A multi-disciplinary holistic approach is considered best practice treatment. This usually includes medical, surgical and sound self-management practices. Work with your health team to consider the treatment options best suited to your needs. This usually depends on:
- your age
- the severity of your symptoms
- whether you plan to have children
- the extent of endometriosis
- your preference
Endometriosis can be well treated and managed but until the cause is determined, no particular treatment will provide a guaranteed cure.
In New Zealand, you can access an appointment with a gynaecologist by getting your GP to refer you to the DHB in your area. If you have private health insurance you can refer yourself to a specialist gynaecologist by directly making an appointment. However, a letter of referral from your GP is recommended.
Laparoscopic Surgery (key-hole surgery)
Laparoscopic surgery (performed in hospital under general anaesthetic) is the only definitive way to diagnose endometriosis.A laparoscope is inserted through a small incision at the base of the navel so the internal organs can be seen. Several small incisions on the lower abdomen are also necessary. The extent of the disease is generally noted at this time and photos can be taken to explain to you afterwards. The aim of a laparoscopy is to remove all the endometriosis and adhesions if they are found. As with all surgery there is an element of risk which should be discussed with you and of course your consent must be in written form prior to any procedure. The success of surgery depends greatly on the skill of the surgeon and the thoroughness of the surgery.
Sometimes it can take weeks or even months to feel the benefits of surgery. Give yourself that healing time and work with your doctor to ensure the best outcomes.
This procedure removes the uterus and is sometimes considered in severe cases of long-standing painful and extensive endometriosis and or adenomyosis.
While the symptoms of endometriosis are often eliminated or helped by hysterectomy, it does not ‘cure’ endometriosis. The decision to proceed with hysterectomy will be dependent on many factors such as your age, fertility and daily function.
Removal of one or both ovaries (oophorectomy or bi-lateral oopherectomy) may be considered but usually only where they have been severely damaged with endometrioma(s). If both ovaries are removed, symptoms of menopause (surgically induced menopause) will usually be experienced. Hormone Replacement Therapy (HRT) is usually recommended and will be dependent on factors such as age, medical history and personal choice.
Sometimes symptoms persist even after major surgery and will require thorough review to find the cause. Expertise from other health practitioners and a pain team is often recommended.
Medical treatments are often used as a first line treatment to control symptoms. They are often used in conjunction with surgery. It’s important to understand how medications work so you can make informed choices. There are no known medications which cure endometriosis. Here’s some which are commonly used:
Pain medications work best when taken on time and before the pain gets too bad. Many are available without prescription and advice should be sought from a pharmacist to ensure the brand you are buying is going to give you the best relief. Sometimes combinations of drugs (e.g. an anti-inflammatory and pain relief preparations taken together) can be very effective but it is crucial that you seek expert advice from your doctor or specialist. You may need prescription pain medication from your doctor or specialist.
The Contraceptive Pill can help to balance and regulate periods and often eases distressing symptoms. If you choose to go on the pill, it’s important to be prescribed the one that is best suited to your condition. Some oral contraceptive pills can mask symptoms but not the progression of endometriosis – this is especially important if you have NOT had a diagnosis. Depo Provera (the injection) may also be offered. Other hormone medications might be recommended. These aim to reduce the growth of endometriosis by suppressing oestrogen
GnRH analogues such as Zoladex (sub-cutaneous injection) are commonly prescribed. It’s important to discuss the benefits and side effects with your doctor.
Intrauterine device or system (IUS) like Mirena® (placed inside the uterus) is a contraceptive which slowly releases a hormone and lasts for about five years. It’s often used to treat heavy bleeding and can lessen painful symptoms. This is sometimes fitted at the same time as laparoscopic surgery.
Natural painkillers such as magnesium can relieve pain. Follow the guidance of a medical herbalist or natural health practitioner.
Unfortunately there is no evidence that medical treatment for endometriosis improves fertility outcomes but they can improve symptoms.
More specific information on medications commonly used and the side effects can be found in the book “Endometriosis and Pelvic Pain” or contact us. It’s important to be informed about all medications.