Endometriosis is such a variable condition that individualisation of the approach to management is important in all cases.
Treatment approaches of endometriosis could involve non-surgical or surgical treatments or both.
Traditional Medical Treatment
First line treatment
- Non-steroidal anti-inflammatories ( NSAIDs )
- Cyclic oral contraception
Second line treatment
- Continuous oral contraception
- Progestogens such as visane
Third line treatment
- GnRH agonist or antagonist with or without add-back estrogen therapy
- Aromatase inhibitors such as Letrozole
Modern non-surgical (medical) approaches
- Selective estrogen receptors modulators (SERMS) such as TZE 5323
- Selective progesterone receptor modulators (SPRMS) such as J867, J912
- Anti-angiogenesis such as ICON
- Statins (anti-oxidants)
Conservative surgery for endometriosis
Conservative laparoscopic surgeries for infertility related endometriosis such as excision of endometriosis, excision of endometrioma or release of adhesions can improve pregnancy rates
- 67-75% cumulative pregnancy rates in three years after treating mild disease
- 20-75% pregnancy rates after treating severe or advanced disease
- Improved pregnancy rates for laparoscopic surgery after failed IVF
Endometriosis population are merely young women in their reproductive age, all measures should be exhausted to preserve their uterus & ovaries, however for advanced cases/recurrent cases or cases who have completed their families, Hysterectomy + removal of both ovaries could be the last resort of treatment.