Endometriosis Treatment
Treatment for tissue similar to the uterine lining growing outside the uterus, which can cause pain and fertility problems
What is endometriosis treatment?
Endometriosis is tissue that behaves like the lining of the uterus growing where it should not, most often on the pelvic wall, the ovaries, the ligaments behind the uterus and the surface of the bowel and bladder. It responds to the same monthly hormones as the lining does, so it builds up and breaks down in place, with nowhere for the blood to go.
That repeated small bleed drives inflammation, and inflammation over years lays down scar tissue. The scar is what turns a collection of deposits into a pelvis where organs are stuck to one another, and it is why the trouble it causes goes well beyond the deposits themselves.
The amount of disease and how much it hurts are only loosely related. A woman can have a few deposits and be in real difficulty, and another can have an extensively involved pelvis found by chance. Both are treated on how they are affected, not on the picture.
What you might notice
- Periods painful enough to stop the day
- Pain during intercourse
- Pelvic pain
- Trying for a baby without success
How it is diagnosed
The history does a great deal of the work here. A doctor is listening for a pattern that repeats with the cycle and has been getting worse over years, and for the two or three days a month that are routinely being written off.
Examination adds what a scan cannot. Nodules felt behind the uterus, and a uterus that will not move freely, point to deep disease and change the plan. A transvaginal scan shows cysts on the ovaries reliably and shows the flat deposits on the pelvic wall poorly; MRI maps the deeper disease before an operation is planned. There is no blood test that makes or excludes the diagnosis.
The average woman waits years for this to be named, so bring dates. A record of which days each month were lost is more persuasive than any single description.
Recovery
Hormonal treatment works by settling the cycle down, and it takes two to three months before the difference is clear. The first few weeks can be unsettled while your body adjusts.
After keyhole surgery expect two to four weeks before you are back to normal, with the shoulder ache from the gas gone within a few days. The relief is often not immediate; inflamed tissue takes several weeks to quieten, and the first cycle afterwards can still be difficult.
Endometriosis is a long-term condition, and surgery treats what is there without changing the tendency to form more. Most women continue on hormonal treatment afterwards unless they are trying to conceive, and that is the single decision that most affects how long the improvement lasts.
If it is left untreated
Not every woman needs treatment. Where the disease is mild and settled, and particularly as the menopause approaches, watching with pain relief is a reasonable course.
Left alone in a woman it is active in, the pattern tends to be slow progression. Deposits enlarge, cysts on the ovaries grow and consume healthy ovarian tissue, and adhesions build until the ovaries and tubes are held out of position and cannot work together, which is how the fertility of a woman who has not yet started a family is quietly lost. Scarring near the bowel or the ureter is uncommon but is the reason deep disease is followed properly.
Pain that stops responding to what used to control it, or that has begun to be there between cycles, is worth reassessment instead of a stronger tablet.
Questions about endometriosis treatment
Is laparoscopy the only way to be certain of the diagnosis?
It is the only way to see the deposits directly and confirm them with a sample, and for a long time it was the standard route to a diagnosis. Practice has shifted. A clear history with the right findings on examination and a good transvaginal scan or MRI is now often enough to start treatment, and putting a woman through an anaesthetic only to confirm what will be treated medically anyway is harder to justify. Laparoscopy comes into its own where the pain has not responded to hormonal treatment, where fertility is the concern, or where deep disease needs mapping before it is dealt with.
Will endometriosis stop me getting pregnant?
Not necessarily, and many women with endometriosis conceive without any assistance. It does reduce the chance overall, through several routes: scarring can hold the tubes and ovaries out of position so the egg is not picked up, cysts on the ovary consume healthy tissue and lower the reserve, and inflammation in the pelvis appears to affect implantation. Removing deposits and freeing adhesions improves natural conception rates in mild and moderate disease, and where the reserve is already low or the tubes are damaged, IVF bypasses the pelvis altogether. If you have endometriosis and want children, the useful conversation is about timing, and it is worth having earlier than feels necessary.
Does it come back after surgery?
It can, and the figures quoted for recurrence over five years are substantial. Surgery removes the disease that is there without altering the process that produced it, so the deciding factor is usually what happens afterwards. Most women stay on hormonal treatment once they have recovered, which keeps the cycle quiet and holds the improvement, and those who stop in order to conceive accept a higher chance of it returning. Complete excision by an experienced surgeon recurs less often than surface treatment, so it is a fair question to ask about the approach being planned.
Other obstetrics & gynaecology treatments
Delivery of a baby through surgery when vaginal delivery is not advisable or safe
InpatientManagement of non-cancerous growths in the uterus, based on symptoms, size, location and reproductive plans
Day CareTalk to a care coordinator about endometriosis treatment
Leave a number and a care coordinator calls you back with what the treatment involves and which hospital it would be at. They book a consult only if you want one