The treatment of endometriosis depends upon the needs of the individual patient.
Her goals – whether they be “immediate” fertility, pain management or pain management and future fertility must be considered when a treatment plan is proposed. At our New Jersey fertility center, Dr. Jane Miller develops an individual treatment plan for and with every patient. There are medical, surgical and combination medical/surgical treatments and, while all are effective for pain, all are contraceptive.
The medical treatments for endometriosis all work by temporarily eliminating ovarian activity. When ovaries are quiescent anything dependent upon their function – ie endometriosis – will recede. Pelvic adhesions, if any, are not affected by medical treatments. Most dysmenorrhea (painful periods) and dyspareunia (painful intercourse) however, are the result of active endometriotic lesions and not the adhesions or scars. Current medical treatments include the oral contraceptive pill, the progestin – only pill, the progesterone – secreting IUD, and Lupron injections.
Surgery for endometriosis is usually performed laparoscopically on an outpatient basis. A thin (5 – 10 mm) telescope or laparoscope is inserted through the umbilicus into the pelvis. Surgical instruments are introduced into the pelvis via additional small “punctures” – usually one or two. The endometriosis lesions can be visualized and cauterized, lasered, or cut out. Endometriosis adhesions can be cut as well if necessary but they can reform quickly. This must be taken into consideration if a patient with adhesions is trying to conceive. Surgery followed by in vitro fertilization may be the wisest plan for such a patient. Endometriomas – collections of endometriosis in ovarian cysts, need to be resected. Surgical removal of the cyst wall of an endometrioma provides the patient the best chance that the endometrioma will not reoccur.
As endometriosis is a chronic disease that is promoted by cycling ovaries there is no quick fix for the problem. If surgery is done to eliminate the endometriosis lesions the latter will return, often within 8 to 18 months, unless the ovaries are medically “shut down”. If a woman wishes to conceive and there are no other factors preventing pregnancy she may resume normal intercourse within days of surgery. If she underwent surgery for pain it is wise to treat her medically after surgery until such time as she is ready to get pregnant. In that way it is less likely that the endometriosis will return and, once again, be an obstacle to conception. At our New Jersey fertility center Dr. Jane Miller shares her nearly thirty years’ experience diagnosing and treating endometriosis and helping patients become pain – free and, when ready, pregnant.