Endometriosis is a disease that affects the female reproductive system due to the development of tissue that normally lines inside the uterus growing in other parts of the body. According to the National Institutes of Health (NIH), it is one of the most common gynecological diseases, and its primary symptoms include pain and infertility. The areas affected by endometriosis are called patches, implants, nodules, or lesions, and are usually found on or under the ovaries, on the fallopian tubes, behind the uterus, on the tissues that hold the uterus in place, and on the bowels or bladder. Despite the fact that there is currently no cure for endometriosis, there are treatments that help relive the symptoms.

In addition to pain and infertility, common symptoms of the disease include painful, even debilitating, menstrual cramps, which may get worse over time and cause pain during or after sex, pain in the intestine or lower abdomen, painful bowel movements or painful urination during menstrual periods, heavy menstrual periods, premenstrual spotting or bleeding between periods, painful bladder syndrome, digestive or gastrointestinal symptoms similar to a bowel disorder, as well as fatigue, tiredness, or lack of energy. The treatments for endometriosis usually address either pain or infertility and depend on the patient’s age, severity of the symptoms, severity of the disease, and if a woman has had children yet or not.

Medication Treatment for Endometriosis

Pain medication is usually recommended for patients who have mild symptoms, and it ranges from over-the-counter pain relievers to strong prescription pain relievers. There are two main types of pain killers used in patients with endometriosis — nonsteroidal anti-inflammatory drugs (NSAIDS) and opioids — which are strong pain drugs that interact directly with the nervous system. However, the NIH emphasizes that “evidence on the effectiveness of these medications for relieving endometriosis-associated pain is limited. Understanding which drugs relieve pain associated with endometriosis could also shed light on how endometriosis causes pain.

Hormonal Therapy for Endometriosis

Due to the hormonal influence, the areas affected by endometriosis go through a cycle similar to menstruation, which is why hormonal treatment can ease the pain by stopping the production or hormones like estrogen in the ovaries. The options for hormonal therapy include oral contraceptives, or birth control pills, which help make the period lighter, more regular, and shorter; progesterone and progestin, which can be taken as pills, injections, or through an intrauterine device (IUD); gonadotropin-releasing hormone (GnRH) agonists, which stop the production of certain hormones to prevent ovulation, menstruation, and the growth of endometriosis, or Danazol, a treatment that stops the release of hormones involved in the menstrual cycle.

Surgical Treatment for Endometriosis

In the field of surgery to treat endometriosis, the purpose is to temporarily relieve the pain, and it is particularly indicated for patients with severe pain. Laparoscopy is the most common type of surgery for endometriosis and it consists on the insertion of an instrument to inflate the abdomen slightly with a harmless gas and removal of the endometriosis tissue with intense heat and cauterizing. Laparotomy is also an option, particularly when the lesions are too small to see in a laparotomy, and surgeons remove the endometriosis patches and in some cases the uterus in a major abdominal surgery. In addition, surgery to sever pelvic nerves is meant for patients with located pain in the center of the abdomen, but the results of the surgery are not consensual.

Treatment for Endometriosis-Related Infertility

Infertility is the second most common symptom of endometriosis, and it is addressed through two main treatments. Physicians may recommend a laparoscopy surgery to remove or vaporize the growths and improve fertility. When surgery is ineffective, patients are usually recommended in vitro fertilization (IVF), which is a treatment that combines sperm  and eggs in laboratory to make an embryo and place into the patient’s uterus. Patients who struggle with infertility and want to get pregnant are discouraged to undergo hormonal therapy since it suppresses ovulation and delays the pregnancy. During the pregnancy, the pain usually becomes less intense, but if not treated, it can come back after the baby is born.

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