Recommendations on Treating Pain Associated with Endometriosis

When treating patients with endometriosis, the American College of Obstetricians and Gynecologists recommends conservative nonsurgical treatment approaches followed by more invasive procedures if previous attempts prove unsuccessful, according to a newly updated Practice Bulletin.

The bulletin, “Management of Endometriosis,” was published in the July issue of the Obstetrics & Gynecology journal. It features the latest recommendations on the incidence, diagnosis, and treatment of the condition.

"We recommend starting with conservative approaches to treating women with endometriosis-associated pain,” said Tommaso Falcone, MD, in a press release. Falcone led the document update. "For instance, continuous oral contraceptives and nonsteroidal anti-inflammatory drugs are effective. If these fail and further medical management is needed, then gonadotropin-releasing hormone agonists or progestins can help by suppressing the disease.”

The use of drugs as medical therapy will not improve fertility for those seeking to get pregnant, since most suppress ovulation. The use of medical therapy may be effective, but once the drugs are discontinued the pain usually recurs. For those seeking to improve fertility, surgery to remove endometriosis tissue may help infertile women improve their pregnancy rates, but by just how much is difficult to predict.

Laparoscopic surgery is the most accurate method to investigate the presence of endometriosis and laparoscopy can also remove visible endometriosis lesions. However, after laparoscopic surgery, symptoms tend to recur. To control pain, both laparoscopic surgery and long term hormone suppression will most likely be needed.

Hysterectomies are the last resort for treating women with the condition.

"If a woman has completed having children and all other conservative treatments haven't worked to stop the pain, she may consider having her uterus removed," said Dr. Falcone, in a press release. "If both ovaries are normal and all of the visible endometriosis is removed, then consideration should be given to conserving them."