What is the treatment for endometriosis?
There is no cure for endometriosis. But there are many treatments, each of which has pros and cons. It is important to build a good relationship with your doctor, so you can decide what option is best for you. Endometriosis that causes only mild symptoms usually does not require medical treatment. Home treatment, such as taking a nonprescription pain medication or using a heating pad, may be all that is needed. Endometriosis is more difficult to treat when it is causing moderate to severe pain or infertility. Treatment may vary depending on whether you are treating pain or infertility. You may need to try several different treatments to find one that works best for you. Treatment may include medications to shrink the implants, laparoscopy to destroy implants, or surgery to remove the uterus and ovaries.
For some women with mild symptoms, no further treatment other than medication for pain may be needed. For women with minimal endometriosis who want to become pregnant, doctors are saying that, depending on the age of the woman and her amount of pain from the disease, the best thing to do is to have a trial period of unprotected sex for six months to one year. If she does not get pregnant in that time, then further treatment may be needed.
For patients who do not wish to become pregnant, but need treatment for their disease, their doctors may suggest hormone treatment. Hormone treatment is most effective when growths are small. Hormones can come in pill form, by shot or injection, or in a nasal spray. There are several hormones used for this treatment including a combination of estrogen and progestin such as birth control pills, a progestin alone, Danocrine (a weak male hormone), and GnRH agonists (gonadotropin releasing hormone).
Birth control pills control the growth of the tissue that lines the uterus and often decrease the amount of menstrual flow. They usually contain two hormones, estrogen and progestin. Once a woman stops taking them, the ability to become pregnant returns, but the symptoms of endometriosis also may return. Some women take birth control pills continuously, without using the sugar pills that signal the body to go through menstruation. When birth control pills are taken in this way, the menstrual period may stop altogether, which can reduce pain or get rid of it entirely. Some birth control pills contain only progestin, a progesterone-like hormone. Women who can't take estrogen use these pills to reduce menstrual flow. With these pills, some women may not have pain for several years after stopping treatment. All birth control pills might cause some mild side effects like weight gain, bleeding between periods, and bloating.
Danocrine has become a more common treatment choice than either progestin or combination hormone pills. Side effects with Danocrine include oily skin, pimples or acne, weight gain, muscle cramps, tiredness, smaller breasts, breast tenderness, headaches, dizziness, weakness, hot flashes, or a deepening of the voice. Women on Danocrine probably will only get a period now and then, or might not get it at all. Women who take Danocrine also should take steps to prevent pregnancy because it can harm a baby growing in the uterus. Because other hormones, like birth control pills, should be avoided, health care providers recommend that you use condoms, a diaphragm, or other "barrier" methods to prevent pregnancy.
GnRH agonists (used daily in a nose spray, or as an injection given once a month or every three months) prevent the body from making certain hormones to prevent menstruation. Without menstruation, the growth of endometriosis is slowed or stopped. These medications can cause side effects, such as hot flashes, tiredness, problems sleeping, headaches, depression, bone loss, and vaginal dryness. Most health care providers recommend that a woman stay on a GnRH agonist for about six months. After that time, the body will start having a period again and a woman could get pregnant. But, after that time, about half of women have some return of their endometriosis symptoms.
Surgery is usually the best choice for women with extensive endometriosis, or those with severe pain. There are both minor and major surgeries that can help. Your doctor might suggest one of the following surgical treatments:
Laparoscopy - also used to diagnose the disease, your doctor can treat you with this surgery as well. If your doctor is going to treat the endometriosis during this surgery, he or she must make at least two more cuts in your lower abdomen, to pass lasers or other small surgical tools into your abdomen. Then he or she will remove the growths and scar tissue or destroy them with intense heat and seal the blood vessels without stitches. The goal is to treat the endometriosis without harming the healthy tissue around it. Recovery from laparoscopy is much faster than for major surgery, like laparotomy.
Laparotomy - this is a last resort for endometriosis treatment because it is major abdominal surgery in which your doctor either removes the endometriosis and / or removes the uterus (a process called hysterectomy). He or she also might remove the ovaries and fallopian tubes at the time of a hysterectomy, if the ovaries have endometriosis on them, or if damage is severe. Having the surgery does not ensure that the disease will not return or that the pain will go away.