Treatment

The treatment strategy for a patient with endometriosis depends whether the patient has infertility or secondary dysmenorrhea (pelvic pain).

In cases where pelvic pain is associated with endometriosis then treatment is indicated even if there is only mild disease found at laparoscopy. A prolonged period of medical treatment (hormonal treatment) is required to treat endometriosis. In general, a treatment period of at least 6 months is undertaken.

In cases of subfertility associated with endometriosis, there is no evidence that medical therapies improve fertility. The limited data available suggests that surgery can improve a woman's chances of conceiving (1,2,3).

NICE state that should:

• offer laparoscopic ovarian cystectomy with excision of the cyst wall to women with endometriomas, because this improves the chance of spontaneous pregnancy and reduces recurrence (4)

Reference:

• Hughes E et al (1999). Ovulation suppression versus placebo in the treatment of endometriosis (Cochrane Review). In: The Cochrane Library Issue 3. Oxford: Update Software, 1999.
• Prescriber (2004); 15(16):18-22.
• Kroon N, Reginald P. Medical management of chronic pelvic pain. Curr. Obs. & Gynae. 2005; 15 (5): 285-290.
• NICE (September 2017). Endometriosis: diagnosis and management