Treatment depends on the the degree of symptoms experienced, the extent of the disease (determined through laparoscopy), the woman's desire for future childbearing, and the woman's age.
Observation may be the appropriate treatment for younger women with minimal disease and symptoms. It is important to have the woman maintain a regular schedule of examinations (every 6 to 12 months) to note any changes or progression of the disease.
Treatment with medications may focus on several strategies. Analgesic therapy, treating the discomfort of the disease only, may be indicated for women with mild to moderate premenstrual pain, with no pelvic examination abnormalities, and with no immediate desire to become pregnant.
"Pseudopregnancy" (a state resembling pregnancy) may be achieved through hormonal drug regimens. This approach was developed in response to the observed regression of endometriosis during pregnancy.
Pseudopregnancy can be induced using oral contraceptives containing estrogen and progesterone. This takes 6 to 9 months and relieves most of the symptoms, but does not prevent scarring and adhesion left by the disease. Potential side effects, such as breakthrough spotting, may limit this option for treatment.
Progesterone medications by themselves are another effective hormonal treatment for endometriosis. Progesterone pills or injections can be used. Possible side effects of these agents -- including depression, weight gain, and breakthrough spotting, may be a problem for some patients.
"Pseudomenopause" (a state resembling menopause) was developed as a means of treatment because of the observation that endometriosis regresses after menopause. Danazol, a weak androgenic (male characteristic) hormonal drug may be used to reduce natural levels of estrogen and progesterone to low levels.
Some studies have shown that the use of danazol may be superior to the "pseudopregnancy" regimens in controlling symptoms and progression of the disease in women with moderate-to-severe endometriosis. However, due to possible side effects from danazol, it is now prescribed less often then some newer medications.
A new class of antigonadotropin drugs has been developed that also produces a "pseudomenopausal" state in women.
These drugs, such as Synarel and Depo Lupron (trade names), prevent stimulation of the pituitary for the production of FSH (follicle stimulating hormone) and LH (luteinizing hormone). This stops the ovary from producing estrogen. Potential side effects of these drugs include: menopausal symptoms (such as hot flashes), vaginal dryness, mood changes, and early loss of calcium from the bones.
Due to the effects on bone density, treatment of endometriosis with one of these agents is usually limited to 6 months or less.
Surgery (either laparoscopy or laparotomy) is usually reserved for women with severe endometriosis, including adhesions and infertility. Conservative surgery attempts to remove or destroy all of the outside endometriotic tissue, remove adhesions, and restore the pelvic anatomy to as close to normal as possible. Nerve removal (neurectomy) may rarely be performed during surgery as a means of relieving the pain associated with endometriosis.
Definitive surgery is appropriate for the woman with severe symptoms or disease, and no desire for future childbearing. This type of surgery involves abdominal removal of the uterus (hysterectomy), both ovaries, both fallopian tubes, and any remaining adhesions or endometriotic implants. Hormonal replacement therapy may be indicated after removal of the ovaries and should be tailored to the individual woman's needs.
