Treatment:

Treatment depends on the following factors:

• Age
• Severity of symptoms
• Severity of disease
• Whether you want children in the future

Some women with mild disease and symptoms may just be monitored. You should have regular exams every 6 to 12 months so your doctor can make sure the disease isn't getting worse.

Painkillers may be prescribed to relieve cramping and pain.

Treatment may involve stopping the menstrual cycle and creating a state resembling pregnancy. This is called pseudopregnancy. It can help prevent the disease from getting worse. It's done using birth control pills containing estrogen and progesterone. You need to take the medicine continuously for 6 to 9 months. This type of therapy relieves most endometriosis symptoms, but does not prevent scarring from the disease. Side effects include spotting of blood.

Another treatment involves progesterone pills or injections. Side effects may be bothersome and include depression, weight gain, and spotting of blood.

Some women may be prescribed medicines that stop the ovaries from producing estrogen. These medicines are called antigonadotropin drugs and include Synarel and Depo Lupron. Potential side effects include menopausal symptoms such as hot flashes, vaginal dryness, mood changes, and early loss of calcium from the bones. Because of the bone density loss, this type of treatment is usually limited to 6 months. In some cases, it may be extended up to 1 year if small doses of estrogen and progresterone are slowly given to reduce the bone weakening side effects.

Surgery (either laparoscopy or laparotomy) is usually only done if a women has severe endometriosis, including women with disease-related adhesions and infertility problems. The goal of surgery is to remove or destroy all of endometriosis-related tissue and adhesions, and restore the pelvic area to as close to normal as possible. In rare cases, nerve removal (neurectomy) may be done to relieve the pain.

Woman with severe symptoms or disease who do not want children in the future may surgery to remove the uterus ( hysterectomy), both ovaries, both fallopian tubes, and any remaining scar tissue or implants. Hormonal replacement therapy may be needed after removal of the ovaries.

Expectations (prognosis):

How well surgery helps improve fertility depends on the severity of the endometriosis. Pregnancy rates after surgery in women previously considered to be infertile are approximately 75% for mild endometriosis, 50-60% for moderate cases, and 30-40% for severe cases.

Complications:

Infertility may result from endometriosis, but not in every patient -- especially if the endometriosis is mild. Endometriosis has been known to come back even after a hysterectomy. Other complications are rare. In a few cases endometriosis implants may cause blockages of the gastrointestinal or urinary tracts.

Calling your health care provider:

Call for an appointment with your health care provider if symptoms of endometriosis occur, or if back pain or other symptoms come back after treatment of endometriosis.

Screening for endometriosis should be considered if your mother or sister has been diagnosed with endometriosis or if you are unable to become pregnant after trying for 1 year.