Medical Therapy for Endometriosis

There are many medical therapy options used to manage endometriosis. Therapy choice may depend on the extent or severity of the endometriosis and whether or not pregnancy is desired.

UNDERSTANDING ENDOMETRIOSIS

Endometriosis occurs when the endometrium – the tissue that lines the inside of the uterus—grows beyond the uterus. This overgrowth can extend throughout the pelvis to the ovaries and fallopian tubes. In severe cases, endometriosis can even spread to other areas of the body.

You may have endometriosis without any symptoms. When symptoms are present, they include pelvic, abdominal or back pain; pain or discomfort during sexual intercourse; painful bowel movements; heavy or irregular menstruation; diarrhea or constipation and infertility.

MEDICAL THERAPIES FOR ENDOMETRIOSIS

Medical treatment therapies won’t cure endometriosis, but they can help control the pain, shrink existing endometriosis implants and limit new growth. It will take 3-4 months for most hormonal treatments to relieve the symptoms of endometriosis. These therapies include:

• Non-steroidal anti-inflammatory drugs (NSAIDs) – work to control discomfort and cramping associated with endometriosis
• Estrogen/progesterone combination drugs – these medications are most effective when taken continuously. Options include:
• Birth control pills – taking only the pills that contain hormones and skipping the inactive ones, thus preventing menstruation
• vaginal contraceptive ring (Nuvaring) – used monthly to suppress ovulation
• patch (Ortho Evra)—weekly application
• Progestin only contraceptives – may stop the spread of endometriosis and reduce pain. They include:
• Pills – Provera, Aygestin, Nor-QD
• Intrauterine device (IUD) Mirena, effective 5 to 7 years
• Contraceptive implant or injection – Depo-Provera, given every 3 months
• Gonadotropin-releasing hormone (GnRH) analogs –reduces pain and shrinks endometriosis implants by interfering with estrogen production. Low dose progesterone pills may be given additionally to reduce side effects. This is known as “add-back” therapy
• Danazol – a synthetic androgen (male hormone) that reduces estrogen levels, shrinks endometrial implants and reduces pain associated with endometriosis. However, Danazol is associated with numerous side effects such as missed or irregular menstrual periods, spotting, oily skin, weight gain, bloating and irritability
• Lupron – an injection given every month that renders endometrial implants inactive by blocking estrogen production in the ovaries, inducing a temporary menopausal state. The drug stops menstrual periods but may cause irregular bleeding initially. May be administered with add-back therapy
• Aromatase inhibitors –these drugs work to block estrogen production in the ovary, fat tissues and endometrial implants. Examples of the medication include Arimidex and Femara. While the therapy appears promising, research into its effectiveness for the treatment of endometriosis continues. A concerning side effect is their tendency to cause significant bone loss with long-term use

Women who are prescribed hormonal medications for the treatment of endometriosis will not be able to get pregnant while taking the medications.

PREGNANCY AND ENDOMETRIOSIS

Pregnancy and breast feeding suppress endometriosis and produce symptom relief and many women with endometriosis go on to conceive naturally. For those who suffer infertility as a result of endometriosis, assisted reproductive technologies, such as IVF, are often very effective. Surgical treatment options are also available.