Endometriosis: Treatment

The treatment strategy depends upon the severity of disease, proximity to menopause, and whether the patient hopes to become pregnant. After menopause, symptoms will likely improve dramatically, even in severe disease.

Analgesics (eg, NSAIDs) and oral contraceptive pills are indicated for pain relief. Oral contraceptives may also reduce the risk of ovarian cancer.¹

Gonadotropin–releasing hormone (GnRH) analogs, danazol, or progestins (eg, norethindrone acetate, intrauterine levonorgestrel) may be very helpful. GnRH analogs (eg, nasal nafarelin, leuprolide injections, goserelin implants) decrease ovarian estrogen production, preventing the pain–inducing stimulation of ectopic endometrial tissue. Treatment usually lasts at least 6 months. These agents cause a temporary decrease in bone density that has not been shown to be clinically important. Supplemental estrogen or norethindrone acetate may minimize the side effects of hot flashes and bone mineral loss.

Medical therapy affords long–term relief in about 50% of patients. Surgery is often used for severe or intractable disease, although it has not been proven superior to medical therapy. Laser ablation or electrocautery of endometrial implants and adhesions may treat the pain, decrease the rate of recurrence, and restore fertility. If there is no desire for future pregnancy, definitive treatment is total abdominal hysterectomy with bilateral salpingo–oopherectomy. However, most patients can be managed effectively without such extreme measures.