If you have endometriosis or know someone who does, you might be interested to know, during your search for endometriosis treatment, that there is no cure for endometriosis. However, there are a number of endometriosis treatment and management options, once a diagnosis has been made. Treatment for endometriosis falls into four, general categories:
Medical: The most common medical therapies for endometriosis are hormonal contraceptives and other hormonal regimens, such as GnRH agonists (gonadotropin releasing hormone drugs), that control hormonal stimulation of the endometrial tissue. Examples of FDA-approved GnRH agonists include: Lupron (leuprorelin), Synarel (nafarelin), and Zoladex (goserelin). Hormonal (oral, transdermal or injectable) contraceptives, along with non-steroidal anti-inflammatories (NSAIDs), such as ibuprofen, are first-line management for most patients suffering from pelvic pain. They may be used indefinitely to manage symptoms, in part because they are cheaper and easier to use, with fewer side effects than other hormonal treatments. However, some women may experience side effects that are uncomfortable. If the pain fails to respond to oral contraceptives within three months, then your health care professional should try something else.
GnRH agonists: (gonadotropin-releasing hormone) This is a class of hormones that has been shown to help temporarily relieve endometriosis by blocking estrogen production that stimulates its growth. GnRH agonists can cause side effects including menopausal symptoms triggered by estrogen deprivation, such as hot flashes, vaginal dryness and significant bone loss. Hormone therapy, a combination of estrogen and progestin hormones, typically is prescribed to alleviate these side effects so that treatment with GnRH agonists can continue for six months or longer, if necessary. However, the safety of hormone therapy for both short-term and long-term use is under intense scrutiny by the Federal government as result of risks identified by several major studies conducted in 2002.
In January 2003, the U.S. Food and Drug Administration (FDA) announced that it would require a new, highlighted and boxed warning on all estrogen products for use by postmenopausal women. The so-called "black box" is the strongest step the FDA can take to warn consumers of potential risks from a medication. The warning highlights the increased risk for heart disease, heart attacks, stroke and breast cancer from supplemental estrogen — risks illuminated by part of the Women's Health Initiative study, which was abruptly halted when the risks were identified.
Endometriosis Treatment (cont.)
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.
Endometriosis Treatment (cont.)
There have been no comparative studies of medical and surgical therapies to see which approach is better. There are advantages and disadvantages for both. Often, the individual plan of care for a woman will be a combination of treatment options.
Alternative Treatments: Some women may also consider alternative treatments for relieving the painful symptoms of endometriosis, including traditional Chinese medicine, nutritional approaches, homeopathy, allergy management, and immune therapy. Ask your health care professional about these options, keeping in mind that they won't also cure endometriosis. While some health care professionals may tell you these alternative paths to seeking pain relief from endometriosis are a waste of time, others may encourage you to try alternative methods of pain relief as long as they are not harmful to your condition. Either way, you should be careful not to take any products without first consulting your health care professional.
Pregnancy: Some women experience pain relief during pregnancy, although pregnancy is not a cure for endometriosis. Still, while endometriosis is a chronic condition and may not go away with pregnancy, many women find that their pain does not come back or is substantially improved after they have a baby.
That's because ovulation stops during pregnancy and endometriosis implants typically become less active and may not be as painful or as large as they were. Health care professionals attribute this pregnancy-related relief of endometriosis to hormonal changes during pregnancy.
In addition, during pregnancy, menstruation stops. Menstruation triggers the pain that many women with endometriosis feel. Sometimes, once pregnancy and nursing are over, and menstruation begins again, the symptoms of endometriosis return.
Results of data compiled recently from the Endometriosis Association research registry, comprising 4,000 women with endometriosis, suggests that women with endometriosis and their families have a heightened risk of autoimmune diseases such as diabetes and thyroid disorders, and cancer (breast cancer, melanoma, and ovarian cancer). There is also a greater risk of non-Hodgkin's lymphoma in the families. These findings parallel other work, including a study of 20,686 endometriosis cases in the Swedish cancer registry, which also found an increased risk of breast cancer, ovarian cancer, and non-Hodgkin's lymphoma in women with endometriosis. Researchers at Harvard Medical School have found an association between melanoma and endometriosis. Readers can learn more about the Endometriosis Association's findings at their Web site located at http://www.endometriosis.org.
Endometriosis Treatment (cont.)
New Treatments on the Horizon
GnRH antagonists are drugs that bind to GnRH receptors and prevent them from being activated. This completely blocks the release of the hormones LH and FSH which, in turn, stops ovulation and reduces estrogen and progesterone levels. The initial hormone stimulation or flare-up seen with GnRH agonist therapy does not occur following the use of GnRH antagonists. Since there would be no initial surge in symptoms, endometriosis patients with pain should have a quicker response to therapy. The two GnRH antagonists that are currently under investigation include: Cetrorelix (currently undergoing a multi-center phase 3 clinical trial) and Ganirelix (investigation has been postponed pending the outcome of a patent litigation). While symptom relief may occur sooner than with GnRH-agonists, the overall degree of pain relief is likely to be equivalent.
Recently, investigators have also begun to study how the immune system might contribute to endometriosis. Some researchers believe that an abnormal immune response may make certain women more susceptible to endometriosis. Numerous immune therapies have been proposed that aim to prevent the development of these lesions. Early data indicates that immune therapy with drugs like interferon may, in fact, suppress endometriosis.
There is growing evidence that endometriosis is a genetic disease. A study is underway to identify the inherited factors that increase the chances that a woman will suffer from endometriosis. The results of the study may: (1) help advance research into why women get endometriosis, (2) lead to the discovery of more effective drugs to treat endometriosis, and (3) lead to the discovery of new classes of drug to prevent the disease from occurring in the first place.