The "black-box" warning advises health care professionals to prescribe estrogen products at the lowest dose and for the shortest possible length of time. Women taking estrogen products are cautioned to have yearly breast exams, perform monthly breast self-exams and receive periodic mammograms.
Ask your health care professional for more information about hormone therapy and managing symptoms triggered by GnRH agonists, if this treatment is recommended for you. Other non-hormonal options to manage symptoms are also available.
A type of androgen (Danazol) is also used, but it can cause some undesirable side effects, including weight gain, hirsutism (hair growth), fluid retention, fatigue, hot flashes, decreased breast size, acne, oily skin, irritation or inflammation of the vagina caused by thinning tissues and decreased lubrication, hot flushes, muscle cramps, emotional instability and lowering of the voice. Some of these side effects are not reversible. Danazol is typically given for six to nine months at a time.
Surgical: Surgical treatments range from removing the endometrial implants by means of laparoscopy to removing the uterus and ovaries (hysterectomy). During a laparoscopic procedure, a surgeon may destroy endometriotic implants with heat, laser or by cutting (excising) them out. With any surgical treatment, there is always a risk of creating scar tissue that may lead to infertility, make pain worse, or damage nearby structures. Surgery to remove endometriosis involving the ureters and bowel can be complicated.
If a health care professional recommends a hysterectomy to treat endometriosis, you should know that it involves removal of the uterus. You will be infertile after this procedure. Hysterectomy alone is not always successful at controlling the pain associated with endometriosis. Removal of the ovaries at the same time improves the likelihood of successful treatment since it is the hormones produced by the ovaries, which cause the diseased growth. A hysterectomy also may not completely eradicate the disease. If you wish to preserve your fertility, discuss other options with your health care professional and consider seeking a second opinion. The goal of any surgical procedure for this medical problem should be to remove your endometriosis, restore the normal anatomical relationship of the tissue, and remove any scar tissue caused by the condition.