Treatment for endometriosis focuses either on surgical resection or destruction of the endometriosis tissue or on using medications to hormonally suppress the endometriosis tissue and reduce symptoms.

 

In our practice, we offer excision of endometriosis, the optimal surgical technique for removing endometriosis.  This type of surgery aims to completely remove endometriosis tissue from the body.  The surgical techniques for doing this are very similar to the techniques that would be use to remove a widely spread cancer.  That is, very technical and painstaking surgery that attempts to remove all disease.   In some practices (not ours), physicians may attempt to remove endometriosis by burning it away (ablation).  This technique may have some effectiveness for very superficial disease, but has no lasting effectiveness for deep endometriotic lesions, and in these cases rarely leads to lasting improvement.

 

Medical therapy usually is focused of two pathways:   Either one uses progesterone to suppress the metabolic activity of the endometriosis tissue (eg birth control pills, oral progestins, progesterone IUD), or one uses some kind of estrogen blocker that starves the endometriosis of the estrogen it needs to grow (eg Lupron, Elagolix).  Many women experience a decrease in their symptoms with one of these pathways of medical therapies.  Neither of these techniques works for all women, and in some cases the endometriosis tissue itself has ways to defeat these techniques (for example, some deep infiltrating endometriosis lesions express aromatase, a way a making estrogen, and thus they can grow and become inflamed even in the absence of external estrogen).  Many women on medical therapy experience some improvement but continue to have some symptoms, particularly in cases of deep infiltrating endometriosis.  Simple medical therapies such as birth control pills and progestins have moderate effectiveness and generally have few side effects, and those that are there are reversible after discontinuation.   Strong hormonal modulators like Lupron (leuprolide) and Orilissa (elagolix) reliably create side effects associated with the low estrogen state (hot flashes, osteoporosis).  Some women have reported experiencing permanent side effects from the use of Lupron, though this is relatively rare.

​

Most patients seek our care because they have tried various medical therapies with their physician, and potentially ablative surgical therapy, without adequate relief.  For this reason, the bulk of our work in in excisional surgery for endometriosis.