Are there any solutions?

If the symptoms are not severe, you may not need any treatment other than pain relief.

If that is not enough, and you don't wish to become pregnant, you could try one of the three main hormonal treatments:

• The oral contraceptive pill is probably the easiest to take but doesn't suit everyone
• Danazol blocks the effects of oestrogen on tissues but also acts as a weak male hormone, so it can cause side effects of acne and unwanted hair
• Gonadorelin analogues such as buserelin nasal spray are designed to simulate menopause, thereby halting the cycle and possibly shrinking endometrial implants

For women with mild endometriosis who wish to become pregnant, the best course of action is to have a trial period of unprotected intercourse for six months to one year. If pregnancy does not occur within this period then further treatment may be needed.

Women who want to become pregnant more quickly, who have severe physical changes or debilitating pain, may need more powerful treatment, possibly surgery. Conservative surgery attempts to remove the diseased tissue without risking damage to healthy surrounding tissue. This procedure is usually done under anaesthetic through a laparoscope: a device like a tiny telescope that's inserted into the abdomen. Some patients may need more radical surgery, such as hysterectomy, to correct the damage caused by untreated endometriosis. If the ovaries are badly damaged, hysterectomy and removal of the ovaries may be the only treatment possible.

To sum up, endometriosis is a long-term disorder. Because it affects each woman differently, it is essential to maintain a good, clear, honest communication with your doctor. The truth about this disease is that there are no clear-cut universal answers. If pregnancy is an issue, then age may affect the treatment plan. If it is not, then treatment decisions will depend primarily on the severity of symptoms.

What about diagnosis?

In 1994 the National Endometriosis Society carried out a survey among its members which revealed that the average time between first reporting symptoms and receiving a diagnosis was seven years.

Why is this?

The society thinks there are a number of factors:

• many of the symptoms of endometriosis are the same as the symptoms of other conditions
• many GPs are unaware of the symptoms that most strongly indicate endometriosis
• definitive diagnosis is only possible by laparoscopy – a surgical procedure involving a general anaesthetic
• women do not always tell clinicians the full extent or range of their symptoms, partly through embarrassment, but also because they assume some of them to be normal.

If left untreated, it is almost certain that the extent or severity of endometriosis will increase, therefore it is important to obtain a diagnosis as quickly as possible.

Where to next?

• The National Endometriosis Society’s helpline number is 020 7222 2776
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