Endometriosis is a disease associated with the abnormal growth of endometrial-like tissue outside the uterus. Endometrial tissue normally lines the uterus and thickens and breaks down as part of the menstrual cycle when a woman is not pregnant. The abnormal growths, or lesions, commonly develop on or around the reproductive organs and on the bowels or bladder, but they can also develop elsewhere.
These lesions also thicken and break down as part of the monthly cycle, but there is no safe route for the tissue to exit the body. This can cause severe pain and infertility, as well as other symptoms. It can also lead to adhesions, where two tissues stick together abnormally.
There is currently no cure for endometriosis, but there are therapies to reduce the pain, slow or prevent the growth of new lesions, and treat infertility. Depending on the age of the patient and the severity of the disease, the range of recommended treatments may differ, and these should be decided in consultation with a medical professional.
Pain relief treatments
Pain is one of the most common symptoms of endometriosis, and managing it can be difficult. Available medication ranges from over-the-counter pain relievers to strong prescription pain relievers.
Simple pain relief medication, such as paracetamol and non-steroidal anti-inflammatory drugs (NSAIDS), can help relieve mild pain. Some patients may also find that physiotherapy and warmth, such as hot baths or a hot water bottle, can also reduce pain. For more severe pain, opioid-based pain relievers such as codeine may be prescribed.
Hormonal therapy
Endometriosis symptoms are usually exacerbated by the monthly changes in the levels of the estrogen hormone, which influences the menstrual cycle. Hormonal therapy can suppress estrogen production and prevent the menstrual cycle. This will stop the thickening and breakdown of endometrial tissue and lesions and may prevent the growth of new lesions. Ultimately, this can help reduce or eliminate the pain caused by endometriosis.
However, hormonal therapy cannot cure endometriosis, and symptoms can return once treatment has been stopped. It also cannot reverse adhesions or improve fertility.
The options for hormonal therapy include oral hormonal contraceptives, gonadotropin-releasing hormone (GnRH) receptor agonists and antagonists, testosterone derivatives, and aromatase inhibitors.
Hormonal contraceptives
Hormonal contraceptives are generally used for birth control, but several of them can also be effective at reducing endometriosis-associated pain. There is a wide range of brands and types available that use a combination of estrogen and progesterone, another hormone involved in the menstrual cycle.
Examples include Nexplanon (etonogestrel), Seasonique (ethinyl estradiol and levonorgestrel), Depo-Provera (Depot medroxyprogesterone acetate), Depo-subQ-Provera 104 (medroxyprogesterone), and Mirena.
Depo-Provera, Depo-subQ-Provera 104, and Mirena are contraceptives that mainly mimic the hormone progesterone and are referred to as progestin therapy. They can at least partially control pain in about 75 percent of women with endometriosis.
GnRH receptor agonists and antagonists
GnRH receptor agonists and antagonists both bind to the GnRH receptors in the pituitary gland and act to stop estrogen production through two different mechanisms, triggering an artificial menopause.
Examples of GnRH receptor agonists include Lupron Depot (leuprolide acetate), Zoladex (goserelin acetate), Synarel (nafarelin acetate), Suprefact (buserelin acetate), and Triptorelin, sold under the brand names of Gonapeptyl, Decapeptyl, and Trelstar.
Examples of GnRH receptor antagonists include the newly approved Orilissa (elagolix) and experimental therapies linzagolix and relugolix.
Testosterone derivatives
Testosterone derivatives use synthetic versions of androgens to suppress the production of estrogen. They include Danocrine (danazol) and gestrinone but are less commonly used due to their side effects.
Aromatase inhibitors
Aromatase inhibitors work by blocking an enzyme involved in producing estrogen. They are usually prescribed alongside another hormonal therapy. They include Femara (letrozole) and Arimidex (anastrozole).
Surgical treatment for endometriosis
Surgery is generally recommended only in cases of severe pain because of the risks involved.
Laparoscopy is the most common type of surgery to treat endometriosis. During the surgery, an instrument is inserted to inflate the abdomen slightly with carbon dioxide gas so endometrial lesions can be removed.
Laparotomy is another option, particularly when the lesions cannot easily be removed by laparoscopy. This surgery requires a larger incision than for a laparoscopy and generally has a longer recovery time.
Patients may choose to have a hysterectomy, the surgical removal of the uterus, and/or an oophorectomy, the removal of the ovaries. These procedures are irreversible, so are only recommended if other treatments have not worked, and the patient has decided not to have children in the future.
Treatment for endometriosis-related infertility
Infertility is the second most common symptom of endometriosis and is addressed through several options.
Physicians may recommend a laparoscopy surgery to remove endometrial growths, as this can help improve fertility. If surgery is ineffective, fertility specialists usually recommend patients undergo:
- intra-uterine insemination, involving the artificial injection of sperm into the uterus.
- in vitro fertilization, where the woman’s egg is fertilized outside the body and the resulting embryo is placed inside the uterus to implant.
Other options include intra-cytoplasmic sperm injection and surrogacy.
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Endometriosis News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.