Treatment Options

Endometriosis

Intermediate Value

The endometrium is the mucus membrane that lines the inside of the uterus, where a mother carries her baby. Endometriosis occurs when tissues or implants like the endometrium grow outside the uterus, where it’s not normally found. This can occur on the surface of organs in the abdominal area and rarely in other parts of the body. Each month, this tissue responds to the monthly cycle of hormones that cause your period by thickening and shedding blood that has no way to leave the body.

Endometriosis may cause little or no pain. However, it may cause abdominal pain before and during your period, with sex, and with urination and bowel movements during your period. Endometriosis may cause heavy periods, bleeding between your periods, less energy, diarrhea, constipation, nausea and inability to get pregnant. The tissue can cause painful adhesions or web-like scar tissues that attach to nearby organs.

To determine if you have endometriosis, or if your symptoms are caused by a different condition, your doctor will ask for your full medical history and give you a complete examination. A laparoscopy may be done to confirm the diagnosis. Laparoscopy is a type of surgery during which a small, lighted instrument is inserted through a small abdominal or belly button incision to look inside the body. If endometriosis is found, sometimes it can be removed at the time of the laparoscopy.

The treatment for endometriosis is difficult to rate. Currently, there is no cure for endometriosis. You and your physician need to discuss your goals and the benefits and risks of the treatment options to determine which is best for you. The type of treatment you choose depends on your age, disease, symptoms, and whether you want to have children. While treatment may relieve your pain for a while and enable you to get pregnant, your symptoms may come back after treatment. Due to the range of options available, an intermediate value as been given to the treatments.

Conservative surgery for endometriosis is intended to remove or destroy the tissue, to relieve the pain, and to allow pregnancy to occur in some cases. One type of conservative surgery is laser laparoscopy, in which the tissue is removed by laser or burned away. Another type of surgery, laparotomy, involves a full incision and removal of the tissue, followed by a longer recovery time. Hormone therapy, to stop your periods, may be prescribed by your doctor along with conservative surgery.

Extensive surgery to remove the diseased tissue includes hysterectomy (removal of the uterus) and oophorectomy (removal of the ovaries). The ovaries are removed because they produce the hormone estrogen, which may encourage endometrial tissue to grow in other areas of the body. If endometriosis affects your bowel, surgery may be necessary to remove the affected part of your bowel.

Things to Consider

  • Endometriosis occurs in about 1 in 10 women of childbearing age.
  • The cause of endometriosis is unknown.
  • Endometriosis is most common in women in their 30s and 40s, but it can occur anytime in women who menstruate.
  • Women at a higher risk for endometriosis have fewer days between their periods; have heavier, longer periods; have a family history of endometriosis; and have not been pregnant.
  • Mild to moderate endometriosis usually ends with menopause.

Results

Intermediate Value

Will I live longer if I have this procedure?

Yes, if you are having treatment as a life-saving operation for uncontrolled bleeding, you may live longer.

Will the treatment of endometriosis improve my quality of life?

Yes, if you have treatment to correct serious problems that interfere with normal functions, the treatment may relieve your pain and heavy periods; improve your energy; eliminate diarrhea, constipation and nausea; and enable you to become pregnant. However, your symptoms may return after you stop medication or after surgery.

Safety

Intermediate Value

How safe is this for me?

Medications:  Include nonsteroidal anti-inflammatory drugs (NSAIDs) that are used to relieve pain, but not to treat other symptoms of endometriosis. Some of these drugs can be bought over the counter without a prescription, but you should talk with your doctor before you take them.

Minor reported complications:

  • Heartburn
  • Decreased attention span
  • Some loss of memory

Major reported complications:

  • Stomach ulcer and bleeding
  • Blood clots
  • Swelling
  • High blood pressure

Hormone therapy: Used to reduce the amount of your period flow or to stop it completely in an effort to decrease or eliminate your symptoms. Improvement usually occurs about 6 to 9 months after the therapy is started. Hormone therapy may prevent the growth of new adhesions, but it will not make them go away. This therapy is not for all women. The type of hormones most frequently prescribed includes:  Oral contraceptives, Gonadotropin-releasing hormone (GnRH Agonists), Progestin, and Danazol. Complications may vary from woman to woman and with the medication prescribed.

Minor reported complications:

  • Depression
  • Weight gain
  • Bleeding between periods
  • Bloating
  • Hot flashes
  • Vaginal dryness
  • Mood changes
  • Sleep problems
  • Headaches

Major reported complication:

  • Early loss of calcium from the bones

Laparoscopy or laparotomy

Minor reported complications:

  • Wound infection
  • Reactions to anesthetics
  • Pain and discomfort

Major reported complication:

  • Injury to internal organs

Hysterectomy

Minor reported complications:

  • Loss of sexual interest
  • Fever
  • Bleeding
  • Fatigue
  • Bladder infection
  • Wound infection
  • Reactions to anesthetics
  • Depression

Major reported complications:

  • Blood clots
  • Severe infection
  • Adhesions
  • Postoperative hemorrhage
  • Bowel obstruction
  • Injury to the urinary tract
  • Incontinence (problems holding your urine)
  • Severe pain
  • Death
  • Increased risk of osteoporosis and heart disease when the ovaries are removed

Comparison

Intermediate Value

Alternative treatments to medication or surgery include:

  • Watching and waiting under the supervision of a physician to see if the condition improves on its own since endometriosis appears to lessen after menopause
  • Dietary changes such as avoiding dairy products; decreasing animal fat; increasing fiber; eating fish rich in omega-3 fatty acids to decrease inflammation; and avoiding alcohol, caffeine and chocolate
  • Exercise may relieve stress and tension

Advantages of medication or surgery compared to alternative treatments include:

  • Earlier relief of symptoms

Disadvantages of medication or surgery compared to alternative treatments include:

  • Possible side effects from medications
  • Possible complications from the surgery and recovery after a surgical procedure

Cost

Intermediate Value

 

Type of treatment for endometriosis

Total average charge

Hysterectomy including physician’s charges for the procedure

$20,310

Laparoscopy including physician’s charges for the procedure

$17,760

Laparotomy including physician’s charges for the procedure

$19,600

Hormone therapy (Cost depends on the medication and dosage order by the physician)

$20-$650 per month

The cost may or may not be covered by your health benefits plan.

Sources

The following are off-site links off-site link :

American Academy of Family Physicians. (2006, August). Diagnosis and management of endometriosis
Retrieved January 8, 2014 from http://www.aafp.org/afp/20060815/594.html.

Endometriosis Association. What is endometriosis? Retrieved January 8, 2014 from http://www.endometriosisassn.org/endo.html.

Endometriosis Association. Treatment options. Retrieved January 8, 2014 from http://www.endometriosisassn.org/treatment.html.

Mayo Clinic. (2013, April). Endometriosis. Retrieved January 8, 2014 from  http://www.mayoclinic.com/health/endometriosis/DS00289.

MedlinePlus. U. S. National Library of Medicine. National Institutes of Health. (2013, August). Endometriosis. Retrieved January 8, 2014 from http://www.nlm.nih.gov/medlineplus/endometriosis.html.

Next Review Date

1/23/2015

This document has been classified as public information.

Table of Findings

results:  intermediate value

safety:  intermediate value

comparison:  intermediate value

cost: intermediate value


total: intermediate value

legend

scale

Page modified:January 31, 2014