Treatment of Endometriosis
Treatment choice in endometriosis includes the following factors:
- whether or not pregnancy is desired
- amount and severity of the growth
- amount and severity of pain
- weighing of side effects
Pain management involves prescription painkillers, non-prescription pain killers, or nerve blocks. Alternative therapies include acupuncture, biofeedback, herbal remedies, relaxation treatment, and others.
Hormone therapies are used to regulate or stop completely the cycle of menstruation. This cessation can slow or inhibit symptoms and growth of endometrial tissue but do not lesson existing lesions that may inhibit conception. Therapy may be halted for attempts at conception.
Birth control pills use estrogen and progestin (sometimes just progestin) to slow menstrual flow and so endometrial growth. Pregnancy is prevented with this method. Side effects include weight gain, spotting, and bloating.
Progesterone and progestin taken together in pill form or as an injection reduces menstrual flow and inhibits the uterine lining from growing. Pregnancy is inhibited and weight gain and depression have been known to occur.
Danocrine stops the release of menstrual hormones by the body. It slows or stops menstruation but does not prevent pregnancy. Danocrine is harmful to embryos so other birth control is necessary during its use.
Gonadotropin-releasing hormone (GnRH) agonists block menstrual cycle hormones in such a way as to produce a menopausal state. They can be taken daily in a nose spray or injected every four months. Side effects mimic those of menopause: hot flashes, headache, fatigue, bone loss, vaginal dryness, and depression. Because of the effects of GnRH on bone density, treatment is usually limited to six-month trials after which symptoms return 50 percent of the time.
Surgical methods of treating endometriosis are used for severe pain and increasing chances of conception.
Laparoscopy is used for both diagnosis and treatment. In treatment, more than one incision is made in the abdomen: one for viewing and one for surgical tools. The endometrial tissue is excised by a variety of methods including laser surgery and cauterization. Recurrence is common.
Laparotomy is more involved abdominal surgery. This can involve any combination of the following removals: of endometrial tissue, uterus, ovaries, and fallopian tubes. Removal of the uterus is a hysterectomy. Removal of the uterus along with ovaries and fallopian tubes is a total hysterectomy. Hormone therapy is often needed after hysterectomies and these can cause endometrial growth to reoccur.
Menopause does generally stop endometrial growth if hormone replacement therapy is not used.
Pregnancy itself seems to lessen endometrial pain and growth for reasons unknown. Conceiving with endometriosis is difficult and often dangerous.
Women with endometriosis are prone to ectopic pregnancy, miscarriage, difficult terms, and labor.
There are methods to increase chance of conception in women with endometriosis. Laparoscopy, intrauterine insemination, in vitro fertilization (IVF), and assisted hatching can help.