Conventional Medical Treatment for Endometriosis

Description

The uterus is lined with a tissue called the endometrium. When cells from this lining escape from the uterus and implant themselves on other organs in the pelvic region-usually the fallopian tubes, uterine ligaments, or the ovaries-they cause a painful condition called endometriosis.

During the menstrual cycle, the wayward cells act exactly as they would if they were still in the uterus, first thickening and then bleeding as menstruation begins. But since these displaced cells have left the uterus, there is nowhere for the blood to go. As a result, blisters form that irritate the surrounding tissue, which may, in an effort to contain the blister, create an encompassing cyst. The cyst may then become either a scar or an adhesion of abnormal tissue that binds organs together. If they are located on the ovaries or fallopian tubes, scars or adhesions can interfere with conception.

The condition is not uncommon-it is estimated that between 8 and 30 percent of women of childbearing age suffer from the condition. While most sufferers have no symptoms, others have symptoms that become increasingly painful and debilitating as the disease progresses. Women with endometriosis are more likely to have an ectopic pregnancy, a pregnancy that occurs outside the uterus (usually in the fallopian tubes).

Endometriosis often runs in families and usually strikes women between the ages of 25 and 40 who have not had children. Although its exact cause is uncertain, some experts believe endometriosis occurs when menstrual flow backs up into the fallopian tubes, spilling blood and shedding endometrial cells into the pelvic cavity.

Signs and Symptoms

Pelvic pain that may begin just before menstruation and last until several days after

Sharp pain during sexual intercourse

Premenstrual spotting

Heavy menstrual periods

Infertility

Pain and straining during bowel movements

Conventional Medical Treatment

If you suspect you have endometriosis, see your gynecologist immediately. Your physician may be able to feel patches of endometriosis during a pelvic examination, but a laparoscopy is the only way to confirm you have the condition. A laparoscope-a slim, lighted instrument that is inserted into the abdomen through a small incision-allows the physician to examine your pelvic organs. Considered a minor procedure, a laparoscopy is usually performed on an outpatient basis with localor general anesthesia. Since ovarian cancer and endometriosis produce nearly identical symptoms-and because some of the hormones prescribed to treat endometriosis can make ovarian cancer grow faster-a laparoscopy is strongly recommended.

Many sufferers find that using birth control pills diminishes the intensity of their symptoms. If oral contraceptives do not help, a testosterone derivative called danazol may be prescribed to cease menstruation. However, most women find danazol difficult to tolerate because of frequent side effects, such as weight gain, excessive hair growth, and acne. During this period, displaced cells and their resulting growths sometimes shrink. Surgery is also an option for removing or destroying growths-electrocautery (using an electric current to destroy the cells) or laser surgery are two common options. Unfortunately, recurrences are common. In extremely severe cases, removal of the uterus and ovaries is the recommended treatment.

Gonadotropin-releasing hormone (GNRH) is now the treatment of choice if contraception or surgery fails. It is given by injection, nasal spray, or via an implant replaced every 28 days. Because GNRH suppresses estrogen, side effects include hot flashes, vaginal dryness, and irregular vaginal bleeding. GNRH is given only for a six-month cycle because of the risk of bone loss associated with the low estrogen. As with all of the treatment options, recurrence after stopping medication is common.

Endometriosis does not always require treatment. Those who do not develop any symptoms rarely require medical care. And since menopause usually remedies mild to moderate endometriosis, post-menopausal women who are not on estrogen replacement therapy usually need no treatment. However, estrogen replacement therapy sometimes reactivates endometriosis.