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Treatment Options for Endometriosis

Surgical treatments for endometriosis
Medical treatments for endometriosis
Alternative treatments for endometriosis

Surgical Treatment for Endometriosis

Surgery can be an effective way to control endometriosis. The one criteria is that your surgeon is experienced and thorough. Many women have undergone multiple surgeries and still fail to find relief from their pain. It is important that ALL the endometriosis is removed at the time of surgery for good results. This includes endometriosis on the delicate internal organs such as the bowel and the bladder, which requires exceptional surgical expertise. The endometriosis can be removed by excision, laser ablation, vaporization, or coagulation. Many experts believe excision is the best tool for removing the endometriosis to insure removal of the entire lesion, as opposed to other methods which make it harder to tell if the whole lesion has actually been removed.

The least invasive kind of surgery, and therefore the most preferred, is called a laparoscopy, in which a lighted tube is inserted into the belly button of the endometriosis patient through which the surgeon can see inside of the abdominal cavity. Other tools for destroying endometriosis can be inserted into other small incisions. This surgery can usually be performed on an outpatient basis. Expert surgeons are able to perform very complicated surgeries using laparoscopy.

A more invasive kind of surgery is called laparotomy, which requires hospitalization. It is considered major abdominal surgery.

While surgery is not considered a cure, if it is administered by an expert surgeon, it can often provide relief for many years. Will the endometriosis come back? Although most patients gain long term relief, about 20% of patients will need a repeat surgery due to recurrent symptoms of pain in the next 5 years.

Medical Treatment for Endometriosis

In general, the hormonal treatments for endometriosis attempt to mimic the state of pregnancy, that is, postpone ovulation and thereby control the production of estrogen in the body. Many women experience significant side effects while taking these hormones, some of which may be irreversible. In addition, many of these treatments can only be taken for a short period of time, to eliminate other significant health problems.

Oral Contraceptives
Birth control pills (usually a combination of estrogen and progesterone) were not originally created for the treatment of endometriosis, but they are often used to keep the disease in check. Some doctors prescribe them on a regular regime (taking a week of placebo pills to allow your body to have a period), while others advise their patients to take them on a continuous basis. When a woman is on continuous birth control pills she doesn't take the sugar pills once a month that would normally allow her body to have a period. Instead, the woman keeps taking the hormone pills, and does not have a period. The theory is that if a woman does not have her period, then the endometrial cells that are displaced in her abdomen won't "bleed" either, causing pain and adhesions. Since using birth control pills aren't officially approved for treatment of endometriosis, no official guidelines exist in the medical literature about how long it is safe for a woman to be on continuous birth control pills.
There is some disagreement about the use of birth control pills for treatment of endometriosis because it contains estrogen which is known to stimulate endometriosis. For this reason, some doctors prescribe progesterone only (Depo-Provera). The side effects associated with birth control pills are slight weight gain, break-through bleeding, mood swings, and headaches.
The GnRH Agonists
Some of the brand names of this drug include Lupron, Synarel, and Zoladex. These drugs were created specifically for the treatment of endometriosis in 1990. It is reputed to decrease the amount of estrogen in the body by taking control of the part of the pituitary gland in the brain which produces the hormones that signal the ovaries to produce estrogen. In more simple terms, these drugs force the body into a state of menopause.
GnRH agonists seem to be a "wonder drug" for many women. But for others, they don't seem to work at all. For many women, the side effects are nearly as unbearable as the symptoms of endometriosis itself. Side effects include hot flashes, vaginal dryness, headaches, depression, insomnia, and memory loss. GnRH drugs are only approved for up to 6 months for pain relief and the recurrence rate is high. Many doctors see this drug as useful only for buying time before trying to conceive, or before surgery (these uses are controversial).
GnRH agonists (i.e. LUPRON) is generally used if the patient has pain – they do not seem to help improve patients fertility. Surgery and assisted reproductive technologies, such as IVF, are the best options for the treatment of infertility due to endometriosis.
The Testosterone Derivatives
Danazol is a synthetic testosterone derivative. It was the first drug approved for the treatment of endometriosis, and it was widely used in the 1980's. It is similar to the GnRH agonists in that by decreasing estrogen in the body it can shrink endometriosis lesions and relieve pain. Danazol can also only be used for up to 6 months and then must be discontinued.
Because Danazol acts like the male hormone testosterone, it has many androgenic side effects. Some of these include, acne, reduction in breast size, weight gain, abnormal facial and body hair growth, and though rare, a deepening of the voice. Most of these are considered temporary, but a few may be permanent.

Alternative Treatments for Endometriosis

Listed here are several of the alternative methods, through which many women have found some relief. Very few offer better relief than placebo, but some patients claim improvement.

Dietary Changes
Many women say they have found some relief by giving up selected things in their diets. The most common things mentioned are caffeine, sugar, and alcoholic beverages. Women have reported good results when following macrobiotic diets and diets which include organic vegetables and few processed foods.
Soy Protein
Soy is an estrogen like herb. It is helpful in alleviating hot flashes in menopause, but may help improve the PMS symptoms that patients with endometriosis experience.
Vitamins and Herbs:
Evening Primrose Oil. This oil is an essential fatty acid that can be used to make prostaglandins in our bodies. It has been theorized that women with endometriosis may have an imbalance of prostaglandins, which are responsible for the stimulation and inhibition of smooth muscle tissue such as is found in the uterus, the intestines and the bladder. This has not been studied and probably doesn’t work very well.
The B Complex Vitamins. These vitamins have reportedly improved emotional symptoms of endometriosis and have been scientifically linked to the breakdown of estrogen in the body.
Vitamin E & Selenium When taken together, these two vitamins have been reported to decrease endometriosis-related inflammation, although there are mixed feelings by specialists about the use of Vitamin E by women with endometriosis because it boosts the production of estrogen.
Acupuncture/Acupressure
This is a traditional chinese medicine treatment for endometriosis which involves the insertion of very thin, long needles (or pressure) at various "energy points" on the body. This treatment has received mixed reviews from women with endometriosis.
Stress-Reduction Techniques
Techniques such as yoga, biofeedback, meditation, and regular exercise have all been reported to increase the general well-being of women with endometriosis.