Endometriosis medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aravind Kuchkuntla, M.B.B.S[2]
Overview
Medical Therapy
Currently, there is no cure for endometriosis, though in some patients menopause (natural or surgical) will abate the process. Nevertheless, a hysterectomy and/or removal of the ovaries will not guarantee that the endometriosis areas and/or the symptoms of endometriosis will not come back. Conservative treatments usually try to address pain or infertility issues. Medical herbal treatments can sometimes be effective in controlling the disease.
The treatments for endometriosis pain include:
- NSAIDs and other pain medication: They often work quite well as they not only reduce pain but also menstrual flow. They are commonly used in conjunction with other therapy. For more severe cases narcotic prescription drugs may be used.
- Gonadotropin Releasing Hormone (GnRH) Agonist: These agents work by increasing the levels of GnRH. Consistent stimulation of the GnRH receptors results in downregulation. This causes a decrease in FSH and LH, thereby decreasing estrogen and progesterone levels.
- It is suggested but unproven that pregnancy and childbirth can stop endometriosis.
- Hormone suppression therapy: This approach tries to reduce or eliminate menstrual flow and estrogen support. Typically, it needs to be done for several months or even years.
- Progesterone or Progestins: Progesterone counteracts estrogen and inhibits the growth of the endometrium. Such therapy can reduce or eliminate menstruation in a controlled and reversible fashion. Progestins are chemical variants of natural progesterone.
- Avoiding products with xenoestrogens, which have a similar effect to naturally produced estrogen and can increase growth of the endometrium.
- Continuous hormonal contraception consists of the use of combined oral contraceptive pills without the use of placebo pills, or the use of NuvaRing or the contraceptive patch without the break week. This eliminates monthly bleeding episodes.
- Danazol (Danocrine) and gestrinone are suppressive steroids with some androgenic activity. Both agents inhibit the growth of endometriosis but their use remains limited as they may cause hirsutism. There has been some research done at Case Western Reserve University on a topical Danocrine, applied locally, which has not produced the hirsutism characteristics. The study has not yet been published in a medical journal.
- Gonadotropin releasing hormone agonists (GnRH agonists) induce a profound hypoestrogenism by decreasing FSH and LH levels. While quite effective, they induce unpleasant menopausal symptoms, and over time may lead to osteoporosis. To counteract such side effects some estrogen may have to be given back (add-back therapy).
- Aromatase inhibitors are medications that block the formation of estrogen and have become of interest for researchers who are treating endometriosis.[1]
- Surgical treatment is usually a good choice if endometriosis is extensive, or very painful. Surgical treatments range from minor to major surgical procedures.
- Laparoscopy is very useful not only to diagnose endometriosis, but to treat it. With the use of scissors, cautery, lasers, hydrodissection, or a sonic scalpel, endometriotic tissue can be ablated or removed in an attempt to restore normal anatomy. Studies have shown that with true excision [3] such as the Redwine Method, recurrence rates are less than 20%.
- Laparotomy can be used for more extensive surgery either in attempt to restore normal anatomy, or at least preserve reproductive potential.
- Hysterectomy (removal of the uterus and surrounding tissue) and bilateral salpingo-oophorectomy (removal of the fallopian tubes and ovaries).
- Bowel resection can be useful if there is bowel involvement.
- For patients with extreme pain, a presacral neurectomy may be indicated where the nerves to the uterus are cut.
- Raising your serotonin level: low serotonin levels reduce the pain threshold, and make people more vulnerable to every pain. Women particularly need adequate amounts of light during the second half of their menstrual cycles, when their serotonin levels may already be low.
- Many people like sweets: eating sugar or chocolate temporarily increases serotonin levels, but creates a rebound effect, characterized by heightened PMS symptoms.
- Melatonin and serotonin are increased by meditation, and the stress hormone cortisol is decreased. Melatonin causes you to go into delta-sleep, during which period Human Growth Hormone is released. As melatonin levels drop from childhood (100%) to age 20 (30%) and age 30 (20%), recovering takes more time, so good deep sleep is essential.
- Serotonin is manufactured by the body from a partial protein or amino acid called tryptophan. This amino acid is found in many foods, including soy, turkey, chicken, halibut, and beans.
- Lavender, primarily in the form of oil, has been found to reduce several physiological parameters of stress by stimulating serotonin and inducing a feeling of calm and happiness.
- Light therapy increases your serotonin levels.
- Complementary or Alternative medicine are used by many women who get great relief from the pain and discomforts from a variety of available treatments.
- Nutrition: There has been research showing that prostaglandins series 1 and 3 have an anti inflammatory effect which can help with endometriosis. Nutrition can also help to boost the immune system, which is important if endometriosis is an auto-immune disorder.
- Avoid coffee and alcohol. Both can increase the levels of estrone.
- In many cases, marijuana (cannabis sativa) has proven to relax or suppress the pain and relieve stress. Although doctors consider this to be an unorthodox method given all the treatments available for this condition and the fact that it may not produce any long term effects, this may still be an effective way to combat endometriosis. Research on this method is minimal since the drug is illegal in many countries.
Treatment of infertility
Laparoscopy to remove or vaporize the growths in women who have mild or minimal endometriosis is effective in improving fertility. One study has shown that surgical treatment of endometriosis approximately doubles the fecundity (pregnancy rate).[2]
In patients with small amounts of endometriosis treatment with fertility medication clomiphene may lead to success.
In-vitro fertilization (IVF) procedures are effective in improving fertility in many women with endometriosis. IVF makes it possible to combine sperm and eggs in a laboratory and then place the resulting embryos into the woman's uterus. IVF is one type of assisted reproductive technology that may be an option for women and families affected by infertility related to endometriosis.
References
- ↑ Attar E, Buttun SE. Aromatase inhibitors: the next generation of therapeutics for endometriosis? Fertil Steril 2006;85:1307-18 PMID 16647373
- ↑ Marcoux S, Maheux R, Berube S. Laparoscopic surgery in infertile women with minimal or mild endometriosis. Canadian Collaborative Group on Endometriosis. N Engl J Med. 1997 Jul 24;337(4):217-22. PMID 9227926.