Endometriosis is a condition where the lining of the womb (called endometrium) occurs outside its usual location e.g. at the back of the uterus and around the ovaries. The tissue induces an inflammatory reaction causing menstrual pain and infertility. Around 1 in 10 women suffer from endometriosis during their reproductive years. With time, endometriosis will have an adverse impact on a woman’s physical and social well- being, leading to formation of ovarian endometriotic cysts, severely painful periods, pain during or after sex, and infertility.
Occasionally, endometriotic cysts may be found incidentally on an ultrasound scan. Cysts caused by endometriosis contain old blood and are often referred to as 'chocolate cysts'.
Treatment of endometriosis and endometriotic cysts
Several options are available. The decision on which is the best treatment option depends on a variety of factors. These include:
- the nature of the symptoms e.g. severity of pain due to endometriosis
- the desire for fertility
- the size of the endometriotic cysts
- the risk for cancerous changes
Options for endometriosis and endometriotic cysts include:
Medication and hormonal treatment for endometriosis
Medication such as painkillers may be prescribed for menstrual pain. Often, hormonal suppression of the menstrual cycle with birth control pills or injections may be recommended. Unfortunately, endometriosis is a condition which tends to worsen with time.
Endometriosis Surgery including endometriotic cysts
Cystectomy for endometriotic cysts and ablation of endometriosis
Surgery can be very effective for removing endometriotic lesions, cysts and scar tissue. Surgery can help enable the cyst to be sent for biopsy and confirm if the cyst is non- cancerous or not. Such surgery is usually performed by laparoscopy (minimally- invasive or key- hole method). Surgery is best performed before fertility treatment to increase pregnancy success rates. As endometriosis tends to recur easily, for women keen for fertility, they should try to conceive as early as possible after surgical treatment. For those who are not keen for fertility, hormone medication can help to control endometriosis.
Oophorectomy for endometriotic cysts and endometriosis
Surgery to remove the ovary is the permanent solution for endometriotic cysts but the ovary is an important source of hormones. If early menopause occurs, hormone replacement therapy may be needed.