Endometriosis is a gynaecological condition characterised by presence of endometrial tissue outside the uterus. It is a wide spectrum of illness and is determined by the extent of endometrial deposits on fallopian tubes, ovaries, peritoneum and bowels.
Medications (stepwise treatments):
Step 1
- Tab. Dolokind MR (Aceclofenac 100 mg, Paracetamol 325 mg, Chlorzoxazone 250 mg) – one tablet twice a day for 3 days.
- Tab. Ovral L (Ethinyl estradiol 0.03 mg, Levonorgestrel 0.15 mg) – for 3 months. Ensure pregnancy is ruled out before starting Ovral L. For more information see below.
Step 2
- Inj. Lupride Depot 3.75 (Luprolide 3.75 mg) – intramuscularly once a month for up to 6 months.
- Tab. Gynaset 5 (Norethisterone 5 mg) – one tablet a day for up to 6 months.
Step 3
- Laser ablation of endometriotic deposits
- Chocolate cyst excision if needed
- Hysterectomy in severe cases resistant to medical management
Supportive treatments:
- Tab. Evecare Forte (Herbal remedy) – one tablet twice a day for 3 to 6 months.
General advice:
- Drink plenty of fluids.
- Applying heat pack or hot water bottle to lower abdomen and lower back may help.
- Reduce strenuous activities during menstruation.
Investigations:
- Transvaginal ultrasound – to identify extent of endometriosis and deposits.
- Laparoscopy – to diagnose intraperitoneal deposits
Referral:
Consider referrial to gynaecologist if patient fails to respond or presents with additional complications.
Safe use of oral contraceptive pill (OCP):
- OCP can be given safely if LMP was within last 5 days.
- If LMP more than 5 days ago – ensure pregnancy has been ruled out i-can pregnancy test kit (urine pregnancy test) – Till then offer counselling and emergency contraception.