What to Consider For Endometriosis Treatment?
- Desire to get pregnant
- Severity of symptoms
- Stage of the disease
The treatment for endometriosis can be in the form of medical, surgical or combined therapy.
Medical Treatment for Endometriosis
This is a form of treatment that should be preferred for patients suffering from endometriosis, who do not have the will to have a child, have a big chocolate cyst (endometrioma), have painful period cycles, feel pain during intercourse, and have chronic pelvic pain.
With medical treatment, endometriosis cannot be cured; it is only possible to eliminate the symptoms mentioned above and correct menstrual irregularities. If the patient discontinues the treatment, the same symptoms may begin to appear again.
What is used in medical treatment include:
- Oral contraceptives
- Non-steroidal anti-inflammatory drugs
- GnRH analogues
Recently, arachis inhibitors have been added as well. Rarely, antidepressant drugs may also be added to the treatment. The benefits of the medical treatment for chocolate cysts have not been seen.
Surgical Treatment for Endometriosis
This treatment method is preferred when endometriomas are greater than 5 cm in diameter, and the patient’s pain still resists to treatment with medicine, including dysmenorrhea, dyspareunia, and chronic pelvic pain. This is also relevant if there is pain caused by deep endometriosis. If endometriomas are smaller than 5 cm, and there is no severe pain, and especially if the patient is single, surgical treatment should be avoided.
Surgical treatment may be laparoscopic or open. Open surgery should be performed in accordance to the principles of microsurgery.
Laparoscopic surgery is more preferred than open surgery. The reasons for this include:
- The percentage of possible postoperative adhesion is less in laparoscopic surgery
- The length of hospital stay is shorter
- Postoperative pain is less
- The healing process of the patient is shorter, so they return to their daily activities and working life earlier.
- The postoperative complication rate is less.
- It has cosmetic superiority; post-operative scarring is hardly seen.
Different techniques for endometriomas have been used in laparoscopic surgery. These include:
- Aspiration of cyst fluid
- Aspiration of cyst fluid and cauterization of cyst skin
- Removal of the cyst with the capsule
Aspiration of the cyst fluid is not a preferred method, because in such patients it has been observed that the cyst returns shortly after. By cauterization of the cyst skin after the aspiration of the cyst fluid, the risk of ovarian reserve is also reduced. It is a technique that can be applied in cases when the cyst cannot be taken out with the capsule.
The technique of fully removing the cyst with a capsule is the most reliable and preferred one. The risk of the reappearance of the cyst after an operation using this technique is less than others.
Patients with infertility have a high rate of conception during the first year following the operation. Therefore, patients, who are young and whose infertility period is not long may be expected to have a spontaneous pregnancy in the first year following the operation.
In cases of deep endometriosis, or where bilateral cysts cannot be removed completely, the medical treatment (with GnRh anogram) which is performed for a period of 3- 6 months following the operation decreases both the recurrence rate and prolongs the painless period.