How can my endometriosis be treated?

In order to decrease endometriosis recurrence after surgical therapy, it has been proposed to use a post-surgical oestrogen-lowering medical treatment. Results from previous trials on this topic are contradictory.

Methods:

A total of 89 women were randomized, by computer-generated list, after laparoscopic conservative surgery for symptomatic endometriosis stage III-IV to receive monthly i. M. injections of gonadotrophin-releasing hormone (GnRH) analogue, leuprolide acetate depot (3.75 mg) for 3 months (n = 44) or to an expectant management (n = 45). All patients were followed up every 6 months for evaluation of pain symptoms, fertility and objective disease recurrence.

Results:

During the follow-up, which ranged from 6-36 months, five (33%) of the 15 women who wanted children and who were allocated the GnRH analogue and six (40%) of the 15 given no treatment became pregnant (not significant). Moderate/severe pelvic pain recurred during the follow-up in 10 (23%) of the women allocated the GnRH analogue and 11 (24%) of those allocated no treatment; the cumulative pain recurrence rates at 18 months were 23 and 29% respectively (not significant). Four women (9%) treated with GnRH analogue and four women (9%) who received no treatment had objective disease recurrence as demonstrated by gynaecological examination and/or pelvic ultrasonography.

Conclusions:

This study does not support the routine post-operative use of a 3 month course of GnRH analogue in women with symptomatic endometriosis stage III-IV.

Please click on the required question.

•  Pelvic Pain. Is this a common problem?
•  What are the common causes of pelvic pain in women?
•  What are the more common gynaecological causes of pelvic pain?
•  What are the more common non-gynaecological causes of pelvic pain?
•  What are primary and secondary dysmenorrhoea - painful periods?
•  What is retrograde menstruation?
•  How can dysmenorrhoea - painful periods be treated?
•  What are ovarian cysts?
•  How do ovarian cysts cause pain?
•  How are ovarian cysts diagnosed?
•  How are ovarian cysts treated?
•  I think I may be pregnant and I have some pelvic pain. What should I do?
•  What is pelvic inflammatory disease and how can it be treated?
• Mittelschmertz

FIBROIDS

•  What are fibroids?
•  I have fibroids. What difficulties might they cause for me?
•  How are fibroids diagnosed?
•  How could my fibroids be treated?

  ENDOMETRIOSIS

•  What is endometriosis?
•  How prevalent is endometriosis?
•  What causes endometriosis?
•  How can my endometriosis be treated?
•  How can my doctor determine the cause of my pelvic pain?
•  What investigations might be recommended by my gynaecologist to investigate my pelvic pain?
•  What is laparoscopy?
•  What are pelvic adhesions?
•  I have chronic pelvic pain. Could this be related to adhesions?
•  What is uterine retroversion (retroverted uterus)
•   Does a retroverted uterus (backward tilted uterus) cause symptoms?
•  How is a retroverted uterus - backward tilted uterus - treated?
•  What is pelvic congestion?
•  What causes pain associated with sexual intercourse (dyspareunia)
•  How can painful sexual intercourse (dyspareunia) be treated?
•  What is a pelvic mass?

  IRRITABLE BOWEL SYNDROME - IBS

•  What is irritable bowel syndrome?
•  How can we find out if I have irritable bowel syndrome?
•  Is irritable bowel syndrome (IBS) a common condition?
•  What causes IBS?
•  What is the pain associated with IBS like?
•  Can IBS be mistaken for gynaecological problems?
•  How can my IBS be treated?
•  What other treatments are available for IBS?
•  What can be done to reduce the amount of bowel gas(flatus)
•  What is constipation?
•  What causes constipation?
•   How can constipation be treated?
•  How could we summarise the treatments that are available for my pelvic pain?
•  Where can I obtain more information?
•  Pelvic Pain Support Groups.
•  Endometriosis Support Groups.
•  IBS Support Groups.




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This is the personal website of David A Viniker MD FRCOG, Consultant Obstetrician and Gynaecologist at Whipps Cross University Hospital, London - Specialist Interests - Reproductive Medicine including Infertility, PCOS, PMS, Menopause and HRT.

I do hope that you find the answers to your women's health questions in the patient information and medical advice provided.