Endometriosis: Which Treatment Is Best For You?

Endometriosis is a very common condition, affecting millions of women worldwide, and often causing debilitating pain as well as fertility issues.

Through knowledge, individualised support and advanced fertility treatments, our team at Cape Fertility empower women on their journey to overcoming endometriosis and achieving their dreams of parenthood. We do this by providing the best endometriosis treatment for you as an individual.

Endometriosis is a non-cancerous condition in which the endometrium (as the lining of the uterus is called) grows outside of the uterus. It can be minimal or mild, with only superficial implants and mild adhesions, or moderate to severe with cysts and more serious adhesions.

Similarly, the symptoms of endometriosis can also range from no symptoms at all to severe symptoms. For this reason, endometriosis is often diagnosed late, misdiagnosed and /or incorrectly treated.

The most common symptoms of endometriosis are pain in the pelvic area, including painful periods and painful intercourse. In the majority of the cases, chronic pelvic pain is due to endometriosis. The pain can also be experienced at other times, such as during sexual intercourse, or when passing urine or stool, especially when during a period. The pain can be so severe that it impacts the quality of a woman’s life.

Other associated symptoms of endometriosis include fatigue, depression, eating problems and gastrointestinal (GI) problems. Another very common symptom of endometriosis is infertility.

Endometriosis treatment options

Fortunately, there are various treatment options for endometriosis, including medical treatment; surgery or laparoscopy; and assisted reproductive therapies (ART) such as IVF (in vitro fertilisation).

However, the treatment option that is right for each patient depends on which of the symptoms of endometriosis the patient requires treatment for. For example, the treatment of endometriosis is different for pain than it is for infertility.

Endometriosis treatment for pain

There are various options for the medical management of endometriosis that is highly effective for the treatment of painful periods and chronic pelvic pain.
The treatment options for pain caused by endometriosis are – in order of priority – hormone treatment; analgesics; and surgery as the last option.

Fortunately, the medical treatment for pain caused by endometriosis can be quite efficient. Oral contraceptives and the Mirena are first line treatments for pelvic pain related to endometriosis, in cases where a patient is not trying to conceive. Surgery should be the last line treatment for pain.

Birth control pills are commonly used, including a drug called Visanne, which is very effective as a long-term treatment option in the treatment of pelvic pain related to endometriosis.

The Mirena® – a hormone-releasing IUD (intrauterine device) used as contraception and for treating heavy periods for up to five years – is also used successfully as treatment of endometriosis. Sometimes injectable contraceptives are used, and there are also GnRH analogues such as Zoladex that produce an artificial menopause.

Endometriosis treatment for fertility

Where infertility is the main issue, the long term medical therapy that is so effective for pain will not be helpful. This is because all the medications mentioned above work as contraceptives, so none of these medical treatment possibilities are an option for women who struggle with infertility.

Instead, where infertility is the symptom requiring treatment, the treatment options include hormone treatment; surgery; and ART such as IVF.

The surgical approach for the treatment of endometriosis-related infertility in all stages of the disease should only be performed by a specialist in the treatment of endometriosis, namely a Reproductive Medicine Specialist. The best time for endometriosis surgery is usually at the time a woman is trying to conceive – not at the time of diagnosis.

IVF as well as IUI (intrauterine insemination) are good options as endometriosis makes it more difficult to achieve a pregnancy, not impossible. With the assistance of your Reproductive Medicine Specialist there is high chance of success for pregnancy for endometriosis sufferers.

How to get the right treatment

At Cape Fertility, we use a patient-centred approach to treating endometriosis that has delivered great success.

We believe that the treatment of endometriosis should be individualised to the patients symptoms and needs therefore entail a combination of medical treatment, surgical treatment and assisted reproduction therapies based on the patient’s situation.

Treatment is required by the patient experiencing a specific set of symptoms. This means that the treatment required depends on what symptoms the patient has.

In the treatment of endometriosis, the questions to answer are: “What symptoms do the patient suffer from?” Are the symptoms just infertility? Or pelvic pain? Or painful periods? Or all of the above? Or one of the other associated symptoms such as fatigue, depression, eating problems and gastrointestinal problems?”

Without such a patient-centred approach, mistakes in the diagnosis and treatment of endometriosis are common. Very often there is already a delayed diagnosis. Often, too, endometriosis is not properly diagnosed, and symptoms like anxiety and depression remains untreated.

For example, a focus on medical treatment for endometriosis to the exclusion of the surgical option and assisted reproductive therapies (ART) such as IVF (In Vitro Fertilisation) may also not resolve the patient’s most pressing symptoms. Similarly, surgery is often offered as a solution without discussing all the treatment options. In many instances, surgery is incomplete. In other cases, surgery can be too aggressive.

Good news for those who do require surgery is that it is done laparoscopically. Laparoscopy is a minimally invasive surgery during which a small incision in the navel allows medical specialists to look inside the abdomen and the pelvis, to inspect the uterus, the ovaries and the fallopian tubes, and to detect as well as treat any endometriosis at the same time.

The bottom line is that the treatment required should be dictated by the patient’s quality of life. Chronic pain and severe pain for an extended time is not normal and has a very negative effect on a person’s quality of life. Similarly, infertility can be a devastating experience.

In many cases, a patient may require a combination of treatments. It is also important to consider the side effects, the efficacy, the availability and the costs of each option, as well as the patient’s personal preferences, when deciding on the treatment of endometriosis. As a result, each patient’s treatment plan for endometriosis will differ.

Where to get the right endometriosis treatment

The only way to know for certain which endometriosis treatment is right for you is to undergo the necessary investigations at an accredited and recognised clinic, where a specialist with state-of-the-art equipment and years of experience will be able to make a professional determination and provide you with the best advice for the right treatment.

If you suspect that you have endometriosis, especially if you are trying to conceive, we would like to invite you to come and meet one of our specialists by clicking here…

At Cape Fertility, we value each individual patient and we look forward to providing you with individualised and personalised care, affordable quality fertility treatment, and higher success rates at our purpose-built premises, situated in the Claremont Medical Village in the beautiful city of Cape Town.

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