The things to be considered for the Treatment of endometriosis are as below;
- The patient’s age,
- The patient’s will to get pregnant,
- The severity of symptoms,
- The stage of the disease
The treatment can be in the form of medical, surgical or combined therapy.
It is a form of treatment which should be preferred with the patients with endometriosis who do not have the will to have a child and big chocolate cyst (endometrioma), and who have painful period cycles, feel pain during intercourse and have chronic pelvic pain.
Within medical treatment, the disease cannot be cured; it is only possible to eliminate the symptoms mentioned above and correct menstrual irregularities. After discontinuation of the treatment, the same symptoms may begin to appear again.
The things used in medical treatment are:
- Oral contraceptives
- non-steroidal anti-inflammatory drugs
- GnRH analogues
Recently, arachis inhibitors have been added to these. Rarely, antidepressant drugs may also be added to the treatment. The benefits of the medical treatment for chocolate cysts have not been seen.
It is a treatment method which should be preferred when endometriomas is greater than 5 cm in diameter, there is a resistant pain to the treatment with medicine (dysmenorrheal, n the treatment of pain resistant to treatment (dysmenorrhea, dyspareunia, chronic pelvic pain) and especially there is a pain caused by deep endometriosis. If endometriomas is smaller than 5 cm, there is no severe pain and especially the patient is single, surgical treatment should be avoided.
Surgical treatment might be laparoscopic or open. Open surgery should be performed in accordance with the principles of microsurgery.
Laparoscopic surgery is more preferred than open surgery.
The reasons for this are:
- 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 she returns to her daily activities and working life earlier.
- 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 are:
a- aspiration of cyst fluid,
b- aspiration of cyst fluid and cauterization of cyst skin,
c- Removal of the cyst with the capsule.
Aspiration of the cyst fluid is not a preferred method because in such patients it is seen that the cyst repeats 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 which can be applied in the cases when the cyst cannot be taken out with the capsule.
The technique, fully removal of the cyst with capsule, is the most trustable and preferred technique. The risk of recurrence of the cyst after an operation with this technique is less than other techniques and is much later.
Infertility patients 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, are expected to have spontaneous pregnancy in the first year following the operation.
In cases of deep endometriosis or in cases 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.