Endometriosis is a chronic condition, it may be difficult to treat and completely cure, it has a tendency to come back and women may suffer long term issues.
Endometriosis is a chronic condition, it may be difficult to treat and completely cure, it has a tendency to come back and women may suffer long term issues.
We do not have good quality evidence on what happens to endometriosis if it is not treated. It is clear that in some women early treatment will avoid the endometriosis progressing and causing more serious problems. We also know that in some women the disease does not get more severe and that in others the disease develops very quickly.
As a result it is not easy to give a clear answer that fits everybody. It is probably best to assess and treat the condition as quickly as possible, but it is best to look at each individual presentation of the condition and make an individual judgement
As doctors we are concerned that incomplete treatment may give rise to long term complications involving the bowel, bladder or ureters.
As a minimum, it would seem wise to monitor symptoms and have regular assessment with ultrasound or MRI.
Fertility may decrease more rapidly in women with endometriosis, particularly when the ovaries are involved. Available evidence does not support surgery to prevent this decline in fertility as the surgery itself may damage the ovaries further. Women with endometriomas need to be aware that their fertility reserve falls more quickly and should consider not waiting too long to try and have children. Alternatively they may wish to consider the option of egg freezing.
Symptoms of pain and bowel and bladder symptoms may be difficult to cure. Some women are left with long term symptoms as a result. The surgery may cause adhesions and if bowel is removed then symptoms may occur as a result.
There may be a need for long term symptom control with Hormones. Involvement of pain Specialists is also often required and some women may benefit from counselling to help them to manage symptoms. Women may also try complex diets, Yoga and pelvic floor physiotherapy to improve their quality of life.
Endometriosis is very common and we know that it is not related to the common forms of ovarian cancer. There are some rare types of ovarian cancer called clear cell cancer that may be related to atypical endometriosis. At the moment the available research information is not conclusive. The current advice is that endometriosis may only very rarely lead to an increased risk of ovarian cancer. We hope to have more information on this in the next 2-3 years.
