What Is the Best Treatment for Endometriosis?

Treatment may include medication, surgery or both

A woman grabs her stomach in pain as a result of endometriosis.

Treatment may include medication, surgery or both

Endometriosis affects millions of women in the United States and is one of the leading causes of infertility. If it hasn’t affected you, chances are it has affected a family member or friend.

“Fortunately there are several endometriosis treatment options to ease symptoms and improve your quality of life,” says Lily Tsai, MD, a robotic surgeon and OB-GYN at Scripps Clinic.

Endometriosis treatment may include medication, surgery or both. When surgery is necessary, it can often be done with both pain reduction and fertility preservation as goals.

“Minimally invasive gynecologic surgery, including robotic surgery, can remove the tissue associated with the condition and help improve fertility,” Dr. Tsai says.

What is endometriosis?

Endometriosis is a condition in which the type of tissue that normally lines the uterus — the endometrium — grows outside the uterus. This tissue can grow in other pelvic organs, including the ovaries and fallopian tubes. Endometriosis can cause severe pain during menstruation, and abnormal growths called cysts, lesions and adhesions.

One in 10 women of childbearing age has endometriosis, according to the American College of Obstetricians and Gynecologists. It is most common in women in their 30s and 40s. The risk is also higher if you have:

  • Never had children
  • Menstrual periods that last more than seven days
  • Short menstrual cycles (27 days or fewer)
  • A family member with endometriosis
  • A health problem that blocks normal flow of menstrual blood

No one knows for certain what causes this disease but treatments are available.

What are the symptoms of endometriosis?

Endometriosis most often occurs on or under the ovaries, on the fallopian tubes, behind the uterus, on the tissues that hold the uterus in place or on the bowels or bladder.

Endometriosis tissue may grow and bleed like the uterine lining does during menstrual cycle. This can cause pain and inflammation in the surrounding tissue.

Chronic pelvic pain is the most common symptom, especially just before and during menstruation.

 Other symptoms include:

  • Pain during or after sex
  • Painful bowel movements or painful urination
  • Heavy menstrual periods
  • Stomach problems

However, many women with the condition experience no symptoms at all.

Endometriosis and infertility

Inflammation may damage the sperm or the egg or interfere with their movements through the fallopian tubes and uterus. Infertility affects up to 50 percent of women with endometriosis, according to the National Institutes of Health.

Surgery can be done to relieve pain and improve fertility.

Endometriosis treatment options

Endometriosis treatment depends on the extent of the disease, which can range from mild to severe. When pain is the main problem, medication is usually tried first.

Diagnosis involves going over your medical history with your doctor, getting a pelvic exam and when necessary, an imaging test.

Surgery is the most certain way to know if you have the disease. The most accurate method is a minimally invasive procedure known as laparoscopic surgery. During this procedure, the surgeon makes small incisions and inserts a tiny camera and surgical instruments into the body.

“The camera projects images onto a video screen that help the surgeon look for the endometriosis and remove it,” Dr. Tsai says.

Robotic surgery for endometriosis

Robotic surgery is a minimally invasive procedure, meaning it is less invasive than open surgery. It is basically a laparoscopic procedure with an added layer of technology for better visualization.

“In some cases, it enables the surgeon to see tissue that we might have missed with standard laparoscopic views,” Dr. Tsai says.

In addition, the robotic instruments mimic the human hand and wrist and can be turned and rotated for better dexterity and precision. “This greatly expands our ability to perform surgery,” she says.

Benefits of minimally invasive surgery

Minimally invasive surgery offers several benefits, including:

  • Reduced risk of complications
  • Less blood loss
  • Less pain
  • Much smaller scars
  • Shorter hospital stays
  • Quicker recovery

“Like all surgery, minimally invasive surgery has both benefits and risks. So, it’s important to talk to your doctor about all your endometriosis treatment options,” Dr. Tsai says.

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