Endometriosis is a chronic condition that often disables a person. To date there is no curative method for endometriosis, the existing methods help to manage the symptoms of the disease and to remove endometriosis lesions. These are pain relievers, hormonal drugs and surgery. The most effective method is excision, a surgical way to remove endometriosis lesions.
As a result of the lack of information among doctors, many patients end up seeing several doctors and receiving several methods of treatment, without having the expected results. Being a complex condition, endometriosis requires a multidisciplinary approach, in a team experienced in this pathology. Surgical therapy is divided into ablation (burning of tissue) and excision (removal of tissue). Cohort studies show that of all the treatment methods, the method that has a low recurrence rate and that, in some cases, can cure the disease, is excision.
Important to know
- Hysterectomy does not cure endometriosis
- Removing the ovaries does not cure endometriosis
- Pregnancy does not cure endometriosis
- Menopause does not cure endometriosis
Drug therapy
Analgesics: A first method of relieving the symptoms caused by endometriosis is the administration of analgesics.
Contraceptives: Contraceptives have the role of reducing/inhibiting menstruation, and relieving menstrual pain.
Progestin: Progestin, a man-made form of progesterone is available as intrauterine devices, implants, injections (Depo-provera) or pills.
GnRH agonists and antagonists: Gonadotropin-releasing hormone therapy that mimics menopause is another treatment method used in endometriosis, based on historical observations that, after menopause, the disease can be cured.
Surgical therapy: Excision
Excision involves the removal of endometriotic tissues from the surrounding tissue using various surgical instruments such as scissors or electrosurgery. This method does not destroy tissue, so the surgeon can send a biopsy of the excised tissue to the pathologist to confirm the diagnosis of endometriosis or other conditions.
Excision can be used both in the case of superficial lesions and in the case of deep lesions or endometriotic nodules that infiltrate different organs. Excision also allows the surgeon to separate the endometriosis lesions from the surrounding tissue, thus ensuring that the entire implant is completely removed.
Endometriosis most often affects the peritoneum, which is a thin membrane that covers the visceral organs. Excision allows this layer to be peeled away, and so the endometriotic tissue can be removed. Deep endometriosis tissue requires more removal, and in order to achieve a complete resection of the tissue, normal healthy tissue must be identified from abnormal tissue, and excision allows this.
Surgical therapy: ablation
Ablation means burning or vaporizing endometriosis lesions using thermal energy. At the time of laparoscopy, endometriosis is visually identified and then an instrument that uses an electric current to produce heat is used to vaporize or burn the affected tissues. There are a number of disadvantages to this approach, including the fact that a specimen is not obtained for pathological diagnosis.
Thermal ablation techniques do not completely destroy the endometriotic tissue and only allow treatment of superficial disease. Lesions that appear superficial are often deep lesions, so these methods vaporize the surface of a lesion and leave behind active disease, especially in the case of nodules that infiltrate the uterosacral ligaments.
In the case of deep endometriosis affecting the bowel, bladder, ureters or major vessels, there is a risk of damaging the underlying tissue and as a result, the surgeon will not treat these lesions for fear of damaging these organs. Again, active disease may remain in the pelvis and will continue to cause pain.