How should I treat endometriosis?

The answer to that question is totally dependent upon what your goals are. Initially, pain control is most important. Reductions in pain can sometimes be obtained by simply taking noncylic low dose birth control pills. (Skip the inactive last seven pills and have no periods). Endometriosis can be suspected clinically, but can only be diagnosed with laparoscopy.

Endometriosis can also be treated laparoscopically by destroying visible endometriosis with electrical energy (heat), excision, or by laser. Pain is often reduced but microscopic endometriosis is not treated. Endometriosis needs estrogen to grow and remain active. There are hormone treatments which will induce a month by month menopause.

With low estrogen levels you will have hot flashes, but the pain should resolve. Lupron is the most commonly used medication. Unfortunately many women with endometriosis will have recurring pain with the above mentioned conservative treatments. These treatments may be repeated, and may be effective each time.

Eventually, when your family is complete and if pain has returned, many women resort to hysterectomy, probably with removal of the ovaries. That is a dramatic step, but does in most all cases end the pain from endometriosis. Hormone replacement is possible and it is uncommon to have recurrences on reasonable doses of hormone replacement. There is hope. You can be free from pain.

Unfortunately, until the final definitive treatment, it is also likely to be a recurring problem. It is for that reason that I say that endometriosis treatment should be goal oriented, depending upon where you are in your life. It's not OK to have a hysterectomy when you want to have children. It may never be OK with you to have hysterectomy and lose your ovaries.

These are the topics you need to take the time to explore with your gynecologist. Don't accept only one proposal of treatment without considering your other options.

Dr. Paul Daum, M.D. Provides Complete OB/GYN Services

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