Endometriosis may be managed medically or surgically. Your doctor will decide the treatment modality based on various factors such as location of the extra-uterine endometrial tissue, size of the tumor (endometrioma, if formed), severity of symptoms, your age and your desire to have baby etc. Most commonly, your doctor will select medical management and use surgery as the last resort, if medical management cannot provide satisfactory result.
Medical management of endometriosis:
- Pain management: simple pain medications such as available over the counter pain medications are helpful in many cases of pain due to endometriosis. If over the counter medications do not work, your doctor may prescribe nsaids (such as ibuprofen, naproxen etc.). These medications can alleviate pain associated with menstrual bleeding. If these cannot provide satisfactory pain relief, your doctor may use hormone therapy.
- Hormone therapy: hormone supplements can reduce or eliminate pain associated with endometriosis. Hormone supplementation can reduce/prevent endometrial thickening, breakdown and bleeding. However, hormone replacement is not permanent solution for endometriosis. Symptoms may recur if you stop hormone supplementation. Hormone therapies used for endometriosis include, hormonal contraceptives (including pills, skin patches), gonadotropin releasing hormone agonist and antagonists, danazol (this hormone prevent growth of endometrial tissue), progestine etc.
Surgical management of endometriosis:
- Conservative surgery for endometriosis: conservative surgery is used for management if patient want to become pregnant. In such case extra uterine endometrial tissues are removed as much as possible while preserving uterus and ovaries. This increase change of successful pregnancy. In some cases, your doctor or you may select to undergo assisted reproduction such as in-vitro fertilization (commonly known as test tube baby), instead of using conservative surgery for increasing chance of pregnancy.
- Hysterectomy: this involve removal of uterus along with removal of extra uterine endometrial tissue, as well as removal of ovaries and cervix, when it is called total hysterectomy. In many cases this is best management for endometriosis, especially in some selected cases, such as women who have completed their family with children, age above 35 years and in patients with very severe symptoms (when medical management cannot remove pain). Only hysterectomy may not completely remove symptoms of endometriosis, because the hormones produced by ovaries (if not removed) can stimulate some endometrial tissue that may be left behind and produce symptoms.
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