Treatment of pelvic endometriosis:
The treatment of pelvic endometriosis must aim for the complete removal of all the active sites while preserving as much as possible the internal genitalia (that is, uterus, uterine tubes, and ovaries). It should also eliminate the adhesions frequently formed between the pelvic organs during the disease; these adhesions and fibrotic changes produce intense pain during the active phase of the disease.
Laparoscopy is the “gold standard” for the endometriosis therapy; it is the only surgical treatment ensuring precision and repeatability, along with low trauma and pain for the patient. It can be performed multiple times to allow a total eradication of endometriosis.
The surgical procedures range from simple removal of the active sites to hysterectomy and adnexectomy (removal of ovaries and uterine tubes) in the most serious cases. However, surgical therapy must always aim to be conservative. During laparoscopy, the surgeon can remove the active sites by using heat, a laser, helium vaporizers or via a small cut.
The uterus removal is not 100% effective in healing the patient, but it surely makes her infertile; therefore, it is not recommended.
If you want to preserve your fertility, discuss this aspect carefully with your gynaecological surgeon. The best result you can get is a disease eradication that restores the relationship among the internal genitalia. Comparative studies are currently conducted to identify the most effective treatment among medical and surgical therapies; the results indicate that the surgical removal of the active sites has the best performance in terms of reduced pain and prevented infertility (fact-finding survey conducted by the Senate of the Italian Republic).
Alternative therapies such as homeopathy, painkillers and acupuncture do not eradicate endometriosis.
Neither pregnancy eradicates endometriosis, but it makes the patient feel much less pain; however, the symptoms generally increase afterwards (Dati Popolazione Italiana 2009 – Endometriosi ed Infertilità).
The medical treatment utilizes drugs, called GnRH agonists, that block the ovarian hormones. In practice, they prevent the hypothalamus (a gland located in the brain) from producing GnRH (gonadotropin-releasing hormone), a substance that stimulates the hypophysis which, in turn, allows the functioning of the ovaries. These drugs induce temporary menopause, which presents all the symptoms of real menopause: vaginal dryness, calcium loss, hot flashes, etc.
At present, low doses of such drugs can be combined with female hormones to reduce effects like temporary menopause; however, these treatments do not eradicate the disease.
This therapy lasts 6 months or more, according to the disease level.
Low-dose birth control pills can also be used to treat endometriosis, but only to relieve the symptoms. Besides, the prescription of oral contraceptives is off-label, that is, outside the indications provided by the Ministry of Health; the literature data are conflicted about the effects of such medications on endometriosis.
Other drugs are currently under study, with promising results. You can consult the section Italian Endometriosis Centre to discover which treatments are conducted there.
Laparoscopy at the Italian Endometriosis Centre
To diagnose certain problems, a doctor needs to look directly inside the abdomen and the reproductive organs. This is possible via laparoscopy.
The term laparoscopy derives from the Greek language and means “view of the abdominal cavity”. The laparoscope is a sort of telescope that is inserted in the abdomen through a small cut (incision); it brings light into the abdominal cavity, allowing the doctor to see inside. Laparoscopy is conducted as day surgery or with a brief hospitalisation.