Endometriosis Consultant explains latest treatments

Lead Consultant Gynaecologist from University Hospital London, Mr Ertan Saridogan has provided patients with a thorough, plain English overview of what endometriosis is, the symptoms and the latest evidence-based approaches to effective treatment.

Mr Saridogan summarises the latest research and describes what this means in real terms. He says, "Surgical treatment of endometriosis is probably the most effective form of treatment.  There is evidence from randomised controlled trials that surgical treatment is effective in improving pain associated with endometriosis.  Comparative trials show improvement of pain or quality of life in approximately 60-70% of women following surgical treatment of endometriosis.  

With regard to how treatments for endometriosis affect fertility, Mr Saridogan goes on to say, "Surgical treatment also improves chances of natural pregnancy in couples who have endometriosis associated infertility.  A review of randomised controlled trials showed approximately 1.6 times higher spontaneous pregnancy rates following surgery for early endometriosis compared to no treatment.  The evidence on the effectiveness of surgery in advanced endometriosis comes from retrospective case series and there are no randomised controlled trials.

Some women choose medical treatment instead of surgery; medical treatment may also be necessary when symptoms persist after surgery or when surgical treatment is not possible or appropriate.  The most commonly used medical treatment approaches include:

• the combined oral contraceptive pill,
• levonorgestrel intrauterine system (Mirena®),
• gonadotrophin releasing hormone analogues (GnRHa) or progestogens (progesterone hormone derivatives).  

These options are usually equally effective in controlling the symptoms of endometriosis; however they do not eliminate it.  Hence the recurrence of symptoms after discontinuation of treatment is very common.  The side effect profile of these drugs varies and the duration they can be used depends on their side effect profile.  

A recent addition to the medical treatment options for endometriosis is aromatase inhibitors such as arimidex or letrozole.  These drugs may particularly be helpful for a small group of women who still have symptoms of endometriosis after menopause.

Analgesic drugs are usually an essential part of medical treatment for patients with significant pain.  Paracetamol, codeine, nonsteroidal anti-inflammatory drugs such as aspirin, ibuprofen, mefenamic acid or diclofenac may all be used for this purpose.  Some women will benefit from complimentary treatment approaches, dietary changes and psychological support.  Input from patients support groups would also be useful.

The full article - Endometriosis, latest treatment options