|What Is The Treatment For Endometriosis?
There is no ‘cure’ as such for endometriosis (primarily because scientists have not yet identified the cause), but there are a variety of treatment options available which can help reduce symptoms. A woman with mild endometriosis symptoms may not need any treatment outside of a few painkillers around period time. While there is always a risk of symptoms worsening, in fact only 25 to 45 percent of women with mild endometriosis go on to develop a severe version of the disease (see, what are the stages of endometriosis?). As there is no way of knowing which women will develop worsening symptoms in the future, doctors usually advise against treatment until it becomes absolutely necessary. Depending on the treatment goal, different options may be advised. For example, the treatment goal may be reduce pain by shrinking endometrial growths, to restore fertility or to prevent recurrence of the condition. Treatments range from over the counter pain relief medications (such as aspirin or ibuprofen) to hormonal therapy and surgery.
Factors To Consider
For women who have received an endometriosis diagnosis and who have disabling symptoms the initial decision will be to choose between hormone and surgical treatment. As there are side effects and drawbacks to both treatments, this decision should be taken by the woman herself in consultation with a gynecologist. Factors affecting which treatment option to choose will include:
1. The severity of the endometriosis and how far it has spread.
2. The location and size of the endometrial implants.
3. If there are any lesions/cysts and if so, how large they are and where they are located.
4. Severity of the symptoms.
5. Infertility problems if children are desired.
6. Age of the woman (symptoms can clear up naturally nearer menopause). Read about the effects of menopause on the body.
7. Success of any previous treatments.
8. The preference of the woman and her gynecologist.
Treatment for minimal or moderate endometriosis is usually hormone treatment. Various prescription medications are available which may also be prescribed after surgery as a way to reduce any remaining implants. Most endometriosis drugs work by preventing the menstrual cycle which means there is no breakdown of endometrial tissue. Pain can thus be avoided by the build up of tissue. If the woman is not trying for a baby, she may also be prescribed an oral contraceptive pill and advised to take it continually without a break, thus again avoiding periods. This treatment is known as pseudo-pregnancy because it mimics the hormonal effects of pregnancy, giving women relief from symptoms. If taken continuously oral contraceptives can provide relief from pelvic pain and cramps in 80 percent of women. The pill can be taken for long periods of time with minimal side effects.
Gonadotropin releasing hormone agonists are an option if symptoms persist despite the regular use of oral contraceptives or if they recur after surgery. These drugs induce a false menopause, which is completely reversible. The FDA has approved 3 GnRH agonists: Lupron, Synarel and Zoladex. These are taken daily or monthly in an injection form or as nasal sprays or implants inserted in the upper abdominal every 28 days. While effective in reducing pelvic pain, women may also suffer menopause side effects such as hot flashes, depression, headaches and nausea. Additionally, as GnRH agonists promote bone loss they can only be taken 6 month at a time, after which symptoms often return. If you are prescribed these drugs, do read our guide to preventing osteoporosis.
Danazol is a synthetic male hormone which was the first FDA drug approved for specifically treating endometriosis. It also mimics the effects of menopause by reducing the body's natural levels of estrogen. The lower levels of estrogen means that the endometrial implants are no longer stimulated to grow and break down each month. As a result of the inactivity they gradually begin to waste away. Symptoms usually start to decrease by the end of the second month of treatment and continue to decline throughout the course. Unfortunately side effects may be severe including weight gain, acne, hot flashes, cramps, breast atrophy and oily skin. 75 percent of women gain anywhere between 5 and 30 pounds of weight while taking this drug. It also reduces 'good' cholesterol levels and increases 'bad' cholesterol levels increasing the chances of heart disease in women.
Initial studies show that the non-surgical abortion drug, mifepristone may decrease the spread of endometriosis and reduce pain (read about abortion procedures). Side effects appear to be minimal on dosages as low as 50 mg a day. More studies are still required before it is available as a treatment.
Useful Tip: Endometriosis Alternative Treatments
Preventing the re growth of endometrial implants naturally: Find out which foods to avoid.
If a woman has severe endometriosis she is more likely to undergo surgical treatment, particularly if she has cysts larger than 2cm which need removing. Today most endometriosis surgery is carried out via a pelvic laparoscopy. The success of the surgery depends on the skill of the surgeon and how thorough it is performed. The aim is to remove all endometriotic cysts, adhesions and lesions. Any visible scar tissue which can cause infertility or pain will also be removed. Techniques used involve laser surgery, electrocautery or curettage (scraping). The surgeon can also perform other procedures at the same time to prevent future pain. He may for example shorten uterine ligaments and then sew the abdominal wall away from adhesions. A laparoscopy is usually carried out under general anesthesia, although the patient may elect to stay awake under a local or epidural anesthetic. Surgery usually lasts about 40 minutes and can be carried out on an out-patient basis, requiring no overnight hospital stay. As with hormone therapy, surgery does relieve most women of pain. Between 70 and 100 percent of women report pain relief benefits within the first month of surgery. However about 45 percent report returning symptoms within the first year. Note: Another form of minimally invasive surgery called da Vinci surgery may be an alternative.
Laparotomy & Hysterectomy
More radical surgery may be necessary if endometriosis adhesions are extensive. A laparotomy or a hysterectomy (removal of the womb and usually the ovaries if a woman no longer wishes to have children) is an option. Although a hysterectomy may seem like an ultimate solution, even then some women continue to have symptoms. This presumably is because endometrial growths have stuck to other tissues or organs and continue to bleed. Symptoms are more likely to persist if a woman starts taking estrogen replacement therapy (ERT). More recently, endometrial ablation is being offered as an alternative to hysterectomy in women who do not wish to preserve fertility.
Is There a Cure For Endometriosis?
Unfortunately not yet as doctors are still trying to identify the causes of endometriosis. As neither drugs nor surgery offer a final solution for endometriosis, and as both have side effects, some doctors advise women to alternate between drug therapy and surgery every few years. Do be sure to read our list of women's health books for advice on self-management.
Infertility & Endometriosis
Research shows that removing mild endometriosis does NOT increase fertility in a woman. However surgery in the case of moderate or severe endometriosis does seem to improve chances of becoming pregnant. In some severe or urgent infertility cases doctors may recommend skipping the surgical removal of endometrial tissue recommending instead going straight to IVF treatment.