The basis of symptom control for patients with endometriosis is to reduce the perceived irritation due to chronic inflammation caused by the presence of numerous active deposits of endometriosis. Men and post-menopausal women do not get endometriosis – neither have high levels of the female hormone oestrogen, which allows deposits to continue to grow.
Symptom control is vastly different from disease-process control. At the simplest end of the spectrum, analgesic medications are available over the counter at the local chemist – Panadol, Panadol Osteo, Nurofen, Naprogesic and Voltaren are examples. Provided these are not used excessively in the short term, no harm will occur. Heartburn, reflux, irritated stomach and diarrhoea are side effects that can occur with frequent or prolonged usage.
Stronger medications are available and frequently required for patients with the most severe symptoms; Tramadol, Oxycodone and Targin can all be prescribed by a GP. When nerve pain is also a factor, then Lyrica and Endep are further options.
Medications with a hormone basis (the oral contraceptive pill, Visanne, Synarel, Zoladex) are variably effective at controlling symptoms too, but none are curative.
In the situation when symptoms such as pelvic pain, back pain and sex pain continue to escalate, consideration for ’disease control‘ by carefully planned laparoscopic surgery is the next step. This surgery is optimally undertaken by excising the lesions using electrosurgical energy – a little like using a fine-tipped knife to cut through butter. This simple analogy explains how the abnormal tissue along with the roots is optimally removed during surgery.
Electrosurgical excision of endometriotic deposits (as opposed to diathermy or laser ablation) will produce the best chance of removing the cause of pain completely. Fertility is always enhanced by such surgery, and the risk of adhesion formation is minimised by careful surgical technique, as practised by Dr Gordon.