help
of a gynaecologist who specialises in
endometriosis and minimally invasive
surgery (keyhole surgery).
For minimal to moderate disease
(Stage 1-3), the surgeon should be
comfortable to diagnose the problem
during laparoscopy and surgically
remove it, preferably by excision,
and at the same time, to get the best
chance of pain relief. Many general
gynaecologists are not fully trained in
If your gynaecologist discovers severe
disease then, to treat it at the same
time, they should have discussed
with you the pros and cons of surgical
removal. In severe cases, endometriosis
surgery is a high-risk complex operation
that should only be attempted by a
fully-trained expert in specialist centres.
Not everyone requires surgical removal
of severe disease as it can compromise
your fertility. Robotic keyhole surgery
now potentially offers the most
accurate and precise surgery for severe
cases of endometriosis with the lowest
risks of complications. About 80 percent
of patients undergoing surgery say that
their pain improves to varying extents.
Your gynaecologist should also be able
to offer you access to other specialists
as required, for example:
• Pain, intestinal or urinary system
• Psychological and psycho-sexual
If you are found to have endometriosisassociated
infertility then the choice
is whether to have surgery or assisted
fertility treatments (IVF or IUI) or both.
With minimal to moderate
endometriosis, there is evidence that
surgically removing the endometriosis
deposits and endometriotic ovarian
cysts improves your chances of
conceiving spontaneously reducing
the need for assisted conception
There is some evidence that surgically
removing severe endometriosis before
infertility treatment improves your
chances of success. However, there is
a small risk of damaging your fertility
with surgery in some cases and so
assisted conception techniques may be
recommended in the first instance so as
not to risk affecting your fertility further
from surgical complications.
Surgery may also be needed first if:
Dysmenorrhoea and endometriosis
can be physically and mentally
debilitating, affecting every aspect
of a woman’s life.
Women with endometriosis tend to
have more problems maintaining
their careers and relationships as
they may be fighting with chronic
pain and fertility issues.
Seeing a gynaecologist who
specialises in this area gives a
good opportunity to keep the pain
under control and achieve fertility
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