Danazol
Danazol is a type of hormonal treatment. It reduces the production of estrogen from the ovary to low levels characteristic of the menopause. Danazol is usually prescribed for six months and is taken in tablet form. During the treatment menses usually stop. Endometriosis usually shrinks during treatment and painful symptoms improve in 60-90% of women. Possible side effects include water retention and weight gain, oily skin and acne, muscle cramps, mood changes and hot flushes. These side effects disappear when treatment is stopped. Occasionally a rash, facial hair or voice deepening may develop; if any of these occur, treatment is stopped immediately.

Progestogens
Some doctors use progestogens to treat endometriosis. These are synthetic progesterone-type drugs prescribed as pills or injections, usually for 6 months or longer. Possible side effects include water retention, weight gain and irregular vaginal bleeding. The injections are contraceptive and may have a prolonged action of up to one year after the last injection. Higher doses than those usually used for contraception are often needed to obtain pain relief with progestogens.

Gonadotrophin releasing hormone agonists (GnRH agonists)
These are the newest class of hormones for the treatment of endometriosis. They are taken as a nasal spray or injection and are usually prescribed for 6 months. They prevent estrogen production by the ovaries and result in a temporary and reversible menopause (pseudomenopause). Endometriosis usually shrinks during treatment and painful symptoms improve in 60-90% of women. Side effects are those of the menopause and may include hot flushes, mood changes, headaches, vaginal dryness and a loss of bone calcium. The loss of bone calcium during 6 months of treatment is small. If longer treatment with GnRH agonists is planned, the side effects can be reduced by combining treatment with hormone replacement therapy.

Birth control pills
Birth control pills may be prescribed, either taken in the usual way with a seven day break at the end of a pack, or continuously, running one packet into another without the seven day break. Taken continuously periods should stop, but there may be some irregular vaginal bleeding. Birth control pills may improve pain, but they are less effective than other medical hormonal treatments in slowing the growth of endometriosis.

Surgery
For infertility treatment, surgery has been shown to be better than medical treatment. It is not clear which is better for the treatment of pain symptoms. The goal of conservative surgery is to remove scar tissue and adhesions, ovarian endometriomas, and all endometriosis implants, but not to remove the uterus or ovaries. Conservative surgery preserves a woman’s potential for fertility. Neurolytic procedures, operations that involve the cutting of certain nerves in the abdomen or pelvis, can sometimes be helpful in obtaining better pain relief during conservative surgery. The most common neurolytic procedures are presacral neurectomy and uterosacral nerve ablation.

Radical Surgery
For women who have no success with other treatments and have completed their families or made the decision that the potential for future fertility is not vital, radical surgery may be the best option. With radical surgery the uterus (hysterectomy) and ovaries (oophorectomy) are removed. After hysterectomy alone (i.e. without removal of the ovaries), there is a significant chance that endometriosis will recur; 10-15% of women had recurrence after 1-3 years and 40-50% after 5 years. The more severe the endometriosis the more likely it is to recur. The chance of recurrence is much smaller if the ovaries are also removed at the time of hysterectomy, but this makes a woman menopausal. To prevent the loss of bone calcium due to estrogen deficiency in the menopause, most women need hormone replacement therapy. The majority of women with endometriosis can take hormone replacement therapy with both estrogen and progestagen without problems.