Endometriosis is a disease associated with the abnormal growth of patches of endometrial tissue outside of the uterus. Endometrial tissue normally lines the uterus, and thickens and breaks down as part of the menstrual cycle in the absence of pregnancy. The abnormal patches, or endometrial implants, commonly develop on or around the reproductive organs and on the bowels or bladder, but they can also develop elsewhere.
These endometrial patches 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 no cure for endometriosis, but there are therapies to reduce the pain, slow or prevent the growth of new implants, 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 like codeine may be prescribed.
The symptoms of endometriosis are 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 growing outside the uterus, and may prevent the growth of new endometrial implants. All of this can help to reduce or eliminate the pain caused by endometriosis.
The options for hormonal therapy include:
- Hormonal contraceptives that are generally used as birth control, and are available as oral pills, injections, patches, or through an intrauterine device (IUD). Many brands and types are available, and are a combination of estrogen and progesterone, another hormone involved in the menstrual cycle.
- Gonadotropin-releasing hormone (GnRH) agonists, which stop the production of estrogen. This can trigger an artificial menopause.
- Progestin therapy that mimics the hormone progesterone and can at least partially control pain in around 75 percent of women. There are many different types available, such as the IUD Mirena or the injected Depo-Provera.
- Testosterone derivatives that use synthetic versions of male reproductive hormones, or androgens, to suppress the production of estrogen. These include Danazol and gestrinone but are used less commonly now.
Hormone therapy cannot cure endometriosis, and symptoms can return once treatment has stopped. It also cannot reverse adhesions or alter problems with fertility.
Surgical treatment for endometriosis
Surgery is generally recommended only in cases of severe pain in endometriosis, as there are risks involved. Laparoscopy is the most common type of surgery for endometriosis. It consists of an instrument being 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 type of surgery requires a larger incision than a laparoscopy, and generally has a longer recovery time.
Some patients may choose to have a hysterectomy, the surgical removal of the womb, and/or a oophorectomy, the removal of the ovaries. This procedure is not reversible, and so is only recommended if other treatments have not worked and the patient has decided not to have children.
Treatment for endometriosis-related infertility
Infertility is the second most common symptom of endometriosis. It may be addressed through several options.
Physicians may recommend a laparoscopy surgery to remove endometrial growths, as this can improve fertility. If surgery is ineffective, patients are usually recommended to undergo either:
- Intra-uterine insemination (IUI), involving the artificial injection of sperm into the uterus, or
- in vitro fertilization (IVF), where the woman’s egg is fertilized outside of the body and then returned to the womb to develop.
Patients struggling with infertility and wanting to get pregnant are discouraged from using hormonal therapy since this suppresses ovulation.
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.