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Treating endometriosis

Currently, there is no cure for endometriosis. The different treatments available aim to reduce the severity of symptoms and improve the quality of life for someone living with the condition.

Treatment for endometriosis at any given point will depend upon a range of factors including age, current symptoms, clinical history, the extent of the condition, co-morbidities, cultural considerations, and your preference and priorities which may include pain management and/or fertility. 

Surgical treatment 

A laparoscopy is a surgical procedure that can diagnose and treat endometriosis and is the gold standard for diagnosing endometriosis. It may be day surgery or an overnight stay in the hospital, or sometimes longer depending on the extent of the surgery and recovery.

Performed under general anaesthetic by a gynaecologist with specialist surgical skills, laparoscopy is the preferred surgical treatment because the smaller incisions lead to quicker healing and faster recovery time.

Highly skilled endometriosis surgeons can excise (remove) endometriosis, divide adhesions, check the patency of the fallopian tubes, and may be able to repair damage caused by endometriosis.

Some studies have shown that following excision surgery the risk of recurrence can be significantly reduced with a long-term hormonal treatment, which may be a major consideration in the lifetime choice of therapies.

Read here what happens during a laparoscopy +

It's important if you have surgery that you understand how your surgeon will remove any endometriosis found. Excision surgery is the gold standard and, based on the surgeon's skill level, is the only surgical treatment that can fully remove endometriosis from locations. Excision surgery involves cutting the endometriosis out at the root and also includes removing healthy tissue surrounding the endometriosis. 

 

It's important to know that ablation surgery, which involves burning the surface layer of the endometriosis off, is no longer recommended by local guidelines.

Preparing for surgery

Laparoscopic surgery is different for everyone, and your experience will be based on the extent of your surgery, length of stay, your surgeon, how you respond to pain, and your expectations. Each person also heals differently - recovery can take from a few days to several weeks.

To help you prepare for surgery, ask questions and talk about any worries you have with your surgeon, anaesthetist, and the staff and nurses at the hospital.

 

Laparoscopy in the public hospital system may be done on an outpatient basis, but an overnight stay or longer may be required depending on the time of day you have your surgery and whether the surgery is complex or lengthy.

Here are some questions you may want to ask about your surgery and what answers to expect +

Download our surgery packing list here

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Recovering from surgery

Everyone recovers differently and how long it takes for you to recover can depend on the complexity of your surgery and how long it took.

Read more about what happens when you wake up from surgery in hospital +

You may be tired and groggy for 2-3 days following your laparoscopy. Soon after your surgery, you will be encouraged in the hospital to get up and move around. Make sure you continue to move around once you are at home, as this will help with recovery, and reduce the risk of adhesions (scar tissue).

If you have an elevated temperature, and/or unusual discharge, or have any other concerns, contact the surgeon’s office or your GP, or head to an after-hours clinic. 

Walking is a great way to exercise after surgery, start with small walks and increase how long you are out for every few days. Around six weeks after your surgery you should be able to exercise as normal, but check with your health professionals. 

Your attitude towards post-operative recovery will help your body heal and how you feel in yourself.

Menstrual periods after surgery

You may find that your first few periods are painful, longer, and/or heavier than usual. If you are concerned about the pain, or if your pain is severe, contact your doctor.

Follow up appointment

Your surgeon may after your laparoscopy let you know what stage/classification of endometriosis they found during the procedure but you will also have a follow-up appointment, which is typically six weeks after surgery. At this follow-up appointment, you will talk about:

  • how your recovery has been

  • look at images from surgery

  • give you the pathology results of the lesions excised and determine the stage/grade or category of your endometriosis

  • ongoing treatment and a management plan, and your gynaecologist may recommend ongoing hormonal treatment to reduce the risk of further endometriosis (reoccurence)

 

The commonly used American Society for Reproductive Medicine (ASRM) Staging System divides endometriosis into four 'stages' or 'grades' according to the number of lesions, depth of infiltration, presence of ovarian cysts, and extent of adhesions. The stages can be useful to determine the complexity of the surgery, with stages III and IV requiring highly-skilled surgeons.

Discover the ASRM stages/grades +

 

The ASRM system scores often do not match the level of pain a person can be in and the Endometriosis Foundation of America proposes a different classification based on the type of endometriosis.

Find out more about the Endometriosis Foundation of America categories +​​

Hormonal treatment

The aim of hormone treatments is to change the cycle of reproductive hormones to:

  • control symptoms, especially pain

  • improve quality of life

  • significantly reduce risks of recurrence following excision surgery

 

Your GP or gynaecologist may recommend hormonal treatments while you wait for surgery or if you do not want surgery. Some studies have shown that following surgery, endometriosis recurrence can be significantly reduced with long-term hormonal treatment.

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Some of these hormonal treatments are birth control (contraceptive) pills and its important to remember you might be prescribed these not for birth control reasons but to give you relief from your symptoms.

The different types of hormonal treatments all work in very different ways. 

It’s important to understand the different hormonal treatments and talk to your doctor about the possible side effects and impacts of taking any treatments long term.

Progestin-only options

Progestin-only treatments that thin the endometrium may have a similar effect on endometriosis and may also directly reduce inflammation. They can be delivered in pill form as well as long-term intra-uterine and implantable devices, which can be combined if symptoms are not sufficiently controlled.

Progestin-only contraceptive pill (POP / Minipill)

  • Cerazette (Desogestrel)

  • Microlut (Levonorgestrel)

  • Noriday (Norethisterone)

Minipills must be taken at about the same time each day to prevent periods (amenorrhoea). Cerazette also prevents ovulation, so can be good for endometrioma. It can be less time-sensitive, but sadly is not fully-funded. 

Other progestin medications

  • Primolut (Norethisterone)

  • Provera (Medroxyprogesterone acetate)

  • Siterone (Cyproterone acetate)

These medications are more usually prescribed for other conditions such as abnormal menstrual bleeding, skin and hair conditions.

Intrauterine devices (IUD)

  • Mirena

  • Jaydess

Intrauterine Devices are small T-shaped frames made from a pliable plastic placed inside the uterus (womb). Often prescribed for heavy periods, the devices contain the progestin Levonorgestrel which is slowly released over several years.

As a treatment for endometriosis, Mirena typically lasts for three years and the smaller Jaydess for two years (as a contraceptive Mirena for five years and Jaydess for three years).

IUDs are commonly fitted by Family Planning clinics, by some GP’s, and may be placed during surgery.

Recent studies have shown that fertility quickly returns after removal.

Implantable device (Jadelle)

 

Jadelle uses the same progestin as the IUD’s (Levonorgestrel) and works similarly, but in the form of a pair of plastic rods inserted beneath the skin – generally on the inside of the upper arm. They have a similar lifetime to Mirena, but women over 60kg may find them less effective over time.

They are commonly fitted by Family Planning clinics and by some GP’s.

Choosing a hormonal treatment

It’s important to discuss the various treatments with your doctor to choose the best option for you. There are advantages and disadvantages to all types of treatments, and everyone's experience is different. It may take some time and trial and error to find the right combination for you. 

The best treatment combination for you may well change over your lifetime experience of endometriosis.

Hormonal treatments are not a cure for endometriosis but they can relieve or stop symptoms but not the cause.

Visit our Info Hub

You can also download all of the information on this webpage in our FREE information guides, visit our info hub for the full range of guides. 

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We rely on the support of our community to provide the resources and support that people with endometriosis need. There are many ways to get involved and make a difference, from making a donation to volunteering your time.

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