Treatment
The causes for the development of endometriosis have not yet been clearly clarified. It is assumed that endometriosis is a multifunctional disease whose development is triggered by the interaction of various factors. For this reason, treatment is extremely difficult for many of the patients affected.
A direct removal of the causes cannot be guaranteed to date. In everyday clinical practice, the treatment of endometriosis focuses primarily on reducing the symptoms and increasing the well-being of the affected women. For this reason, symptomless forms of endometriosis do not require treatment in most cases.
In general, a distinction is made between two categories of treatment for this gynecological disorder: drug treatment and surgical treatment. In addition, the so-called “fertility treatment” and the psychosomatic care of the affected patients are important pillars in the therapy of endometriosis. In most cases, the treating gynecologist does not choose between drug therapy and surgical treatment.
In everyday clinical practice, the combination of both methods has proven to be the most sensible. Surgical treatment If the presence of endometriosis causes fertility problems, surgical treatment should be considered. The sole administration of specific drugs is not very useful for this basic problem.
As a rule, surgical treatment of endometriosis is performed laparoscopically (laparoscopy). The advantages of this minimally invasive treatment method are the significantly less conspicuous scars and adhesions, the much shorter hospital stay and the faster recovery. The disadvantage of laparoscopic treatment of endometriosis is the comparatively long duration of the operation.
Alternatively, an open surgical method can be considered. Basically, both forms of treatment pursue the same goals: During the surgical procedure, the scattered endometrial cells are removed with the help of an electrical conductor, a laser or with a scalpel. In many cases, parts of the ovary or the fallopian tubes must be removed during the surgical treatment.
The success of the surgical treatment of endometriosis can be further improved by taking hormones for six months. For patients whose family planning has already been completed, the complete removal of the uterus (hysterectomy) may be the most effective therapeutic strategy. 2nd drug treatment The drug treatment for endometriosis includes the use of various hormone preparations.
In most cases gestagens and/or so-called GnRH analogues are used. With the conservative strategy, the duration of treatment ranges from three to six (maximum twelve) months. The basic principle of hormonal treatment for endometriosis is to reduce the body’s own hormone production.
In this context, the reduction of estrogen production (relative estrogen deprivation) plays a decisive role. In many cases, a reduction in the endometriosis foci and the associated relief of symptoms can be demonstrated after just a few months.However, this treatment method is not suitable for young women with an existing desire to have children. The most commonly used hormone preparations are In addition, pain therapy represents an important branch in the drug treatment of endometriosis.
The pain in the abdominal area is very pronounced in most cases. For this reason, the patients affected often need to be given high doses of painkillers. Young women suffering from endometriosis in particular often suffer from tension, exhaustion and depressive moods due to the chronic pain.
In addition, the fear of further pain and/or reduced fertility is also a serious problem for endometriosis patients. For this reason, the pressure of suffering felt by women can become enormously high. Psychosomatic treatment should therefore not be neglected in the case of a complex medical history.
Since the presence of scattered uterine lining cells can have a strong influence on fertility, the desire for children often becomes a problem, especially for young patients. Endometriosis foci can, under certain circumstances, block the fallopian tubes or impair the transport of sperm in the uterus. For this reason, a specific fertility treatment should be considered, especially for young patients with an existing desire for children.
- Removal of the scattered endometrial cells
- Restoration of normal anatomical conditions
- Preservation of the affected organs
- Histological backup of the diagnosis
- Gestagens (corpus luteum hormones)
- Oral contraceptives/”pill” (especially monophasic combination products)
- GnRH analogs (menopausal hormones)
