Endometriosis Treatment
A chronic condition that causes severe pain and can delay pregnancy. Modern diagnosis relies on examination and specialized ultrasound, and treatment uses hormones or laparoscopy depending on symptoms and fertility plans.
Endometriosis is the growth of tissue similar to the uterine lining outside the uterus, most often on the ovaries, the peritoneum lining the pelvis, or the ligaments behind the uterus. It is a common chronic condition that responds to the hormones of the menstrual cycle, and it can cause severe pain and delayed pregnancy.
Common symptoms
- Severe period pain that ordinary painkillers do not relieve.
- Chronic pelvic pain between periods.
- Pain during intercourse.
- Pain with bowel movements or urination during periods.
- Difficulty becoming pregnant.
Modern diagnosis
Under the 2022 guideline of the European Society of Human Reproduction and Embryology (ESHRE), laparoscopy is no longer the first step for diagnosis. Diagnosis now starts with:
- History and clinical examination.
- Specialized transvaginal ultrasound, which shows endometriomas ("chocolate cysts") and deep lesions.
- MRI in some cases.
Laparoscopy is used when imaging is normal but symptoms continue, or when medical treatment has not worked.
Treatment options
- Painkillers to ease the pain.
- Hormonal treatment: such as progestins (for example dienogest) or the contraceptive pill, to calm the activity of the endometriosis.
- Laparoscopic surgery: to remove lesions or cysts when needed, in a way that preserves ovarian tissue.
Endometriosis and pregnancy
Deciding on surgery before pregnancy needs care, because removing ovarian cysts can lower the ovarian reserve. AMH, the woman's age and the severity of symptoms are assessed before the decision. In some cases ICSI is the shorter path to pregnancy. In others, laparoscopy improves the chances of a natural pregnancy.
Endometriosis needs a long-term plan that changes with the symptoms and the wish to have children. It is not a one-time treatment.