Endometriosis
By The Treatment Registry editors
A chronic gynaecological condition in which endometrial-like tissue grows outside the uterus, causing pelvic pain, painful periods, painful intercourse, and infertility. Severity ranges from minimal disease (microscopic deposits) to severe deep-infiltrating endometriosis affecting bowel or bladder. Treatment is staged from hormonal medical management through laparoscopic excision and may include fertility treatment when conception is the priority.
Treatment ladder
Conservative options are first-line where appropriate; surgical options are typically reserved for cases where lower-tier options are unsuitable or have failed. Decisions are individual and depend on clinical assessment.
Conservative
- Combined hormonal contraception
First-line medical therapy for symptomatic endometriosis when pregnancy is not currently desired. Suppresses ovulation and menstrual flow, often substantially reducing pain.
- Progestin-only therapy (oral or IUS)
Alternative or second-line option; particularly useful when oestrogen is contraindicated. The levonorgestrel intrauterine system is well-evidenced for symptom control.
- GnRH analogues
Hormonal suppression producing a temporary menopausal state. Effective for severe symptoms but limited in duration by bone-density and other oestrogen-deficiency effects unless add-back therapy is used.
Procedural
- Diagnostic and operative laparoscopy
Direct visualisation and biopsy of suspected lesions remains the diagnostic gold standard for endometriosis. Visible disease can be ablated or excised in the same procedure.
- IVF / ICSI · View procedure page
Indicated for fertility preservation or treatment in patients with endometriosis-related infertility, often after or instead of further surgical management.
Surgical
- Laparoscopic excision of endometriosis
Specialist surgical excision of endometriotic deposits with preservation of fertility where possible. Outcomes substantially better with surgeons specifically trained in advanced endometriosis surgery.
- Hysterectomy with bilateral salpingo-oophorectomy
Considered in patients who have completed family planning and have severe refractory symptoms. Hysterectomy alone does not always cure endometriosis if extra-uterine disease remains.