Treatment of Endometriosis

Endometriosis is the development of uterine-lining tissue outside the uterus. The tissue that normally lines the inside of your uterus, grows outside your uterus. Endometriosis most commonly involves your ovaries, fallopian tubes and the ti

Updated: June 16, 2022

Endometriosis is the development of uterine-lining tissue outside the uterus. The tissue that normally lines the inside of your uterus, grows outside your uterus. Endometriosis most commonly involves your ovaries, fallopian tubes and the tissue lining your pelvis. Rarely, endometrial tissue may spread beyond pelvic organs.

Treatment of Endometriosis:

Depending on the severity of your signs and symptoms and whether you hope to become pregnant, the treatment plan could be with medications or surgery.

Pain medications:

Over-the-counter pain reliever, such as the nonsteroidal anti-inflammatory drugs (NSAIDs) ibuprofen (Advil, Motrin IB, others) or naproxen (Aleve, others) are recommended to help ease painful menstrual cramps. These pain-relieving medications have no effect on the endometrial implants or the progression of endometriosis. However, they do decrease prostaglandin production, and prostaglandins which causes the pain. NSAIDs are commonly used as a first line treatment before the confirmation of endometriosis.
If these medications does not provide full relief even after taking maximum dose, you may need to try another approach to manage your signs and symptoms.

Hormone therapy:

Since endometriosis occurs during the reproductive years, many of the available medical treatments for endometriosis rely on interruption of the normal cyclical hormone production by the ovaries. These medications include GnRH analogs, oral contraceptive pills, and progestins. Sometimes reducing or eliminating the pain of endometriosis can be effective by hormone supplements. The endometrial implants thicken, break down and bleed during the menstrual cycle because of the rise and fall of hormones. Hormone medication may slow down the growth of endometrial tissue and prevent new implants of endometrial tissue.
It is not a permanent fix for endometriosis. After stopping treatment, the symptoms will return. Therapies used to treat endometriosis include:

Hormonal contraceptives:

Birth control pills, patches and vaginal rings help control the hormones responsible for the buildup of endometrial tissue each month. Most women when using a hormonal contraceptive can have lighter and shorter menstrual flow. Using hormonal contraceptives especially continuous cycle regimens may reduce or eliminate the pain of mild to moderate endometriosis.
Oral contraceptive pills which are available in combination of estrogen and progesterone are also sometimes used to treat endometriosis. The most common combination used is in the form of the oral contraceptive pill (OCP). Occasionally, weight gain, breast tenderness, nausea, and irregular bleeding may occur. Oral contraceptive pills are usually well-tolerated in women with endometriosis.

Gonadotropin-releasing hormone (Gn-RH) agonists and antagonists:

These drugs lowers estrogen levels and hence block the production of ovarian-stimulating hormones and prevent menstruation. This results endometrial tissue to shrink. Because an artificial menopause is created by these drugs, taking a low dose of estrogen or progestin along with Gn-RH agonists and antagonists may decrease menopausal side effects, such as hot flashes, vaginal dryness, irregular vaginal bleeding, mood alterations, fatigue and bone loss. The process of adding with progesterone in pill form along with Gn-RH agonists and antagonists to eliminate most of the unwanted side effects of GnRH therapy causing due to lack of estrogen is known as Add back therapy.Stoping the medication will return your periods and the ability to get pregnant. Nasal and injection forms of GnRH agonists are available.

Progestin therapy:

A contraceptive containing only progestin, such as an intrauterine device (Mirena), contraceptive implant or contraceptive injection (Depo-Provera), can stop menstrual periods and the growth of endometrial implants, which may relieve endometriosis signs and symptoms. This therapy is recommended for women who do not obtain pain relief from or cannot take a birth control pill. They may be helpful in women who do not respond, or cannot take oral contraceptives for any medical reasons.
Breast tenderness, bloating, weight gain, irregular uterine bleeding, and depression are the most common side effects.

Danazol:

It is a synthetic drug that creates a high androgen and low estrogen hormonal environment by interfering with ovulation and ovarian production of estrogen. This drug blocks the production of ovarian-stimulating hormones to suppresses the growth of the endometrium, preventing menstruation and the symptoms of endometriosis. However, danazol may cause serious side effects and can be harmful to the baby if you become pregnant while taking this medication. Also it should not be taken by women with certain types of liver, kidney, or heart conditions. Weight gain, edema (swelling), breast shrinkage, acne, oily skin, hirsutism (male pattern hair growth), deepening of the voice, headache, hot flashes, changes in libido, and mood alterations are the common side effects. All of these side effects are reversible except for the voice changes.



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