Treatment for Endometriosis

There is no cure for endometriosis. However, there are treatments that may help reduce pain and restore fertility. Among the most common treatments:
Pain medication — If the woman has a mild case of endometriosis and little pain, her doctor may suggest drugs that inhibit the production of prostaglandins, which are released from the endometrium, such as ibuprofen, indomethicin and naproxen sodium. The doctor may also recommend over-the-counter pain relievers such as aspirin or acetaminophen.

Hormone therapy — This approach tricks the body into thinking it is pregnant and therefore halts the menstrual cycle and stops women from getting their periods. It is most effective when the endometrial implants are small. At best, hormone therapy can send endometriosis into remission; the remission may last even months or years after the hormones are stopped.

The downside is that all of these drugs can have negative side effects, some of which are quite significant. Contraceptives, oral or injectable, can be successful with the fewest side effects. Examples include Depo-Provera, an injection, or Micronor, a low-dose contraceptive pill. Unlike other contraceptive pills in which the woman takes hormones for three weeks and then stops for a week to menstruate, these hormones are taken continuously in order to prevent the menstrual cycle. Another hormone, danazol, is sometimes prescribed to inhibit ovarian hormone production. But because danazol is an androgenic drug and a derivative of testosterone, it can have side effects including deepening of the voice; hair growth in new parts of the body, such as the face or back; weight gain; and acne. A woman is unlikely to get pregnant while she is taking danazol. However, since the drug can cause female fetuses to develop abnormally, sexually active women on danazol are advised to use a barrier method of birth control, such as a diaphragm or condom. Gonadotropin releasing hormone, or GnRH, agonists such as Lupron are usually only prescribed for six months because they have significant side effects. Since these drugs effectively mimic menopause, the side effects resemble those of menopause: hot flashes, headaches, depression and decreased bone density. Because the side effects can be so debilitating, some doctors rarely prescribe GnRH agonists to treat endometriosis.

Surgery — In some cases, doctors may suggest surgery performed under anesthesia to remove or destroy the implants in an attempt to reduce pain and increase the chances of pregnancy. In surgical laparoscopy, the surgeon looks through the laparoscope and uses tiny instruments to trim, burn away or remove the implants with a laser. This surgery uses tiny incisions and causes less bleeding and scarring than abdominal surgery. In other cases, doctors will perform open surgery, called laparotomy, particularly in cases in which the disease is advanced. The incisions are larger and the hospital stay and recovery time are longer. Surgery doesn?t prevent the disease from recurring. As a last resort, in the most aggressive cases of endometriosis, a woman may be advised to have surgery to remove the uterus, ovaries and all implants. After such surgery, endometriosis rarely comes back.
Anecdotally, some women have said that alternative therapies such as special diets, Chinese medicine, homeopathy and allergy management have been helpful in treating the endometriosis symptoms. However, there have been no scientifically controlled trials on such treatments.

Whether women should get pregnant to help their endometriosis is a delicate issue for doctors. There is no doubt that pregnancy can send the disease into remission, reducing pain and halting implant growth. Like many of the hormones used to treat endometriosis, pregnancy stops the body from ovulating monthly and continuing the cycle that advances the disease. However, doctors are appropriately hesitant to recommend pregnancy as a treatment unless the woman is ready to have a child — emotionally, practically and financially. Endometriosis sometimes creates an aggravating Catch-22: Pregnancy may halt the disease, but the disease may make pregnancy impossible.

Because endometriosis can cause infertility, most doctors will warn women who have the disease that if they want to get pregnant, sooner is better than later. Researchers believe that the longer the disease is present, the more likely it is that it will cause infertility. A woman trying to conceive must stop taking hormones used to treat endometriosis, since they may either prevent pregnancy or damage the fetus. If she is younger than 30 and doesn’t have a severe case of endometriosis, doctors often recommend that she first try to conceive by having unprotected sex for six months.

If she does not succeed in getting pregnant, the doctor may consider surgery to reduce diseased tissue. Because endometriosis has a tendency to recur, pregnancy rates are the highest during the first year after surgery.

Endometriosis often recedes or disappears after a woman goes through menopause. However, estrogen replacement therapy may reactivate the disease.