Medical vs Surgical Management of Endometriosis
Endometriosis is a chronic, often debilitating condition affecting 1 in 9 Australian women. It occurs when tissue similar to the endometrium grows outside the uterus, leading to inflammation, adhesions, and scarring. Endometriosis can significantly impact daily life, causing severe pelvic pain, heavy periods, painful intercourse, and infertility.
Endometriosis management requires a tailored approach, falling into two categories: medical (hormonal and pain management) and surgical (laparoscopy) treatments. For general practitioners (GPs), it’s important to guide patients in choosing the most appropriate treatment course. Factors such as symptom severity, reproductive goals, and disease progression should always be taken into consideration.
Pros and Cons of Hormonal Endometriosis Treatments
Hormonal therapy is often the first-line of treatment for endometriosis management, aimed at suppressing ovulation and reducing endometrial tissue activity. Common hormonal endometriosis treatments include:
- Combined Oral Contraceptive Pill (COCP): Regulates menstrual cycles and reduces endometriosis-related pain.
- Progestins: Such as depot injections, implants, and oral progestins help thin the endometrial lining and reduce inflammation.
- Gonadotropin-Releasing Hormone (GnRH) Agonists: Induce a temporary menopausal state to suppress endometrial tissue.
- Mirena Intrauterine Device (IUD): Releases localised progestin to reduce pain and bleeding.
Pros of Hormonal Therapy for Endometriosis
Hormonal endometriosis treatments are non-invasive and available through a GP prescription, making them a convenient option for most patients. They’re suitable for patients who do not wish to have surgical endometriosis treatment immediately as they can be used for long-term symptom management. Many women experience significant symptom relief from hormonal treatments
Cons of Hormonal Therapy for Endometriosis
While hormonal therapy alleviates symptoms, it does not remove endometrial implants. Hormonal therapy also has potential side effects, including mood changes, weight gain, nausea, and decreased libido. In particular, GnRH agonists may cause bone density loss with prolonged use. Once hormonal endometriosis treatment is discontinued, endometrial tissue may become active again, leading to recurrent symptoms.
Because patient responses to hormonal therapy vary, it’s important to tailor treatment based on their symptom severity, tolerance to side effects, and reproductive plans.
When to Consider Surgical Endometriosis Treatment
Laparoscopy is a surgical endometriosis treatment and is necessary for patients whose symptoms persist despite using hormonal therapy. Another reason for surgical intervention is when a woman is found to have endometriomas (large ovarian cysts related to endometriosis) or when deep infiltrating endometriosis is suspected. This more aggressive form of endometriosis can invade surrounding tissue, requiring surgical excision. Surgery may also improve fertility by removing endometriotic lesions affecting the fallopian tubes.
Laparoscopy is a minimally invasive procedure for endometriosis management and allows for:
- Diagnosis of endometriosis through direct visualisation and biopsy.
- Removal of endometrial lesions, alleviating symptoms and improving fertility.
- Removing scar tissue, helping restore normal pelvic anatomy and organ function.
Risks and Limitations of Surgical Endometriosis Treatment
Endometriosis has a high recurrence rate, especially if post-operative hormonal therapy is not initiated. Although laparoscopy is minimally invasive, complications such as infection, bleeding, or damage to surrounding organs can occur. Excision of ovarian endometriomas can also reduce ovarian reserve, which may affect fertility.
Laparoscopy can provide significant symptom relief, but long-term endometriosis management strategies should be in place to maintain its benefits.
Long-Term Management of Endometriosis
A multidisciplinary approach is essential for sustained endometriosis symptom control and improved patient outcomes. Following surgery, long-term endometriosis management should include:
- Hormonal Therapy: Post-operative hormonal therapy, such as COCPs, progestins, or GnRH agonists, can delay recurrence and prolong symptom relief.
- Pelvic Physiotherapy: Pelvic floor physiotherapy can be beneficial in managing chronic pain, improving pelvic mobility, and reducing muscle tension that contributes to discomfort.
- Psychological Support: Endometriosis can have a huge psychological impact, contributing to anxiety, depression, and emotional distress. Psychological support, such as counselling or support groups, is essential for holistic care.
Role of GPs in Long-Term Endometriosis Care
GPs are highly important to a woman’s long-term care after endometriosis treatment. They’re available for monitoring symptom recurrence, as patients may experience a return of endometriosis symptoms, necessitating further treatment adjustments. GPs can also tailor hormonal therapy based on patient response, ensuring optimal endometriosis treatment outcomes. Women with infertility concerns may require referral to reproductive specialists for assisted conception options such as IVF, and GPs can provide these referrals. GPs also collaborate with gynaecologists, physiotherapists, pain specialists, and psychologists to ensure comprehensive patient care.
Both medical and surgical endometriosis treatments are important to managing endometriosis, with individualised treatment plans tailored to each patient’s symptoms, fertility goals, and response to therapy. While hormonal therapy is often the first-line of treatment, surgery becomes necessary in certain cases or those with structural complications.
For patients with persistent symptoms or fertility concerns, referring them to Dr Kelly Hankins I North Gosford ensures expert evaluation and management. Dr Hankins provides specialised care, helping women achieve better symptom control, improved quality of life, and optimised reproductive health.