Dr Roger McMaster-Fay

Gynaecologist and Endoscopic Surgeon - Clinical Lecturer, Sydney University

A brief explanation of treatments for Endometriosis

Patients not trying to become pregnant

The best results come from a combination of surgical removal (excision) and hormonal inhibition of ovulation.

When a woman ovulates the (Graffian) follicle ruptures and releases the egg. Also released is the fluid of the follicle, which is very rich in oestrogen. As oestrogen in the blood stimulates the endometrium to grow, so the rich oestrogen solution, released from the ovary into the pelvic peritoneal cavity, stimulates the endometriosis to grow.Thus by inhibiting ovulation the greatest stimulation to the endometriosis is removed.

Patients trying to become pregnant

Fertility is improved by surgically removing endometriosis but the disease will come back. Most become pregnant but if the patient does not conceive within six to twelve months of surgery then IVF should be considered.

Patients who have completed their family and want a cure

Endometriosis can be cured but it means a hysterectomy. The hysterectomy is often combined with removal of the ovaries and hormone replacement. The ovaries are removed because if they are left, then ongoing ovulation may well continue to stimulate the endometriosis to reactivate. Many of these cases with ‘residual ovaries’ end up needing further surgery. This surgery for residual ovaries is often quite difficult and complicated.