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Hysterectomy and endometriosis
There is no perfect way of managing endometriosis. The three basic treatment approaches are:
The choice depends on a number of factors, including the woman's symptoms, her age, whether fertility is a factor, and the severity of the disease.
Delaying treatment may be most appropriate for women with mild endometriosis or those who are approaching the age of menopause.
Women may also use lifestyle modifications, such as exercise and relaxation, to cope with their pain. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil) and naproxen (Aleve), or acetaminophen (Tylenol), can help provide some pain relief.
Hormonal therapies are used to mimic states in which ovulation does not occur (such as pregnancy or menopause) or to directly block ovulation. Hormonal drugs include oral contraceptives, progestins, GnRH agonists, and danazol. They can be very effective in relieving endometriosis symptoms. Some of these drugs may also be used after surgery to help prevent recurrence of endometriosis. Downsides of these drugs include:
Surgery is an option for women who:
There are two basic surgical approaches for endometriosis:
In choosing between hysterectomy (with or without removal of the ovaries) and conservative surgeries, age and the desire for children are important factors.
For women with severe endometriosis who want to become pregnant, conservative surgery (typically laparoscopy) is the appropriate approach for restoring fertility. Hormonal therapies that treat endometriosis itself, such as GnRH agonist or progestins, generally do not help fertility. If surgery fails, fertility drugs and artificial reproductive technologies, such as in vitro fertilization, are options. Women with endometriosis who are trying to conceive should discuss all treatment options with a fertility specialist. [For more information, see In-Depth Report #22: Infertility in women.]
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