At the end of endometriosis treatment, the patient should optimally be disease and symptom free. Treatment should be individualised to take account of the severity of each patient’s endometriosis and to minimise the side effects of treatment.
Laparoscopic surgery with excision and removal of all the endometriosis is the best treatment for most levels of endometriosis.
Minor surgery, in the form of laparoscopy/laser treatment, may in some cases be as effective as drug treatment in relieving symptoms and producing pregnancies. It has a definitive role to play in the management of mild or moderate endometriosis.
Laparotomy (major open, large cut surgery) should hardly ever be used even in severe endometriosis.
Hormonal (drug) therapy can be used as a primary method of treating minor endometriosis. It is less invasive than surgery but often less effective.
All forms of hormone therapy have potential side effects. These are usually minor in nature, are tolerated and it is uncommon to have to change a drug once it is started by a patient. However, doctors must be flexible if the patient is experiencing problems.
Before drug treatment is ceased, or soon after, a “second look” laparoscopy can be performed to ensure it has worked and the endometriosis is gone.
Pregnancy can relieve endometriosis
Sometimes it is better to attempt to achieve a pregnancy to improve the endometriosis, rather than use hormonal or surgical treatment. This decision will depend on the individual patients fertility needs.