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Endometriosis: choosing treatments ENDOMETRIOSIS: CHOOSING TREATMENTS
For the majority of women with endometriosis the initial decision regarding treatment is whether to have hormonal or surgical treatment. Ideally, you should make this decision yourself in consultation with your gynecologist.
The reasons for selecting a particular treatment vary widely and will depend on a number of factors including:
• extent and severity of the endometriosis
• size and location of the endometrial implants
• extent and location of any adhesions
• nature and severity of symptoms
• duration of any infertility
• desire for future childbearing
• age
• whether or not related problems exist
• success of previous treatments
• your preferences
• the preferences and practices of your gynecologist.
If you have minimal to moderate endometriosis, hormonal treatment is usually recommended. In contrast, if you have severe endometriosis you are more likely to have surgical treatment although hormonal treatment may still be appropriate if you do not have any large cysts.
If you have any adhesions or endometriomas greater than two centimeters in diameter, these can only be removed surgically as hormonal treatment has no effect on adhesions or large endometriomas.
Some women choose hormonal treatment rather than surgery because they do not want to have their lives totally disrupted for several weeks while they recover from an operation. Others choose hormonal treatment because they feel that it is a less drastic form of treatment or because they do not like the idea of having surgery. Some women do not want surgery because they do not want to take the risk of developing adhesions which surgery can cause.
Some women choose surgery because they do not want to delay trying to conceive for another six to nine months while they are having hormonal treatment. Others may have already experienced intolerable side effects from previous hormonal treatment and would rather try surgery. Others simply do not wish to use drugs or are concerned about the possible long-term effects of hormonal treatment.
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