Treatment of endometriosis depends on various factors like age, reproductive profile (whether she has child or desires to have child), presence or absence of symptoms (period pain), stage of disease and so many.  The basic principles are:

   
A. You are below 35; you have pain and desire to have pregnancy but not right now:
 
 
Laparoscopic surgery can be done to remove all the diseased tissue keeping the uterus, ovaries and tubes. After surgery you may be put on long term medicine like oral pills which will prevent pregnancy and hopefully keep the disease controlled (remember, not cured!). Medicines are withdrawn when you plan to conceive. However, there always remains a chance of recurrence of pain and disease during this time.
   
   
B. You are below 35; you have pain and desire to have pregnancy at earliest:
 
 

Laparoscopic surgery to remove all the diseased tissue keeping the uterus, ovaries and tubes. After surgery we advise you to try for natural conception for about six months. You are lucky if you conceive by this time or at least, the pain does not come back. If you don’t become pregnant by six months to one year – you better prepare yourself for IVF (test tube baby).

Some IVF experts, in this situation, advise straight for test tube baby. Evidence, however, suggests clearing disease by surgery before IVF gives better result.

   
   
C. You are above 35; you have pain and desire to have pregnancy at some time:
 
 
We recommend laparoscopic surgery for clearing the disease, try natural conception for maximum 6 months immediately after surgery and go for IVF after 6 months – because chance of pregnancy rapidly declines after this age.
   
   
D. You are below 45; you have pain but completed your family or you are sure you don’t want a baby:
 
 

Treatment depends on your desire. The surest way to treat is to remove all the diseased tissue along with the uterus, ovaries and tubes. Unfortunately, you will stop to menstruate and your female hormones will be no more – you land up into menopause!

Otherwise, we may advise treatment as situation A – surgery followed by long term medicine until natural menopause sets in – keeping in mind the risk of recurrence!
   
   
E. You are above 45; you have pain and completed your family:
   
 
The trend of treatment decision will be towards removal of all the diseased tissue along with the uterus, ovaries and tubes. However, if you strongly desire to keep you uterus and ovaries to continue menstruating- you may opt for the second option as in situation A until natural menopause sets in – keeping in mind the risk of recurrence!
   
   
F. You are not conceiving even after trying for more than 1 year; you have no symptom but laparoscopy finds out mild endometriosis:
 
 
Endometriosis may not be the cause of your present childlessness. We usually clear the mild disease during diagnostic laparoscopy. If you are below 35; you may wait for natural pregnancy up to 6-12 months and if it dose not succeed, go for induction of ovulation (IOO) and intra-uterine insemination (IUI). If pregnancy still does not occur, the ultimate option is IVF. If you are above 35, it is better not wait for natural pregnancy after surgery.
   
 

If you don’t fit into any of these categories or need further clarification- feel free to contact us at our e-mail address.

   
   

 

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