Treatment Options
A number of effective endometriosis treatments
-- including those that restore a woman's ability
to get pregnant -- are available.
The best treatment depends upon the symptoms
and their severity, as well as personal preference.
Expectant management, commonly known as the "wait-and-see"
approach, means just that: The patient and doctor
monitor the symptoms closely for any changes.
This is a good option for someone with mild symptoms.
Unfortunately, in many cases, endometriosis can
get worse without treatment. Other treatment options
include:
Surgery and medication may also be used together
to treat endometriosis. After menopause, when
estrogen production decreases, endometriosis usually
subsides.
Medication
Medications, mostly hormonal, can be used instead
of surgery to treat endometriosis. Medication
also can be used after surgery to prevent recurrence,
which occurs in 10 to 50% of patients.
Since endometriosis needs the female hormone
estrogen to survive, medications that reduce estrogen
production can help relieve symptoms. While they
don't eliminate endometriosis, they can diminish
painful episodes. These medications include:
- Gonadotropin-releasing (GnRH) analogues
- Danazol
- Oral contraceptives
- Progestins
Synthetic hormones -- known as gonadotropin-releasing
(GnRH) analogues -- are among the newer and more
promising drugs being used to treat endometriosis.
GnRH analogues act like real hormones, stopping
estrogen production and causing a menopauselike
state in which endometriosis can't thrive. Unfortunately,
users might also experience menopause symptoms,
including hot flashes, sleep disturbances, mood
changes, vaginal dryness and -- with usage over
6 months -- bone loss.
Another type of hormonal treatment is danazol,
a synthetic form of the male hormone testosterone.
Danazol generally has more side effects than GnRH
analogues and so isn't prescribed as frequently.
Possible side effects include weight gain, acne,
headaches and hair growth in a male pattern (called
hirsutism).
Oral contraceptives can help prevent endometriosis
from spreading in women with mild cases. The combination
of estrogen and progestin in oral contraceptives
prevents ovulation and reduces menstrual flow
and cramps. Oral contraceptives can't reduce pain,
however, nor are they recommended for women who
wish to become pregnant.
The female hormones known as progestins can also
be used to treat endometriosis. One of its most
common forms is an injectable drug known as medroxyprogesterone
acetate, although it can have unwanted side effects
such as weight gain, fluid retention, elevated
blood pressure and headaches.
Nonhormonal medications, both over-the-counter
or by prescription, can also temporarily relieve
pain. In more severe cases, narcotic pain relievers
can be prescribed, but narcotic drugs are available
only with a doctor's prescription and may be habit-forming
with prolonged use.
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Surgery
Surgery for endometriosis attempts to remove as
much of the endometriosis as possible, while preserving
the woman's ability to get pregnant. In addition,
if needed, the doctor re-creates the "normal
architecture" of the pelvic and abdominal
organs that the endometriosis has damaged.
Minimally invasive laparoscopic surgery is most
commonly used for endometriosis. Laparoscopy gives
the doctor a view inside the pelvis and abdomen.
The doctor makes a small incision next to the
navel and then inserts a thin tube called a laparoscope.
A camera and light attached to the laparoscope
allow the doctor to search for abnormalities,
scarring or any other evidence of endometriosis.
Depending on the case, the doctor can sometimes
diagnose, biopsy and remove endometriosis all
in one procedure. Otherwise, laparoscopic surgery
is used to further confirm an endometriosis diagnosis
or to remove it once it's already been diagnosed.
Occasionally, laparoscopy reveals a very severe
case of endometriosis that requires more invasive
surgery, called a laparotomy. In this procedure,
the surgeon opens the abdomen to get a better
view and more easily access the endometriosis
and scar tissue.
Radical surgery entails removing the entire uterus
and both ovaries, along with all of the endometriosis.
This treatment is only recommended for the most
severe cases in which symptoms are debilitating
and other types of treatment have failed.
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Lifestyle changes
Some women have found that lifestyle changes help
relieve endometriosis symptoms. Improving your
diet, starting an exercise program or practicing
a relaxation technique may not only help reduce
pain, but also stress. In the process, you'll
feel better about yourself because you've taken
charge of your life.
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