What Is the Medical Treatment for Endometriosis?Dr Chinmayie R

Endometriosis can be treated with medications and/or surgery. The approach you and your doctor choose will depend on the severity of your signs and symptoms and whether you hope to become pregnant. What medications treat endometriosis?

Pain medications: Your doctor may recommend that you take an over-the-counter pain reliever, such as Non-steroidal anti-inflammatory drugs (NSAIDs) to help ease painful menstrual cramps. However, these pain-relieving medications have no effect on the endometrial implants or in the regression of endometriosis. If these pain medications are ineffective then additional evaluation and treatment will be necessary. Hormone therapy Supplemental hormones are sometimes effective in reducing or eliminating the pain of endometriosis. The rise and fall of hormones during the menstrual cycle causes endometrial implants to thicken, break down and bleed.

Hormone medication: may slow endometrial tissue growth and prevent new implants of endometrial tissue. Hormone therapy isn’t a permanent solution for endometriosis. You could experience a return of your symptoms after stopping treatment.

1. Hormonal contraceptives: Birth control pills, patches and vaginal rings help control the hormones responsible for the build-up of endometrial tissue each month. Using hormonal contraceptives — especially continuous cycle regimens — may reduce or eliminate the pain of mild to moderate endometriosis. Most women have lighter and shorter menstrual flow when they’re using a hormonal contraceptive. Occasionally, weight gain, breast tenderness, nausea, and irregular bleeding may occur. Oral contraceptive pills are usually well-tolerated in women with endometriosis

2. Gn-RH agonists and antagonists: These drugs block the production of ovarian-stimulating hormones, lowering estrogen levels and preventing menstruation. This causes endometrial tissue to shrink. Because these drugs create an artificial menopause, it causes side effects like:

> hot flashes

> vaginal dryness

> irregular vaginal bleeding

> mood alterations

> fatigue, and loss of bone density (osteoporosis)

Taking a low dose of estrogen or progestin “Add Back Therapy” along with Gn-RH agonists may decrease menopausal side effects. Your periods and the ability to get pregnant return when you stop taking the medication.

3. Progestin therapy: A progestin-only contraceptive, such as an intrauterine device (Mirena), contraceptive implant or contraceptive injection, can halt menstrual periods and the growth of endometrial implants, which may relieve endometriosis signs and symptoms.

4. Ovarian Stimulation: Hormone Blockers This drug suppresses the growth of the endometrium by blocking the production of ovarian-stimulating hormones, preventing menstruation and the symptoms of endometriosis. Eighty per cent of women who take this drug will have pain relief and shrinkage of endometriosis implants, but up to 75% of women develop significant side effects from the drug. These include:

> weight gain

> oedema (swelling)

> breast shrinkage

> acne

> oily skin

> hirsutism (male pattern hair growth)

> deepening of the voice

> headache

> hot flashes

> changes in libido, and mood alterations.

> and can be harmful to the baby if you become pregnant while taking this medication

5. Aromatase inhibitors: A more current approach to the treatment of endometriosis has involved the administration of drugs known as aromatase inhibitors. These drugs act by interrupting local estrogen formation within the endometriosis implants themselves. They also inhibit estrogen production within the ovary and adipose tissue. Aromatase inhibitors can cause significant bone loss with prolonged usage.