How is endometriosis treated?
Endometriosis can be treated at the time of diagnosis. Endometriosis is diagnosed using a surgical procedure called laparoscopy. Endometrial lesions (implants of endometrial tissue outside of the endometrium) can be cut away (excised) or burned away using a high-energy heat source, such as a laser (ablated). Treatment with laparoscopy is more difficult with advanced disease that involves large areas of the rectum or larger lesions.
How are endometriomas treated?
Several surgical treatments are available for endometriomas. They are:
Simple puncture: This procedure is completed by draining the fluid from the cyst. Endometriomas have been shown to recur in more than 50 percent of the patients treated with simple puncture. However, a more aggressive surgical approach, such as cutting away the mass, can cause extensive adhesions (scar tissue) that may prevent the ovary from releasing an egg. Therefore experience is required to prevent damage.
Ablation: Another approach is to drain the cyst and remove its base with laser or electrosurgery. However, heat can also damage the ovary.
Cutting away of the cyst wall: This is the procedure of choice to decrease recurrence of disease. This procedure can also damage the outer layer of the ovary that contains the eggs.
Draining, drug therapy, and surgery: Endometriomas can also be drained, treated with medication, and later removed by surgery.
Results from several different prospective studies have reported pregnancy rates of 50% over 3 years. There are no randomized clinical trials comparing these different treatment methods.
How is advanced endometriosis treated?
The most challenging surgery by laparoscopy or by laparotomy (traditional abdominal surgery, which requires a larger incision) is the management of advanced endometriosis within the pelvic cavity and the rectum and vagina. Several studies have reported pregnancy rates over 2 years of 50% to 60% of cases treated with surgery. According to several reports, endometriosis may recur in 20% of the cases.