Patient's question:
I discovered endometriosis ten years ago. I have undergone two laparoscopies, taken oral medications such as Ulipristal Acetate, Danazol, and Mifepristone, and received Depo-Provera injections for nine months. I have also been treated with traditional Chinese medicine, but none of these have improved the condition. Could you please recommend a more effective treatment?I have never been pregnant. What is the remaining chance of pregnancy?
Age
Doctor's answer:
Hello: Treatment methods are mainly divided into two categories: surgical and pharmacological, based on comprehensive consideration of factors such as the patient's age, the severity of the condition, and whether there are fertility requirements. Treatment should be tailored to the individual.I. Surgical Treatment: The earliest method used for treating endometriosis, it remains one of the primary approaches to this day. Surgical treatment is mainly suitable for patients with severe conditions or those with severe pain that does not respond to medication.
（1）Conservative Surgery: Only the endometriotic lesions are removed, while the ovaries and uterus are preserved. It is suitable for young patients who wish to preserve their fertility, with approximately 50%-60% achieving pregnancy after surgery. However, the recurrence rate of pain is relatively high.
（2）Semi-radical Surgery: Endometriotic lesions are removed along with the uterus, while at least part of the ovaries must be preserved. It is suitable for patients who have already given birth, are over 35 years old, suffer from persistent pain, or have concurrent uterine lesions. Semi-radical surgery can cure dysmenorrhea, and the recurrence rate of endometriosis after surgery is very low.
（3）Radical Surgery: Both bilateral adnexa and the uterus are removed, which can completely cure endometriosis. It is suitable for women in menopause. In recent years, laparoscopic surgery has been widely used to treat endometriosis. All surgeries that can be performed through open surgery can also be done laparoscopically. Additionally, laparoscopic surgery offers advantages such as minimal trauma, faster recovery, and reduced postoperative pelvic adhesion.
The relief rate of postoperative symptoms and pregnancy rates can achieve the same effects as open surgery. It is gaining increasing attention.
II. Medication Treatment: Suitable for patients with mild conditions and small chocolate cysts. The treatment course is generally 6-9 months. If used as adjuvant therapy before or after surgery, the course can be shortened to 3-6 months.