TreatmentThere is currently no known treatment for endometriosis, most treatments help to ease the symptoms and try to prevent the formation of cysts:
HormonalThe main approach is the use of hormone replacement therapy that suppresses the growth of the endometrium by interfering with the production of cyclic hormones. In this way, the growth of cysts are prevented because growth of the uterine lining is prevented. The main families of drugs are: analogues of GnRH, birth control pills that are taken continuously, Danazol and aromatase blockers. The main problem with HRT is that sometimes the side effects can be severe and affect the quality of life. With the suppression of Decapeptyl for example many women feel symptoms of hot flashes, osteoporosis, severe migraines, memory problems and more.
SurgicalToday, laparoscopy (surgery through a small incision in the abdomen using an optical fiber) is the main tool for definite diagnosis of endometriosis and for treatment. The goal is to remove all cysts and adhesions caused by the endometriosis. For the majority, the surgeries that treat endometriosis are performed by laparoscopy. Laparoscopy has many advantages over laparotomy (large abdominal incision) including faster recovery and a better cosmetic result. At Hadassah, as in many places around the world this surgery is used with laser energy to give precise treatment of endometriosis foci while preventing surrounding damage to healthy tissue. Due to the complexity of these surgeries, there is an advantage to collaboration both within the hospital and outside it. Senior doctors from the Surgery and Urology departments cooperate within the hospital. In addition, they are assisted by experts in Radiology and Anesthesia. The endometriosis staff at Hadassah work in collaboration with doctors abroad who perform these surgeries, such as a team at Oxford, UK and in Toronto, Canada. Similarly, we are also establishing an exchange of experience and knowledge, training doctors and joint surgery.
Results of surgeryPain
Seven to eight out of every ten women operated indicate a significant improvement in pain after surgery. Out of ten women who felt better, 9 indicated satisfaction after one year, while five noted a significant improvement in pain even five years after surgery. In cases where the degree of disease is severe after surgery, meaning that there are many cysts or the need to remove part of the intestines, treatment moves to laparotomy.
In many places in the world, great emphasis is placed on laparoscopic surgery to improve fertility. However it should be kept in mind that when talking about fertility problems without pain there is probably a great advantage in fertility treatments and ivf. Due to the availability of these treatments in Israel, we advise patients to consider the various alternatives. In many cases we prefer to perform fertility treatments and fertilization if the main goal is fertility.