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Treatment and Management for Endometriosis

by Daniel on April 27th, 2012

There are several treatment options for endometriosis and the choice of treatment is usually based on the nature of symptoms, the severity of the disease and the goals of the patient.

Treatment for endometriosis includes expectant management (observation, or a “wait and see” approach) medication, surgery or a combination of both medication and surgery. Without treatment, endometriosis may become increasingly severe. It subsides after menopause when estrogen production decreases.

Finding someone who understands your experiences and can give you support is very important. You do not need to go through the pain or the treatment alone.

Surgical Treatment
Whether treating infertility or pain, the use of laparoscopic assisted surgery is increasingly common. In some cases, laparoscopy has made it possible for doctors to locate and diagnose the disease, take a biopsy and remove abnormal endometrial tissue and scarring all in the same procedure.
General surgical principles followed by physicians who treat endometriosis include:

Attempt to remove as much of the endometriosis as possible.
Retain fertility potential (the ability to become pregnant) whenever possible.
Recreate normal relationships of the pelvic and abdominal organs and surrounding structures.
Only in the most severe cases that cause debilitating symptoms and that have failed multiple other types of therapy, should “radical” surgery be performed. Radical surgery entails removing the entire uterus and both ovaries, along with all of the endometriosis, if possible.
These surgical principles can usually be accomplished with laparoscopy. Occasionally, in very severe cases of endometriosis, more invasive surgery follows a diagnosis by laparoscopy. The abdomen is opened to give the surgeon broader access to the endometriosis and scar tissue. This is called laparotomy.

Medical Treatment
What happens after surgery depends on why it was done. If pregnancy is the objective, patients may need fertility medications or in vitro fertilization. If the primary goal is pain management, the next step may be hormonal medications. The endometrial tissue is very sensitive to estrogens, one of the female sex hormones.
Drugs that induce low levels of estrogens can help improve the problems associated with endometriosis. These medications may not destroy endometrial tissue, but they might help to reduce the chances of painful recurrences.

Some of the newer and more promising drugs being used for this purpose are synthetic hormones known as gonadotropin-releasing analogues (GnRH Analogues). Acting like hormones that occur naturally in our bodies, these “look-alikes” essentially stop the ovaries’ production of estrogen creating a menopause-like state. This may result in side effects that are similar to the symptoms of menopause including hot flashes, sleep disturbances, mood changes, vaginal dryness, and with extended usage over six months, bone loss.

Another type of hormonal treatment is Danazol, a synthetic derivative of testosterone (a male hormone). This medication generally has more side effects than the GnRH Agonist and is, therefore, not used as frequently in the management of endometriosis as compared to the GnRH Agonist. Its potential side effects include weight gain, acne, headaches and hirsutism (hair growth in a male pattern).

Oral contraceptives with their combination of estrogen and progestin female hormones can also be used. They prevent ovulation and reduce menstrual flow and cramps. These are mainly used with mild cases of endometriosis because oral contraceptives may limit the spread of the disease. They are, however, ineffective in reducing pain. They are not of value to women who wish to become pregnant.

The female hormones known as progestins can also be used in the management of endometriosis.

The injectable form of a drug known as Medroxyprogesterone Acetate is one of the more commonly used progestins, but it may have side effects of unwanted weight gain, fluid retention, elevated blood pressure and headache.

Temporary pain relief may be possible with non-hormonal medications such as ibuprofen or other over-the-counter or prescription analgesics (pain medications). In more severe cases, narcotic (stronger drugs available only with a prescription from a doctor that may be habit forming with prolonged use) pain relievers can be prescribed.

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